51
|
Coagulation Disorders in Sepsis and COVID-19-Two Sides of the Same Coin? A Review of Inflammation-Coagulation Crosstalk in Bacterial Sepsis and COVID-19. J Clin Med 2023; 12:jcm12020601. [PMID: 36675530 PMCID: PMC9866352 DOI: 10.3390/jcm12020601] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2022] [Revised: 12/27/2022] [Accepted: 01/10/2023] [Indexed: 01/15/2023] Open
Abstract
Sepsis is a major cause of morbidity and mortality worldwide. Sepsis-associated coagulation disorders are involved in the pathogenesis of multiorgan failure and lead to a subsequently worsening prognosis. Alongside the global impact of the COVID-19 pandemic, a great number of research papers have focused on SARS-CoV-2 pathogenesis and treatment. Significant progress has been made in this regard and coagulation disturbances were once again found to underlie some of the most serious adverse outcomes of SARS-CoV-2 infection, such as acute lung injury and multiorgan dysfunction. In the attempt of untangling the mechanisms behind COVID-19-associated coagulopathy (CAC), a series of similarities with sepsis-induced coagulopathy (SIC) became apparent. Whether they are, in fact, the same disease has not been established yet. The clinical picture of CAC shows the unique feature of an initial phase of intravascular coagulation confined to the respiratory system. Only later on, patients can develop a clinically significant form of systemic coagulopathy, possibly with a consumptive pattern, but, unlike SIC, it is not a key feature. Deepening our understanding of CAC pathogenesis has to remain a major goal for the research community, in order to design and validate accurate definitions and classification criteria.
Collapse
|
52
|
Iba T, Levi M, Thachil J, Helms J, Scarlatescu E, Levy JH. Communication from the Scientific and Standardization Committee of the International Society on Thrombosis and Haemostasis on sepsis-induced coagulopathy in the management of sepsis. J Thromb Haemost 2023; 21:145-153. [PMID: 36695377 DOI: 10.1016/j.jtha.2022.10.022] [Citation(s) in RCA: 13] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2022] [Revised: 10/16/2022] [Accepted: 10/22/2022] [Indexed: 01/09/2023]
Abstract
Disseminated intravascular coagulation (DIC) is a life-threatening complication in sepsis and other critical conditions. The International Society on Thrombosis and Haemostasis (ISTH) released the diagnostic criteria for overt DIC in 2001. Since then, ISTH overt DIC has been used as the global standard criterion for a decompensated stage of DIC. Because detecting an earlier stage of DIC would be useful for therapeutic considerations, the scientific standardization committees of the ISTH introduced the sepsis-induced coagulopathy (SIC) scoring system in 2019. The SIC scoring system is specifically designed to detect the compensated phase of DIC in sepsis, which can lead to overt DIC with disease progression. Studies examining the performance of the SIC scoring system have reported its usefulness over the past 5 years. The reported incidence of SIC was approximately 60% in patients with sepsis, which was twice as much as that of overt DIC. Almost all patients with overt DIC were diagnosed with SIC earlier. The reported mortality of SIC was ≥30% and, thus, can be used for patient selection for anticoagulant therapy. Despite the limited data, some continue to suggest the potential efficacy of anticoagulant therapy in patients with SIC. Although heparin, antithrombin, and thrombomodulin are the candidates for anticoagulation, none of them have proven to be effective with robust evidence, and future trials are warranted.
Collapse
Affiliation(s)
- Toshiaki Iba
- Department of Emergency and Disaster Medicine, Juntendo University Graduate School of Medicine, Tokyo, Japan.
| | - Marcel Levi
- Department of Vascular Medicine, Amsterdam University Medical Center, the Netherlands; Department of Medicine, University College London Hospitals National Health Service Foundation Trust, and Cardio-metabolic Programme-National Institute for Health and Care Research University College London Hospitals/University College London Biomedical Research Centre, London, UK
| | - Jecko Thachil
- Department of Haematology, Manchester Royal Infirmary, Manchester, UK
| | - Julie Helms
- Strasbourg University (UNISTRA); Strasbourg University Hospital, Medical Intensive Care Unit - NHC; INSERM (French National Institute of Health and Medical Research), Regenerative Nanomedicine, Fédération de Médecine Translationnelle de Strasbourg, Strasbourg, France
| | - Ecaterina Scarlatescu
- University of Medicine and Pharmacy "Carol Davila," Bucharest, Romania; Department of Anaesthesia and Intensive Care, Fundeni Clinical Institute, Bucharest, Romania
| | - Jerrold H Levy
- Department of Anesthesiology, Critical Care, and Surgery, Duke University School of Medicine, Durham, North Carolina, USA
| |
Collapse
|
53
|
Li Y, Li H, Wang Y, Guo J, Zhang D. Potential Biomarkers for Early Diagnosis, Evaluation, and Prognosis of Sepsis-Induced Coagulopathy. Clin Appl Thromb Hemost 2023; 29:10760296231195089. [PMID: 37605466 PMCID: PMC10467369 DOI: 10.1177/10760296231195089] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2023] [Revised: 07/23/2023] [Accepted: 07/30/2023] [Indexed: 08/23/2023] Open
Abstract
Sepsis-induced coagulopathy (SIC) is a life-threatening complication characterized by the systemic activation of coagulation in sepsis. The diagnostic criteria of SIC consist of three items, including Sequential Organ Failure Assessment (SOFA) score, platelet count, and prothrombin time (PT)-international normalized ratio (INR). SIC has a high prevalence and it can lead to a higher mortality rate and longer length of hospital and ICU stay. Thus, the early detection of SIC is extremely important. It is unfortunate that there is still no precise biomarker for early diagnosis and assessment of the prognosis of SIC. We reviewed the current literature and discovered that some potential biomarkers, such as soluble thrombomodulin (sTM), thrombin-antithrombin complex (TAT), tissue plasminogen activator-inhibitor complex (t-PAIC), α2-plasmin inhibitor-plasmin complex (PIC), C-type lectin-like receptor 2 (CLEC-2), neutrophil extracellular traps (NETs), prothrombin fragment 1.2 (F1.2), Angiopoietin-2 (Ang-2), plasminogen activator inhibitor-1 (PAI-1), and tissue inhibitor of metalloproteinase-1 (TIMP-1) may be useful for early diagnosis, evaluation, and prognosis of SIC. Early initiation of treatment without missing any therapeutic opportunities may improve SIC patients' prognosis. Further large-scale clinical studies are still needed to confirm the role of these biomarkers in the diagnosis and prognosis assessment of SIC.
Collapse
Affiliation(s)
- Yuting Li
- Department of Critical Care Medicine, The First Hospital of Jilin University, Changchun, Jilin, China
| | - Hongxiang Li
- Department of Critical Care Medicine, The First Hospital of Jilin University, Changchun, Jilin, China
| | - Youquan Wang
- Department of Critical Care Medicine, The First Hospital of Jilin University, Changchun, Jilin, China
| | - Jianxing Guo
- Department of Critical Care Medicine, The First Hospital of Jilin University, Changchun, Jilin, China
| | - Dong Zhang
- Department of Critical Care Medicine, The First Hospital of Jilin University, Changchun, Jilin, China
| |
Collapse
|
54
|
Wauthier L, Favresse J, Hardy M, Douxfils J, Le Gal G, Roy P, van Es N, Ay C, ten Cate H, Lecompte T, Lippi G, Mullier F. D-dimer testing: A narrative review. Adv Clin Chem 2023. [DOI: 10.1016/bs.acc.2023.02.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/31/2023]
|
55
|
Liufu R, Chen Y, Wan XX, Liu RT, Jiang W, Wang C, Peng JM, Weng L, Du B. Sepsis-induced Coagulopathy: The Different Prognosis in Severe Pneumonia and Bacteremia Infection Patients. Clin Appl Thromb Hemost 2023; 29:10760296231219249. [PMID: 38126337 DOI: 10.1177/10760296231219249] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2023] Open
Abstract
Sepsis-induced coagulopathy (SIC) is a critical condition in sepsis patients, with varying outcomes depending on the type of infection. This study aims to analyze the prognosis of different infections in SIC cohort. A retrospective cohort study was conducted on 525 patients diagnosed with SIC in the intensive care unit from December 2013 to December 2022. These patients were divided into four groups: a non-pneumonia or bacteremia group, a severe pneumonia group, a bacteremia group, and a severe pneumonia concomitant with bacteremia group. The 28-day mortality was 18% (49/271) in the other infections group, 31% (33/106) in the lung infections group, 23% (29/126) in the blood infections group and 36% (8/36) in the lung and blood co-infections group, respectively. Pearson correlation analysis showed that procalcitonin (PCT) correlated strongly with all detected hemostatic markers (p < 0.001). The 28-day mortality rate in Lung infections group was significantly higher (p = 0.019), while Blood infections group had a higher incidence of disseminated intravascular coagulation (p = 0.011). By multivariable model analyses, longer duration of ventilation (p = 0.039) and severe pneumonia (p = 0.040) are risk factors associated with mortality. Different infections, including Lung and Blood infections, indicated different conditions in vivo. Longer duration of ventilation is associated with mortality, while Lung infections indicated higher 28-day mortality rate.
Collapse
Affiliation(s)
- Rong Liufu
- State Key Laboratory of Complex Severe and Rare Diseases, Medical ICU, Peking Union Medical College Hospital, Peking Union Medical College & Chinese Academy of Medical Sciences, Beijing, China
- Department of Cardiovascular Intensive Care Unit, Guangdong Cardiovascular Institute, Guangdong Provincial Key Laboratory of South China Structural Heart Disease, Guangdong Academy of Medical Sciences, Southern Medical University, Guangzhou, China
| | - Yan Chen
- State Key Laboratory of Complex Severe and Rare Diseases, Medical ICU, Peking Union Medical College Hospital, Peking Union Medical College & Chinese Academy of Medical Sciences, Beijing, China
| | - Xi-Xi Wan
- State Key Laboratory of Complex Severe and Rare Diseases, Medical ICU, Peking Union Medical College Hospital, Peking Union Medical College & Chinese Academy of Medical Sciences, Beijing, China
| | - Rui-Ting Liu
- State Key Laboratory of Complex Severe and Rare Diseases, Medical ICU, Peking Union Medical College Hospital, Peking Union Medical College & Chinese Academy of Medical Sciences, Beijing, China
| | - Wei Jiang
- State Key Laboratory of Complex Severe and Rare Diseases, Medical ICU, Peking Union Medical College Hospital, Peking Union Medical College & Chinese Academy of Medical Sciences, Beijing, China
| | - ChYao Wang
- State Key Laboratory of Complex Severe and Rare Diseases, Medical ICU, Peking Union Medical College Hospital, Peking Union Medical College & Chinese Academy of Medical Sciences, Beijing, China
| | - Jin-Min Peng
- State Key Laboratory of Complex Severe and Rare Diseases, Medical ICU, Peking Union Medical College Hospital, Peking Union Medical College & Chinese Academy of Medical Sciences, Beijing, China
| | - Li Weng
- State Key Laboratory of Complex Severe and Rare Diseases, Medical ICU, Peking Union Medical College Hospital, Peking Union Medical College & Chinese Academy of Medical Sciences, Beijing, China
| | - Bin Du
- State Key Laboratory of Complex Severe and Rare Diseases, Medical ICU, Peking Union Medical College Hospital, Peking Union Medical College & Chinese Academy of Medical Sciences, Beijing, China
| |
Collapse
|
56
|
Chen Y, Chen W, Ba F, Zheng Y, Zhou Y, Shi W, Li J, Yang Z, Mao E, Chen E, Chen Y. Prognostic Accuracy of the Different Scoring Systems for Assessing Coagulopathy in Sepsis: A Retrospective Study. Clin Appl Thromb Hemost 2023; 29:10760296231207630. [PMID: 37920943 PMCID: PMC10623916 DOI: 10.1177/10760296231207630] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2023] [Revised: 09/26/2023] [Accepted: 09/27/2023] [Indexed: 11/04/2023] Open
Abstract
There is no gold standard for the diagnosis of coagulation dysfunction in sepsis, and the use of the current scoring systems is still controversial. The purpose of this study was to assess the performance of sepsis-induced coagulopathy (SIC), the Japanese Association for Acute Medicine Disseminated Intravascular Coagulation (JAAM DIC), and the International Society on Thrombosis and Haemostasis overt DIC (ISTH overt-DIC). The relationship between each scoring system and 28-day all-cause mortality was examined. Among 452 patients (mean age, 65 [48,76] years), 306 [66.7%] were men, the median SOFA score was 6 [4,9], and the median APACHE II score was 15 [11,22]. A total of 132 patients (29.2%) died within 28 days. Both the diagnosis of SIC (AUROC, 0.779 [95% CI, 0.728-0.830], P < 0.001) and ISTH overt-DIC (AUROC, 0.782 [95% CI, 0.732-0.833], P < 0.001) performed equally well in the discrimination of 28-day all-cause mortality (between-group difference: SIC versus ISTH overt-DIC, -0.003 [95% CI, -0.025-0.018], P = 0.766). However, the SIC demonstrated greater calibration for 28-day all-cause mortality than ISTH overt-DIC (the coincidence of the calibration curve of the former is higher than that of the latter). The diagnosis of JAAM DIC was not independently associated with 28-day all-cause mortality in sepsis (RR, 1.115, [95% CI 0.660-1.182], P = 0.684). The SIC scoring system demonstrated superior prognostic prediction ability in comparison with the others and is the most appropriate standard for diagnosing coagulopathy in sepsis.
Collapse
Affiliation(s)
- Yuwei Chen
- Department of Emergency, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- Department of Emergency, the First Hospital of Handan, Handan, China
| | - Weiwei Chen
- Department of Emergency, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Fuhua Ba
- Department of Emergency, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Yanjun Zheng
- Department of Emergency, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Yi Zhou
- Department of Emergency, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Wen Shi
- Department of Emergency, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Jian Li
- Clinical Research Center, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Zhitao Yang
- Department of Emergency, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Enqiang Mao
- Department of Emergency, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Erzhen Chen
- Department of Emergency, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Ying Chen
- Department of Emergency, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| |
Collapse
|
57
|
Lemiale V, Mabrouki A, Miry L, Mokart D, Pène F, Kouatchet A, Mayaux J, Bruneel F, Perez P, Meert AP, Moreau AS, Benoit D, Darmon M, Zafrani L, Clere-Jehl R. Sepsis-associated coagulopathy in onco-hematology patients presenting with thrombocytopenia: a multicentric observational study. Leuk Lymphoma 2023; 64:197-204. [PMID: 36305707 DOI: 10.1080/10428194.2022.2136971] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
Coagulation disorders increase mortality rate during septic shock, but the impact of concomitant hematological malignancies remains unknown. The study assessed coagulation disorders in onco-hematological patients with thrombocytopenia (<100 G/L) admitted to ICU for septic shock. Among 146 included patients, 50 patients had lymphoma and 49 patients had acute leukemia. ICU mortality rate was 43.8% (n = 64). Median increase in prothrombin time (PT) at day(d) 1 was 4.7 s (IQR 3.2-7.9) in ICU survivors vs. 6.4 s (IQR 4.5-13.7; p < 0.01) in non-survivors. Fibrinogen kinetics (increase in fibrinogen levels between d1 and d2) was +0.55 (-0.22-1.55) vs. +0.10 g/L (-0.40-0.50; p = 0.03) in surviving and non-surviving patients, respectively. PT increase ≥6 s at d1 (OR 5.5; 95% CI 1.1-6.0; p = 0.03) and mechanical ventilation (OR 7.4; 95% CI 3.3-17.7; p < 0.001) were independently associated with ICU mortality. This study provides information and new ways to identify hematological patients with high-risk mortality.
Collapse
Affiliation(s)
- Virginie Lemiale
- Department of Medical Intensive Care Unit, Saint-Louis Teaching Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Asma Mabrouki
- Department of Medical Intensive Care Unit, Saint-Louis Teaching Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Loïc Miry
- Neuro-Intensive Care Unit, Rothschild Foundation Hospital, France
| | - Djamel Mokart
- Medical and Surgical Intensive Care Unit, Institut Paoli-Calmettes, Marseille, France
| | - Frédéric Pène
- Service de Médecine Intensive-réanimation, Hôpital Cochin, AP-HP, Centre & Université Paris Cité, Paris, France
| | - Achille Kouatchet
- Medical Intensive Care Unit, Angers University Hospital, Angers, France
| | - Julien Mayaux
- Service de Médecine Intensive et Réanimation (Département R3S), AP-HP, Groupe Hospitalier Universitaire-Sorbonne Université, site Pitié-Salpêtrière, Paris, France
| | - Fabrice Bruneel
- Department of Critical Care, Versailles Hospital, Le Chesnay, France
| | - Pierre Perez
- Medical Intensive Care Unit, Hôpital Brabois, Vandoeuvre Les Nancy, France
| | - Anne-Pascale Meert
- Soins intensifs et urgences oncologiques, Service de Médecine interne, Institut Jules Bordet, Université Libre de Bruxelles (ULB), Bruxelles, Belgique
| | - Anne-Sophie Moreau
- Pôle de médecine intensive réanimation, Hôpital Roger Salengro, CHU Lille, Lille cedex, France
| | - Dominique Benoit
- Medical Unit, Department of Intensive Care, Ghent University Hospitalc, Ghent, Belgium
| | - Michael Darmon
- Department of Medical Intensive Care Unit, Saint-Louis Teaching Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Lara Zafrani
- Department of Medical Intensive Care Unit, Saint-Louis Teaching Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France.,INSERM U976, Human Immunology, Pathophysiology and Immunotherapy, Saint-Louis Teaching Hospital, Paris University, Paris, France
| | - Raphaël Clere-Jehl
- Department of Medical Intensive Care Unit, Saint-Louis Teaching Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France.,Laboratoire d'ImmunoRhumatologie Moléculaire, INSERM (French National Institute of Health and Medical Research), UMR_S1109, Centre de Recherche d'Immunologie et d'Hématologie, Faculté de Médecine, Fédération de Médecine Translationnelle de Strasbourg (FMTS), Université de Strasbourg, Strasbourg Cedex, France
| | | |
Collapse
|
58
|
Nishita Y, Taga M, Sakurai M, Iinuma Y, Masauji T. Prognostic factors in patients with septic disseminated intravascular coagulation treated with thrombomodulin: the effect of reduced thrombomodulin dose; a single-center, retrospective, observational study. J Pharm Health Care Sci 2022; 8:32. [PMID: 36503588 PMCID: PMC9743769 DOI: 10.1186/s40780-022-00264-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2022] [Accepted: 10/27/2022] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Human soluble recombinant thrombomodulin (TM alfa), a treatment for septic Disseminated intravascular coagulation (DIC), is recommended for patients with severe renal dysfunction in reduced doses. However, no studies have examined yet how dose reduction affects clinical efficacy. In this study, we investigated the significance of the TM alfa dose as a prognostic factor in clarifying the clinical background factors related to the clinical effect of TM alfa in patients with septic DIC. METHODS This study involved 102 patients with septic DIC admitted to a single-center intensive care unit between April 2013 and March 2020, receiving TM alfa. The following factors were retrospectively collected from the medical records of the target patients: (1) patient background, (2) sequential organ failure assessment (SOFA) score, (3) Japanese Association for Acute Medicine DIC diagnostic criteria score, (4) DIC treatment information, (5) TM alfa dose per bodyweight (normal dose: 0.06 mg/kg or reduced dose: 0.02 mg/kg), (6) DIC resolution within 7 days after the start of TM alfa administration (DIC resolution), (7) all deaths within 30 days after the start of TM alfa administration (30-days-all-cause mortality), (8) presence or absence of new hemorrhagic side effects after the start of TM alfa administration. Multiple logistic regression analysis was used to assess factors associated with DIC resolution and 30-days-all-cause mortality. RESULTS The SOFA score (odds ratio: 95% confidence interval, 0.76: 0.66-0.89), pneumonia (0.24: 0.08-0.75), and reduced dose administration of TM alfa (0.23: 0.08-0.66) were independent of and negatively related to the DIC resolution. For the 30-days-all-cause mortality, the SOFA score (1.66: 1.31-2.09), pneumonia (9.50: 2.49-36.25), and TM alfa dose reduction (3.52: 1.06-11.69) were independent, poor prognostic factors. We found no association between the hemorrhagic side effects and the TM alfa dose per bodyweight. CONCLUSIONS The reduced dose of TM alfa for patients with severe renal dysfunction was observed to be an influential factor for DIC resolution and 30-day all-cause mortality, as were SOFA scores and pneumonia. Further studies are required in the future to verify this finding.
Collapse
Affiliation(s)
- Yoshihiro Nishita
- grid.510345.60000 0004 6004 9914Department of Pharmacy, Kanazawa Medical University Hospital, 1-1 Daigaku, Uchinada-cho, Kahoku-gun, Ishikawa 920-0293 Japan
| | - Masatoshi Taga
- grid.510345.60000 0004 6004 9914Department of Pharmacy, Kanazawa Medical University Hospital, 1-1 Daigaku, Uchinada-cho, Kahoku-gun, Ishikawa 920-0293 Japan
| | - Masaru Sakurai
- grid.411998.c0000 0001 0265 5359Department of Social and Environmental Medicine, Kanazawa Medical University, 1-1 Daigaku, Uchinada-cho, Kahoku-gun, Ishikawa 920-0293 Japan
| | - Yoshitsugu Iinuma
- grid.411998.c0000 0001 0265 5359Department of Infectious Disease, Kanazawa Medical University, 1-1 Daigaku, Uchinada-cho, Kahoku-gun, Ishikawa 920-0293 Japan
| | - Togen Masauji
- grid.510345.60000 0004 6004 9914Department of Pharmacy, Kanazawa Medical University Hospital, 1-1 Daigaku, Uchinada-cho, Kahoku-gun, Ishikawa 920-0293 Japan
| |
Collapse
|
59
|
Alavi-Darazam I, Forouhar K, Moradi O, Saffaei A, Asadi S, Sahraei Z. Efficacy and Safety of Two Different Enoxaparin Doses for Thromboprophylaxis in Non-critically Ill Patients: A Randomized Controlled Trial. IRANIAN JOURNAL OF PHARMACEUTICAL RESEARCH : IJPR 2022; 21:e126555. [PMID: 36942062 PMCID: PMC10024325 DOI: 10.5812/ijpr-126555] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/17/2021] [Revised: 09/22/2021] [Accepted: 10/03/2021] [Indexed: 11/16/2022]
Abstract
Background Recently, a few studies based on anti-factor Xa activity levels have propounded doubtful and sub-prophylactic levels by the usual dose of enoxaparin in surgical and critically ill patients. In this study, we assessed two doses of enoxaparin in adult non-critically ill patients. Methods Patients were randomly assigned into two groups of intervention and control. While the intervention group received enoxaparin with a daily dose of 60 mg, the control group received enoxaparin 40 mg. Anti-factor Xa activity was measured based on the peak steady-state levels. The level of 0.2 to 0.4 IU/mL was considered as a prophylactic goal. All individuals were followed for bleeding or thromboembolic events during admission. Results The mean levels of anti-factor Xa were 0.29 ± 0.13 IU/mL in the control group (n = 31) and 0.44 ± 0.19 IU/mL in the intervention group (n = 29). More patients in the control group had an optimal level of anti-factor Xa compared to the patients in the intervention group (62.1% vs. 29%). No adverse outcomes were detected in any of the groups. Conclusions Enoxaparin dose of 60 mg daily provided anti-factor Xa level higher than desired in most patients. In non-critically ill patients, the dose of 40 mg is the proper dose for thromboprophylaxis.
Collapse
Affiliation(s)
- Ilad Alavi-Darazam
- Department of Infectious Diseases and Tropical Medicine, Loghman Hakim Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Kimia Forouhar
- Student Research Committee, Department of Clinical Pharmacy, School of Pharmacy, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Omid Moradi
- Student Research Committee, Department of Clinical Pharmacy, School of Pharmacy, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Ali Saffaei
- Student Research Committee, Department of Clinical Pharmacy, School of Pharmacy, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Sara Asadi
- Department of Clinical Pharmacy, School of Pharmacy, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Zahra Sahraei
- Department of Clinical Pharmacy, School of Pharmacy, Shahid Beheshti University of Medical Sciences, Tehran, Iran
- Pharmaceutical Care Unit, Loghman Hakim Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
- Corresponding Author: Department of Clinical Pharmacy, School of Pharmacy, Shahid Beheshti University of Medical Sciences, Tehran, Iran. Tel: +98-2188200209,
| |
Collapse
|
60
|
Rinaldi I, Sudaryo MK, Prihartono NA. Disseminated Intravascular Coagulation in Sepsis and Associated Factors. J Clin Med 2022; 11:jcm11216480. [PMID: 36362708 PMCID: PMC9658286 DOI: 10.3390/jcm11216480] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2022] [Revised: 10/22/2022] [Accepted: 10/26/2022] [Indexed: 11/06/2022] Open
Abstract
Background: sepsis is a life-threatening organ dysfunction caused by an excessive host immunological response to infection. The incidence of sepsis is increasing every year, and sepsis is the primary cause of mortality in intensive care units (ICUs). DIC is a coagulopathy syndrome that causes microvascular and macrovascular thrombosis and increases the risk of bleeding due to consumptive coagulopathy. The pathophysiology of DIC in sepsis is complex, and further research is required to investigate the involved mechanisms and risk factors. Method: this study is a prognostic analysis of a retrospective cohort. Samples were patients diagnosed with sepsis and admitted to Cipto Mangunkusumo National General Hospital from January 2016 to October 2022. Research subjects were followed until occurrence of DIC during sepsis or recovery from sepsis. The research subjects were selected from medical records using a consecutive total sampling approach. The inclusion criteria were patients aged ≥18 years old and diagnosed with sepsis according to qSOFA criteria with a score of 2. The exclusion criterion was an incomplete medical record. Bivariate and multivariate logistic regression analyses were performed to determine which independent variables contributed to the incidence of DIC and obtain the odds ratios (ORs). p < 0.05 was considered to indicate a statistically significant difference. Results: a total of 248 patients were included after considering the inclusion and exclusion criteria. Of these, 50 (20.2%) septic patients developed DIC. In the multivariate analysis, albumin ≤2.5 g/dL (OR: 2.363; 95% CI: 1.201−4.649), respiratory infection (OR: 2.414; 95% CI: 1.046−5.571), and antibiotic treatment ≥1 h (OR: 2.181; 95% CI: 1.014−4.689) were associated with DIC development. On the basis of the ROC curve, the area under the curve (AUC) was determined to be 0.705 with 95% CI = (0.631−0.778). Conclusion: in our study, the prevalence of DIC in septic patients was 20.2%. Low albumin, respiratory infection, and antibiotic treatment ≥1 h were found to be risk factors for development of DIC in septic patients.
Collapse
Affiliation(s)
- Ikhwan Rinaldi
- Department of Epidemiology, Faculty of Public Health, Universitas Indonesia, Depok 16424, Indonesia
- Division of Hematology and Medical Oncology, Department of Internal Medicine, Cipto Mangunkusumo National General Hospital, Faculty of Medicine, Universitas Indonesia, Jakarta 10430, Indonesia
| | - Mondastri Korib Sudaryo
- Department of Epidemiology, Faculty of Public Health, Universitas Indonesia, Depok 16424, Indonesia
- Correspondence:
| | | |
Collapse
|
61
|
Wang B, Zhang B, Shen Y, Li J, Yuan X, Tang N. Validation of Two Revised, Simplified Criteria for Assessing Sepsis-Associated Disseminated Intravascular Coagulation in ICU Patients with Sepsis-3: A Retrospective Study. Lab Med 2022; 54:291-298. [PMID: 36239637 DOI: 10.1093/labmed/lmac112] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/29/2023] Open
Abstract
Abstract
Objective
This study aimed to validate the performance of modified Japanese Association for Acute Medicine (m-JAAM) and simplified Japanese Society on Thrombosis and Hemostasis (s-JSTH) criteria in diagnosing coagulation disorders in sepsis and examine their prognostic value compared with sepsis-induced coagulopathy (SIC) and International Society on Thrombosis and Hemostasis (ISTH) criteria.
Methods
This retrospective study included subjects diagnosed with sepsis (August 2020 to February 2021, n = 296). The m-JAAM, s-JSTH, SIC, and ISTH criteria were evaluated and compared using receiver operating characteristic (ROC) curves and areas under the curve (AUCs).
Results
There was no significant difference in AUC for predicting in-hospital 28-day mortality by m-JAAM, s-JSTH, SCI, and ISTH criteria (0.745, 0.763, 0.760, and 0.730, respectively). The proportion of patients fulfilling the m-JAAM and SIC criteria was higher than that of the s-JSTH and ISTH criteria (43.2%, 56.1% vs. 25.0%, 22.6%, P < .05).
Conclusion
The m-JAAM criteria might be more suitable for early-stage disseminated intravascular coagulation of sepsis than s-JSTH criteria.
Collapse
Affiliation(s)
- Bin Wang
- Department of Clinical Laboratory, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Bo Zhang
- Department of Clinical Laboratory, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Ying Shen
- Department of Clinical Laboratory, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Jiaoyuan Li
- Department of Clinical Laboratory, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Xu Yuan
- Department of Clinical Laboratory, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Ning Tang
- Department of Clinical Laboratory, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| |
Collapse
|
62
|
Bepouka B, Odio O, Mayasi N, Longokolo M, Mangala D, Mandina M, Mbula M, Kayembe JM, Situakibanza H. Prevalence and Outcomes of COVID -19 Patients with Happy Hypoxia: A Systematic Review. Infect Drug Resist 2022; 15:5619-5628. [PMID: 36172621 PMCID: PMC9512283 DOI: 10.2147/idr.s378060] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2022] [Accepted: 09/14/2022] [Indexed: 01/08/2023] Open
Abstract
Background In Coronavirus disease 2019 (COVID-19), some patients have low oxygen saturation without any dyspnea. This has been termed “happy hypoxia.” No worldwide prevalence survey of this phenomenon has been conducted. This review aimed to summarize information on the prevalence, risk factors, and outcomes of patients with happy hypoxia to improve their management. Methods We conducted a systematic search of electronic databases for all studies published up to April 30, 2022. We included high-quality studies using the Newcastle-Ottawa Scale (NOS) tool for qualitative assessment of searches. The prevalence of happy hypoxia, as well as the mortality rate of patients with happy hypoxia, were estimated by pooled analysis and heterogeneity by I2. Results Of the 25,086 COVID-19 patients from the 7 studies, the prevalence of happy hypoxia ranged from 4.8 to 65%. The pooled prevalence was 6%. Happy hypoxia was associated with age > 65 years, male sex, body mass index (BMI)> 25 kg/m2, smoking, chronic obstructive pulmonary disease, diabetes mellitus, high respiratory rate, and high d-dimer. Mortality ranged from 01 to 45.4%. The pooled mortality was 2%. In 2 studies, patients with dyspnea were admitted to intensive care more often than those with happy hypoxia. One study reported that the length of stay in intensive care did not differ between patients with dyspnea and those with happy hypoxia at admission. One study reported the need for extracorporeal membrane oxygenation (ECMO) in patients with happy hypoxia. Conclusion The pooled prevalence and mortality of patients with happy hypoxia were not very high. Happy hypoxia was associated with advanced age and comorbidities. Some patients were admitted to the intensive care unit, although fewer than dyspneic patients. Its early detection and management should improve the prognosis.
Collapse
Affiliation(s)
- Ben Bepouka
- Department of Internal Medicine, University of Kinshasa, Kinshasa, The Democratic Republic of the Congo
| | - Ossam Odio
- Department of Internal Medicine, University of Kinshasa, Kinshasa, The Democratic Republic of the Congo
| | - Nadine Mayasi
- Department of Internal Medicine, University of Kinshasa, Kinshasa, The Democratic Republic of the Congo
| | - Murielle Longokolo
- Department of Internal Medicine, University of Kinshasa, Kinshasa, The Democratic Republic of the Congo
| | - Donat Mangala
- Department of Internal Medicine, University of Kinshasa, Kinshasa, The Democratic Republic of the Congo
| | - Madone Mandina
- Department of Internal Medicine, University of Kinshasa, Kinshasa, The Democratic Republic of the Congo
| | - Marcel Mbula
- Department of Internal Medicine, University of Kinshasa, Kinshasa, The Democratic Republic of the Congo
| | - Jean Marie Kayembe
- Department of Internal Medicine, University of Kinshasa, Kinshasa, The Democratic Republic of the Congo
| | - Hippolyte Situakibanza
- Department of Internal Medicine, University of Kinshasa, Kinshasa, The Democratic Republic of the Congo
| |
Collapse
|
63
|
Tang Y, Chen Q, Liang B, Peng B, Wang M, Sun J, Liu Z, Zha L, Yu Z. A retrospective cohort study on the association between early coagulation disorder and short-term all-cause mortality of critically ill patients with congestive heart failure. Front Cardiovasc Med 2022; 9:999391. [PMID: 36187010 PMCID: PMC9524154 DOI: 10.3389/fcvm.2022.999391] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2022] [Accepted: 08/30/2022] [Indexed: 01/10/2023] Open
Abstract
Purpose Coagulation disorder in congestive heart failure (CHF) has been well-documented. The prognostic value of a composite coagulation disorder score, which combines the absolute platelet count, international normalized ratio (INR), and activated partial thromboplastin time (APTT), has not been assessed in CHF. The present study endeavored to explore the association between the coagulation disorder score and adverse outcomes of critically ill patients with CHF. Methods Patients diagnosed with CHF in the Medical Information Mart for Intensive Care III (MIMIC-III) database were included in the present retrospective cohort study. The coagulation disorder score was calculated according to the abnormalities of the absolute platelet count, INR, and APTT within 24 h after intensive care unit admission. The primary outcomes were the short-term all-cause mortality, including 30-, 90-day and in-hospital mortalities. The Kaplan-Meier (K-M) survival curve and the Cox proportional hazard model were performed to assess the correlation between coagulation disorder score and outcome events. Results A total of 6,895 patients were enrolled in this study and divided into four groups according to the coagulation disorder score. K-M survival curve preliminarily indicated that subjects with higher coagulation disorder score presented lower survival rate and shorter survival time. After adjustment for potential confounders, the multivariate Cox analysis further illustrated that elevated coagulation disorder score as a quartile variable was significantly associated with increased all-cause mortality (quartile 4 vs. quartile 1, 30-day: HR [95% CI], 1.98 [1.50, 2.62], 90-day: HR [95% CI], 1.88 [1.49, 2.37], in-hospital: HR [95%CI], 1.93 [1.42, 2.61]). Conclusion In critically ill patients with CHF, ones with high coagulation disorder score tend to be worse clinical prognosis, which would be a promising biomarker and helpful for the management of CHF patients.
Collapse
Affiliation(s)
- Yiyang Tang
- Department of Cardiology, Xiangya Hospital, Central South University, Changsha, China
| | - Qin Chen
- Department of Cardiology, Xiangya Hospital, Central South University, Changsha, China
| | - Benhui Liang
- Department of Cardiology, Xiangya Hospital, Central South University, Changsha, China
| | - Baohua Peng
- Department of Cardiology, Xiangya Hospital, Central South University, Changsha, China
| | - Meijuan Wang
- Department of Cardiology, Xiangya Hospital, Central South University, Changsha, China
| | - Jing Sun
- Department of Cardiology, Xiangya Hospital, Central South University, Changsha, China
| | - Zhenghui Liu
- Department of Neurology, Xiangya Hospital, Central South University, Changsha, China
| | - Lihuang Zha
- Department of Cardiology, Xiangya Hospital, Central South University, Changsha, China,National Clinical Research Center for Geriatric Disorders (Xiang Ya), Changsha, China,Lihuang Zha
| | - Zaixin Yu
- Department of Cardiology, Xiangya Hospital, Central South University, Changsha, China,National Clinical Research Center for Geriatric Disorders (Xiang Ya), Changsha, China,*Correspondence: Zaixin Yu
| |
Collapse
|
64
|
Xin Q, Xie T, Chen R, Wang H, Zhang X, Wang S, Liu C, Zhang J. Construction and validation of an early warning model for predicting the acute kidney injury in elderly patients with sepsis. Aging Clin Exp Res 2022; 34:2993-3004. [PMID: 36053443 DOI: 10.1007/s40520-022-02236-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2022] [Accepted: 08/18/2022] [Indexed: 11/28/2022]
Abstract
BACKGROUND Sepsis-induced acute kidney injury (S-AKI) is a significant complication and is associated with an increased risk of mortality, especially in elderly patients with sepsis. However, there are no reliable and robust predictive models to identify high-risk patients likely to develop S-AKI. We aimed to develop a nomogram to predict S-AKI in elderly sepsis patients and help physicians make personalized management within 24 h of admission. METHODS A total of 849 elderly sepsis patients from the First Affiliated Hospital of Xi'an Jiaotong University were identified and randomly divided into a training set (75%, n = 637) and a validation set (25%, n = 212). Univariate and multivariate logistic regression analyses were performed to identify the independent predictors of S-AKI. The corresponding nomogram was constructed based on those predictors. The calibration curve, receiver operating characteristics (ROC)curve, and decision curve analysis were performed to evaluate the nomogram. The secondary outcome was 30-day mortality and major adverse kidney events within 30 days (MAKE30). MAKE30 were a composite of death, new renal replacement therapy (RRT), or persistent renal dysfunction (PRD). RESULTS The independent predictors for nomogram construction were mean arterial pressure (MAP), serum procalcitonin (PCT), and platelet (PLT), prothrombin time activity (PTA), albumin globulin ratio (AGR), and creatinine (Cr). The predictive model had satisfactory discrimination with an area under the curve (AUC) of 0.852-0.858 in the training and validation cohorts, respectively. The nomogram showed good calibration and clinical application according to the calibration curve and decision curve analysis. Furthermore, the prediction model had perfect predictive power for predicting 30-day mortality (AUC = 0.813) and MAKE30 (AUC = 0.823) in elderly sepsis patients. CONCLUSION The proposed nomogram can quickly and effectively predict S-AKI risk in elderly sepsis patients within 24 h after admission, providing information for clinicians to make personalized interventions.
Collapse
Affiliation(s)
- Qi Xin
- Department of Hepatobiliary Surgery, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, 710061, Shaanxi, China
| | - Tonghui Xie
- Department of Hepatobiliary Surgery, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, 710061, Shaanxi, China
| | - Rui Chen
- Department of Hepatobiliary Surgery, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, 710061, Shaanxi, China
| | - Hai Wang
- Department of Hepatobiliary Surgery, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, 710061, Shaanxi, China
| | - Xing Zhang
- Department of Hepatobiliary Surgery, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, 710061, Shaanxi, China
| | - Shufeng Wang
- Department of General Surgery, The First Affiliated Hospital of Xi'an Jiaotong University, 277 Yanta West Road, Xi'an, 710061, China.
| | - Chang Liu
- Department of Hepatobiliary Surgery, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, 710061, Shaanxi, China. .,Department of SICU, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, 710061, Shaanxi, China.
| | - Jingyao Zhang
- Department of Hepatobiliary Surgery, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, 710061, Shaanxi, China. .,Department of SICU, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, 710061, Shaanxi, China.
| |
Collapse
|
65
|
Kassif Lerner R, Levinkopf D, Zaslavsky Paltiel I, Sadeh T, Rubinstein M, Pessach IM, Keller N, Lerner-Geva L, Paret G. Thrombocytopenia and Bloodstream Infection: Incidence and Implication on Length of Stay in the Pediatric Intensive Care Unit. J Pediatr Intensive Care 2022; 11:209-214. [DOI: 10.1055/s-0040-1722338] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2020] [Accepted: 11/26/2020] [Indexed: 10/22/2022] Open
Abstract
AbstractThe incidence and prognosis of thrombocytopenia in critically ill patients with bloodstream infection (BSI) is not well delineated in the pediatric intensive care unit (PICU) setting. We assessed these variables in our PICU and sought to determine whether thrombocytopenia could serve as a prognostic marker for length of stay (LOS). The study was conducted at the medical PICU of a university hospital, on all critically ill pediatric patients consecutively admitted during a 3-year period. Patient surveillance and data collection have been used to identify the risk factors during the study period. The main outcomes were BSI incidence and implication on morbidity and LOS. Data from 2,349 PICU patients was analyzed. The overall incidence of BSI was 3.9% (93/2,349). Overall, 85 of 93 patients (91.4%) with BSI survived and 8 patients died (8.6% mortality rate). The overall incidence of thrombocytopenia among these 93 patients was 54.8% (51/93) and 100% (8/8) for the nonsurvivors. Out of the 85 survivors, 27 thrombocytopenic patients were hospitalized for >14 days versus 14 of nonthrombocytopenic patients (p = 0.007). Thrombocytopenia was associated with borderline significance with an increased LOS (adjusted odds ratio = 3.00, 95% confidence interval: 0.93–9.71, p = 0.066). Thrombocytopenia is common in critically ill pediatric patients with BSI and constitutes a simple and readily available risk marker for PICU LOS.
Collapse
Affiliation(s)
- Reut Kassif Lerner
- Department of Pediatric Intensive Care, The Edmond and Lily Safra Children's Hospital, The Chaim Sheba Medical Center, Tel Hashomer, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Dana Levinkopf
- Neonatal Intensive Care Unit, The Edmond and Lily Safra Children's Hospital, The Chaim Sheba Medical Center, Tel Hashomer, Israel
| | - Inna Zaslavsky Paltiel
- Women and Children's Health Research Unit, The Gertner Institute for Epidemiology and Health Policy Research, The Chain Sheba Medical Center, Tel Hashomer, Israel
| | - Tal Sadeh
- Department of Pediatric Intensive Care, The Edmond and Lily Safra Children's Hospital, The Chaim Sheba Medical Center, Tel Hashomer, Israel
| | - Marina Rubinstein
- Department of Pediatric Intensive Care, The Edmond and Lily Safra Children's Hospital, The Chaim Sheba Medical Center, Tel Hashomer, Israel
| | - Itai M. Pessach
- Department of Pediatric Intensive Care, The Edmond and Lily Safra Children's Hospital, The Chaim Sheba Medical Center, Tel Hashomer, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Nathan Keller
- Tel Aviv University, Sheba Medical Center, Tel Hashomer, Israel
- Ariel University, Israel
| | - Liat Lerner-Geva
- Women and Children's Health Research Unit, The Gertner Institute for Epidemiology and Health Policy Research, The Chain Sheba Medical Center, Tel Hashomer, Israel
- School of Public Health, Sackler Faculty of Medicine, Tel Aviv University, Israel
| | - Gideon Paret
- Department of Pediatric Intensive Care, The Edmond and Lily Safra Children's Hospital, The Chaim Sheba Medical Center, Tel Hashomer, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| |
Collapse
|
66
|
Xin Q, Xie T, Chen R, Zhang X, Tong Y, Wang H, Wang S, Liu C, Zhang J. A Predictive Model Based on Inflammatory and Coagulation Indicators for Sepsis-Induced Acute Kidney Injury. J Inflamm Res 2022; 15:4561-4571. [PMID: 35979508 PMCID: PMC9377403 DOI: 10.2147/jir.s372246] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2022] [Accepted: 07/30/2022] [Indexed: 11/23/2022] Open
Abstract
Background Sepsis-induced acute kidney injury (S-AKI) is associated with systemic inflammatory responses and coagulation system dysfunction, and it is associated with an increased risk of mortality. However, there was no study to explore the predictive value of inflammatory and coagulation indicators for S-AKI. Methods In this retrospective study, 1051 sepsis patients were identified and divided into a training cohort (75%, n = 787) and a validation cohort (25%, n = 264) in chronological order according to the date they were admitted. Univariate analyses and multivariate logistic regression analyses were performed to identify the independent predictors of S-AKI. The logistic regression analyses (enter methods) were used to conducted the prediction models. The ROC curves were used to determine the predictive value of the constructed models on S-AKI. To test whether the increase in the AUC is significant, we used a two-sided test for ROC curves available online (http://vassarstats.net/roc_comp.html). The secondary outcome was different AKI stages and major adverse kidney events within 30 days (MAKE30). Stage 3B of S-AKI was defined as both meeting the stage 3 criteria [increase of Cr level by > 300% (≥ 4.0 mg/dL with an acute increase of ≥ 0.5 mg/dL) and/or UO < 0.3 mL/kg/h for > 24 h or anuria for > 12 h and/or acute kidney replacement therapy] and having cystatin C positive. MAKE30 were a composite of death, new renal replacement therapy (RRT), or persistent renal dysfunction (PRD). Results We discovered that cardiovascular disease, white blood cell (WBC), mean arterial pressure (MAP), platelet (PLT), serum procalcitonin (PCT), prothrombin time activity (PTA), and thrombin time (TT) were independent predictors for S-AKI. The predictive value (AUC = 0.855) of the simplest model 3 (constructed with PLT, PCT, and PTA), with a sensitivity of 77.6% and a specificity of 82.4%, had a similar predictive value comparing with the model 1 (AUC = 0.872) and the model 2 (AUC = 0.864) in the training cohort (P > 0.05). Compared with the model 1 (AUC = 0.888) and the model 2 (AUC = 0.887), the model 3 (AUC = 0.887) had a similar predictive value in the validation cohort. Moreover, model 3 had the best predictive power for predicting S-AKI in the stage 3 (AUC = 0.777), especially in stage 3B (AUC = 0.771). Finally, the model 3 (AUC = 0.843) had perfect predictive power for predicting MAKE30 in sepsis patients. Conclusion Within 24 hours after admission, the simplest model 3 (constructed with PLT, PCT, and PTA) might be a robust predictor of the S-AKI in sepsis patients, providing information for timely and efficient intervention.
Collapse
Affiliation(s)
- Qi Xin
- Department of Hepatobiliary Surgery, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, 710061, People's Republic of China
| | - Tonghui Xie
- Department of Hepatobiliary Surgery, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, 710061, People's Republic of China
| | - Rui Chen
- Department of Hepatobiliary Surgery, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, 710061, People's Republic of China
| | - Xing Zhang
- Department of Hepatobiliary Surgery, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, 710061, People's Republic of China
| | - Yingmu Tong
- Department of Hepatobiliary Surgery, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, 710061, People's Republic of China
| | - Hai Wang
- Department of Hepatobiliary Surgery, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, 710061, People's Republic of China
| | - Shufeng Wang
- Department of General Surgery, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, 710061, People's Republic of China
| | - Chang Liu
- Department of Hepatobiliary Surgery, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, 710061, People's Republic of China.,Department of SICU, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, 710061, People's Republic of China
| | - Jingyao Zhang
- Department of Hepatobiliary Surgery, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, 710061, People's Republic of China.,Department of SICU, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, 710061, People's Republic of China
| |
Collapse
|
67
|
Ghanem M, Brown SJ, EAT Mohamed A, Fuller HR. A Meta-summary and Bioinformatic Analysis Identified Interleukin 6 as a Master Regulator of COVID-19 Severity Biomarkers. Cytokine 2022; 159:156011. [PMID: 36067713 PMCID: PMC9420723 DOI: 10.1016/j.cyto.2022.156011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2022] [Revised: 07/22/2022] [Accepted: 08/16/2022] [Indexed: 12/15/2022]
Abstract
With the rising demand for improved COVID-19 disease monitoring and prognostic markers, studies have aimed to identify biomarkers using a range of screening methods. However, the selection of biomarkers for validation from large datasets may result in potentially important biomarkers being overlooked when datasets are considered in isolation. Here, we have utilized a meta-summary approach to investigate COVID-19 biomarker datasets to identify conserved biomarkers of COVID-19 severity. This approach identified a panel of 17 proteins that showed a consistent direction of change across two or more datasets. Furthermore, bioinformatics analysis of these proteins highlighted a range of enriched biological processes that include inflammatory responses and compromised integrity of physiological systems including cardiovascular, neurological, and metabolic. A panel of upstream regulators of the COVID-19 severity biomarkers were identified, including chemical compounds currently under investigation for COVID-19 treatment. One of the upstream regulators, interleukin 6 (IL6), was identified as a “master regulator” of the severity biomarkers. COVID-19 disease severity is intensified due to the extreme viral immunological reaction that results in increased inflammatory biomarkers and cytokine storm. Since IL6 is the primary stimulator of cytokines, it could be used independently as a biomarker in determining COVID-19 disease progression, in addition to a potential therapeutic approach targeting IL6. The array of upstream regulators of the severity biomarkers identified here serve as attractive candidates for the development of new therapeutic approaches to treating COVID-19. In addition, the findings from this study highlight COVID-19 severity biomarkers which represent promising, robust biomarkers for future validation studies for their use in defining and monitoring disease severity and patient prognosis.
Collapse
|
68
|
NETosis and Nucleosome Biomarkers in Septic Shock and Critical COVID-19 Patients: An Observational Study. Biomolecules 2022; 12:biom12081038. [PMID: 36008932 PMCID: PMC9405965 DOI: 10.3390/biom12081038] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2022] [Revised: 07/22/2022] [Accepted: 07/23/2022] [Indexed: 02/04/2023] Open
Abstract
Background: Neutrophil extracellular traps’ (NETs’) formation is a mechanism of defense that neutrophils deploy as an alternative to phagocytosis, to constrain the spread of microorganisms. Aim: The aim was to evaluate biomarkers of NETs’ formation in a patient cohort admitted to intensive care unit (ICU) due to infection. Methods: Forty-six septic shock patients, 22 critical COVID-19 patients and 48 matched control subjects were recruited. Intact nucleosomes containing histone 3.1 (Nu.H3.1), or citrullinated histone H3R8 (Nu.Cit-H3R8), free citrullinated histone (Cit-H3), neutrophil elastase (NE) and myeloperoxidase (MPO) were measured. Results: Significant differences in Nu.H3.1 and NE levels were observed between septic shock and critical COVID-19 subjects as well as with controls (p-values < 0.05). The normalization of nucleosome levels according to the neutrophil count improved the discrimination between septic shock and critical COVID-19 patients. The ratio of Nu.Cit-H3R8 to Nu.H3.1 allowed the determination of nucleosome citrullination degree, presumably by PAD4. Conclusions: H3.1 and Cit-H3R8 nucleosomes appear to be interesting markers of global cell death and neutrophil activation when combined. Nu.H3.1 permits the evaluation of disease severity and differs between septic shock and critical COVID-19 patients, reflecting two distinct potential pathological processes in these conditions.
Collapse
|
69
|
Dietrich M, Hölle T, Lalev LD, Loos M, Schmitt FCF, Fiedler MO, Hackert T, Richter DC, Weigand MA, Fischer D. Plasma Transfusion in Septic Shock—A Secondary Analysis of a Retrospective Single-Center Cohort. J Clin Med 2022; 11:jcm11154367. [PMID: 35955987 PMCID: PMC9369152 DOI: 10.3390/jcm11154367] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2022] [Revised: 07/09/2022] [Accepted: 07/22/2022] [Indexed: 11/16/2022] Open
Abstract
In sepsis, both beneficial and detrimental effects of fresh frozen plasma (FFP) transfusion have been reported. The aim of this study was to analyze the indication for and effect of FFP transfusion in patients with septic shock. We performed a secondary analysis of a retrospective single-center cohort of all patients treated for septic shock at the interdisciplinary surgical intensive care unit (ICU) of the Heidelberg University Hospital. Septic shock was defined according to sepsis-3 criteria. To assess the effects of FFP administration in the early phase of septic shock, we compared patients with and without FFP transfusion during the first 48 h of septic shock. Patients who died during the first 48 h of septic shock were excluded from the analysis. Primary endpoints were 30- and 90-day mortality. A total of 261 patients were identified, of which 100 (38.3%) received FFP transfusion within the first 48 h after septic shock onset. The unmatched analysis showed a trend toward higher 30- and 90-d mortality in the FFP group (30 d: +7% p = 0.261; 90 d: +11.9% p = 0.061). In the propensity-matched analysis, 30- and 90-day mortality were similar between groups. Plasma administration did not influence fluid or vasopressor need, lactate levels, ICU stay, or days on a ventilator. We found no significant harm or associated benefit of FFP use in the early phase of septic shock. Finally, plasma should only be used in patients with a strong indication according to current recommendations, as a conclusive evaluation of the risk-benefit ratio for plasma transfusion in septic shock cannot be made based on the current data.
Collapse
Affiliation(s)
- Maximilian Dietrich
- Department of Anesthesiology, Heidelberg University Hospital, Im Neuenheimer Feld 420, 69120 Heidelberg, Germany; (T.H.); (L.D.L.); (F.C.F.S.); (M.O.F.); (D.C.R.); (M.A.W.); (D.F.)
- Correspondence:
| | - Tobias Hölle
- Department of Anesthesiology, Heidelberg University Hospital, Im Neuenheimer Feld 420, 69120 Heidelberg, Germany; (T.H.); (L.D.L.); (F.C.F.S.); (M.O.F.); (D.C.R.); (M.A.W.); (D.F.)
| | - Lazar Detelinov Lalev
- Department of Anesthesiology, Heidelberg University Hospital, Im Neuenheimer Feld 420, 69120 Heidelberg, Germany; (T.H.); (L.D.L.); (F.C.F.S.); (M.O.F.); (D.C.R.); (M.A.W.); (D.F.)
| | - Martin Loos
- Department of General, Visceral and Transplantation Surgery, Heidelberg University Hospital, Im Neuenheimer Feld 420, 69120 Heidelberg, Germany; (M.L.); (T.H.)
| | - Felix Carl Fabian Schmitt
- Department of Anesthesiology, Heidelberg University Hospital, Im Neuenheimer Feld 420, 69120 Heidelberg, Germany; (T.H.); (L.D.L.); (F.C.F.S.); (M.O.F.); (D.C.R.); (M.A.W.); (D.F.)
| | - Mascha Onida Fiedler
- Department of Anesthesiology, Heidelberg University Hospital, Im Neuenheimer Feld 420, 69120 Heidelberg, Germany; (T.H.); (L.D.L.); (F.C.F.S.); (M.O.F.); (D.C.R.); (M.A.W.); (D.F.)
| | - Thilo Hackert
- Department of General, Visceral and Transplantation Surgery, Heidelberg University Hospital, Im Neuenheimer Feld 420, 69120 Heidelberg, Germany; (M.L.); (T.H.)
| | - Daniel Christoph Richter
- Department of Anesthesiology, Heidelberg University Hospital, Im Neuenheimer Feld 420, 69120 Heidelberg, Germany; (T.H.); (L.D.L.); (F.C.F.S.); (M.O.F.); (D.C.R.); (M.A.W.); (D.F.)
| | - Markus Alexander Weigand
- Department of Anesthesiology, Heidelberg University Hospital, Im Neuenheimer Feld 420, 69120 Heidelberg, Germany; (T.H.); (L.D.L.); (F.C.F.S.); (M.O.F.); (D.C.R.); (M.A.W.); (D.F.)
| | - Dania Fischer
- Department of Anesthesiology, Heidelberg University Hospital, Im Neuenheimer Feld 420, 69120 Heidelberg, Germany; (T.H.); (L.D.L.); (F.C.F.S.); (M.O.F.); (D.C.R.); (M.A.W.); (D.F.)
| |
Collapse
|
70
|
Li J, Zhou J, Ren H, Teng T, Li B, Wang Y, Xiang L. Clinical Efficacy of Soluble Thrombomodulin, Tissue Plasminogen Activator Inhibitor complex, Thrombin-Antithrombin complex,α2-Plasmininhibitor-Plasmin complex in Pediatric Sepsis. Clin Appl Thromb Hemost 2022; 28:10760296221102929. [PMID: 35603624 PMCID: PMC9134456 DOI: 10.1177/10760296221102929] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Objective To investigated the clinical efficacy of Soluble thrombomodulin (sTM), tissue
plasminogen activator inhibitor complex (t-PAI·C),thrombin-antithrombin
complex (TAT),α2-plasmininhibitor-plasmin complex (PIC) in pediatric sepsis
and pediatrics sepsis-induced coagulopathy (pSIC). Methods We prospectively collected patient data with sepsis diagnosed in the PICU of
Shanghai Children's Medical Center from June 2019 to June 2021. sTM,t-PAI·C,
TAT,PIC and classical coagulation laboratory tests (CCTs) were evaluated on
the day of sepsis diagnosis. Results Fifty-nine children were enrolled, There were significant differences in
t-PAI·C (P = 0.001), Plt (P < 0.001), PT (P < 0.001), INR (P <
0.001), aPTT (P < 0.001), and TT (P = 0.048) between the pSIC and
non-pSIC groups, logistic regression analysis showed that Plt (P = 0.032)
was an independent risk factor for pSIC. Logistic regression analysis showed
that sTM (P = 0.007) and Plt (P = 0.016) were independent risk factors for
the outcome in pediatrics sepsis following discharge. The AUC of sTM
combined with Plt on the mortality outcome of children with sepsis at
discharge was 0.889 (95%CI: 0.781,0.956). which was better than that for
PRISM III (AUC, 0.723), pSOFA (AUC, 0.764), and blood Lac (AUC, 0.717) when
sepsis was diagnosed in the PICU. Conclusions The t-PAI·C increased in children with pSIC. The prediction of sepsis outcome
using sTM combined with Plt was better than with PRISM III, pSOFA, or
Lac.Further research is still needed in the future to explore the clinical
value of sTM, TAT, PIC, and t-PAI·C in diagnosis and outcome of pediatrics
sepsis and pSIC.
Collapse
Affiliation(s)
- Juanzhen Li
- Department of Critical Care Medicine, Shanghai Children’s Medical Center, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Jingyi Zhou
- Ren Ji Hostipal, Shanghai Jiao Tong University School of Medicine, Shanghai,China
| | - Hong Ren
- Department of Critical Care Medicine, Shanghai Children’s Medical Center, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Teng Teng
- Department of Critical Care Medicine, Shanghai Children’s Medical Center, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Biru Li
- Department of Critical Care Medicine, Shanghai Children’s Medical Center, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Ying Wang
- Department of Critical Care Medicine, Shanghai Children’s Medical Center, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Long Xiang
- Department of Critical Care Medicine, Shanghai Children’s Medical Center, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
- Department of Neonatal, Second People’s Hospital of Kashgar, Xinjiang Uygur Autonomous Region, China
| |
Collapse
|
71
|
Bai Y, Wen L, Zhao Y, Li J, Guo C, Zhang X, Yang J, Dong Y, Ma L, Liang G, Kou Y, Wang E. Clinical course and outcomes of COVID-19 patients with chronic obstructive pulmonary disease: A retrospective observational study in Wuhan, China. Medicine (Baltimore) 2022; 101:e29141. [PMID: 35550462 PMCID: PMC9276460 DOI: 10.1097/md.0000000000029141] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/12/2021] [Accepted: 03/03/2022] [Indexed: 11/25/2022] Open
Abstract
Information about coronavirus disease 2019 (COVID-19) patients with pre-existing chronic obstructive pulmonary disease (COPD) is still lacking. The aim of this study is to describe the clinical course and the outcome of COVID-19 patients with comorbid COPD.This retrospective study was performed at Wuhan Huoshenshan Hospital in China. Patients with a clear diagnosis of COVID-19 who had comorbid COPD (N = 78) were identified. COVID-19 patients without COPD were randomly selected and matched by age and sex to those with COPD. Clinical data were analyzed and compared between the two groups. The composite outcome was the onset of intensive care unit admission, use of mechanical ventilation, or death during hospitalization. Multivariable Cox regression analyses controlling for comorbidities were performed to explore the relationship between comorbid COPD and clinical outcome of COVID-19.Compared to age- and sex-matched COVID-19 patients without pre-existing COPD, patients with pre-existing COPD were more likely to present with dyspnea, necessitate expectorants, sedatives, and mechanical ventilation, suggesting the existence of acute exacerbations of COPD (AECOPD). Greater proportions of patients with COPD developed respiratory failure and yielded poor clinical outcomes. However, laboratory tests did not show severer infection, over-activated inflammatory responses, and multi-organ injury in patients with COPD. Kaplan-Meier analyses showed patients with COPD exhibited longer viral clearance time in the respiratory tract. Multifactor regression analysis showed COPD was independently correlated with poor clinical outcomes.COVID-19 patients with pre-existing COPD are more vulnerable to AECOPD and subsequent respiratory failure, which is the main culprit for unfavorable clinical outcomes. However, COPD pathophysiology itself is not associated with over-activated inflammation status seen in severe COVID-19.
Collapse
Affiliation(s)
- Yang Bai
- Department of Neurosurgery, General Hospital of Northern Theater Command, Shenyang, Liaoning, China
- Department of Gastroenterology, Tangdu Hospital, Fourth Military Medical University, Xi’an, Shaanxi, China
| | - Liang Wen
- Department of Neurosurgery, General Hospital of Northern Theater Command, Shenyang, Liaoning, China
| | - Yulong Zhao
- Department of Neurosurgery, General Hospital of Northern Theater Command, Shenyang, Liaoning, China
| | - Jianan Li
- Department of Neurosurgery, General Hospital of Northern Theater Command, Shenyang, Liaoning, China
| | - Chen Guo
- Department of Neurosurgery, General Hospital of Northern Theater Command, Shenyang, Liaoning, China
| | - Xiaobin Zhang
- Department of Neurosurgery, General Hospital of Northern Theater Command, Shenyang, Liaoning, China
| | - Jiaming Yang
- Department of Neurosurgery, General Hospital of Northern Theater Command, Shenyang, Liaoning, China
| | - Yushu Dong
- Department of Neurosurgery, General Hospital of Northern Theater Command, Shenyang, Liaoning, China
| | - Litian Ma
- Department of Gastroenterology, Tangdu Hospital, Fourth Military Medical University, Xi’an, Shaanxi, China
| | - Guobiao Liang
- Department of Neurosurgery, General Hospital of Northern Theater Command, Shenyang, Liaoning, China
| | - Yun Kou
- Department of Ultrasound, General Hospital of Northern Theater Command, Shenyang, Liaoning, China
| | - Enxin Wang
- Department of Gastroenterology, Tangdu Hospital, Fourth Military Medical University, Xi’an, Shaanxi, China
- Department of Medical Affairs, Air Force Hospital of Western Theater Command, Chengdu, Sichuan, China
| |
Collapse
|
72
|
Labbe V, Contou D, Heming N, Megarbane B, Ait-Oufella H, Boissier F, Carreira S, Robert A, Vivier E, Fejjal M, Doyen D, Monchi M, Preau S, Noel-Savina E, Souweine B, Zucman N, Picos SA, Dres M, Juguet W, Mariotte E, Timsit JF, Turpin M, Razazi K, Gendreau S, Baloul S, Voiriot G, Fartoukh M, Audureau E, Mekontso Dessap A. Comparison of standard prophylactic, intermediate prophylactic and therapeutic anticoagulation in patients with severe COVID-19: protocol for the ANTICOVID multicentre, parallel-group, open-label, randomised controlled trial. BMJ Open 2022; 12:e059383. [PMID: 35473740 PMCID: PMC9044512 DOI: 10.1136/bmjopen-2021-059383] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
INTRODUCTION COVID-19 induces venous, arterial and microvascular thrombosis, involving several pathophysiological processes. In patients with severe COVID-19 without macrovascular thrombosis, escalating into high-dose prophylactic anticoagulation (HD-PA) or therapeutic anticoagulation (TA) could be beneficial in limiting the extension of microvascular thrombosis and forestalling the evolution of lung and multiorgan microcirculatory dysfunction. In the absence of data from randomised trials, clinical practice varies widely. METHODS AND ANALYSIS This is a French multicentre, parallel-group, open-label, randomised controlled superiority trial to compare the efficacy and safety of three anticoagulation strategies in patients with COVID-19. Patients with oxygen-treated COVID-19 showing no pulmonary artery thrombosis on computed tomography with pulmonary angiogram will be randomised to receive either low-dose PA, HD-PA or TA for 14 days. Patients attaining the extremes of weight and those with severe renal failure will not be included. We will recruit 353 patients. Patients will be randomised on a 1:1:1 basis, and stratified by centre, use of invasive mechanical ventilation, D-dimer levels and body mass index. The primary endpoint is a hierarchical criterion at day 28 including all-cause mortality, followed by the time to clinical improvement defined as the time from randomisation to an improvement of at least two points on the ordinal clinical scale. Secondary outcomes include thrombotic and major bleeding events at day 28, individual components of the primary endpoint, number of oxygen-free, ventilator-free and vasopressor-free days at day 28, D-dimer and sepsis-induced coagulopathy score at day 7, intensive care unit and hospital stay at day 28 and day 90, and all-cause death and quality of life at day 90. ETHICS AND DISSEMINATION The study has been approved by an ethical committee (Ethics Committee, Ile de France VII, Paris, France; reference 2020-A03531-38). Patients will be included after obtaining their signed informed consent. The results will be submitted for publication in peer-reviewed journals. TRIAL REGISTRATION NUMBER NCT04808882.
Collapse
Affiliation(s)
- Vincent Labbe
- Service de Médecine Intensive Réanimation, Hôpital Tenon, Département Médico-Universitaire APPROCHES, Assistance Publique-Hôpitaux de Paris (APHP), Sorbonne Université, Paris, France
- Université Paris Est, Groupe de Recherche Clinique GR05 CARMAS, Institut Mondor de recherche biomédicale, INSERM, Créteil, France
| | - Damien Contou
- Service de Réanimation Polyvalente, Centre Hospitalier Victor Dupouy, Argenteuil, France
| | - Nicholas Heming
- Department of Intensive Care, Hôpital Raymond Poincaré, Assistance Publique - Hopitaux de Paris, University Versailles Saint Quentin - University Paris Saclay, Garches, France
- Laboratory of Infection & Inflammation - U1173, School of Medicine Simone Veil, University Versailles Saint Quentin - University Paris Saclay, INSERM, Garches, France
| | - Bruno Megarbane
- Service de Réanimation Médicale et Toxicologique, Hôpital Lariboisière, Assistance Publique-Hôpitaux de Paris, INSERM UMRS-1144, Université de Paris, Paris, France
| | - Hafid Ait-Oufella
- Service de Médecine Intensive Réanimation, Hôpital Saint Antoine, Assistance Publique-Hôpitaux de Paris, Sorbonne Université, Paris, France
| | - Florence Boissier
- Service de Médecine Intensive Réanimation, Centre Hospitalo-Universitaire de Poitiers, INSERM CIC 1402 (ALIVE group), Université de Poitiers, Poitiers, France
| | - Serge Carreira
- Service d'Anesthésie-Réanimation polyvalente, Hôpital Saint Camille, Bry-sur-Marne, France
| | - Alexandre Robert
- Service de Médecine Intensive Réanimation, Hôpital Simone Veil, Centre Hospitalier de Cannes, Cannes, France
- Unité INSERM 1065, Laboratoire C3M, Université Côte d'Azur, Nice, France
| | - Emmanuel Vivier
- Service de Réanimation Polyvalente, Centre Hospitalier Saint Joseph-Saint Luc, Lyon, France
| | - Mohamed Fejjal
- Service de Médecine Intensive Réanimation, Centre Hospitalier Léon Binet, Provins, France
| | - Denis Doyen
- Service de Médecine Intensive Réanimation, Hôpital l'Archet 1, Centre Hospitalier Universitaire de Nice, Nice, France
- UR2CA Unité de Recherche Clinique Côte d'Azur, Université Côte d'Azur, Nice, France
| | - Mehran Monchi
- Département de Médecine intensive, Groupe Hospitalier Sud Ile de France, Melun, France
| | - Sebastien Preau
- Service de Réanimation, INSERM, Institut Pasteur de Lille, U1167, Université de Lille, Centre Hospitalo-Universitaire Lille, Lille, France
| | - Elise Noel-Savina
- Service de Pneumologie et de soins intensifs Respiratoires, Hôpital Larrey, Toulouse, France
| | - Bertrand Souweine
- Service de Médecine Intensive Réanimation, Centre Hospitalo-Universitaire Gabriel-Montpied, Clermont-Ferrand, France
| | - Noémie Zucman
- Service de Médecine Intensive Réanimation, Hôpital Louis-Mourier, DMU ESPRIT, Assistance Publique-Hôpitaux de Paris, Colombes, France
- Université de Paris, UFR de médecine Paris Nord, Paris, France
| | - Santiago Alberto Picos
- Service de Médecine Intensive Réanimation, Centre Hospitalier La Dracenie De Draguignan, Draguignan, France
| | - Martin Dres
- Service de Médecine intensive Réanimation, Hôpital Pitie Salpêtrière, Assistance Publique-Hôpitaux de Paris, Sorbonne Université, Paris, France
| | - William Juguet
- Service de Réanimation Médico-Chirurgicale, Hôpital Avicenne, Assistance Publique-Hôpitaux de Paris, Université Sorbonne Paris Nord, Bobigny, France
| | - Eric Mariotte
- Service de Médecine Intensive Réanimation, Hôpital Saint-Louis, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Jean-François Timsit
- Medical and infectious diseases ICU (MI2), Bichat Hospital, Assistance Publique-Hôpitaux de Paris, University of Paris, IAME, INSERM U1137, Paris, France
| | - Matthieu Turpin
- Service de Médecine Intensive Réanimation, Hôpital Tenon, Département Médico-Universitaire APPROCHES, Assistance Publique-Hôpitaux de Paris (APHP), Sorbonne Université, Paris, France
| | - Keyvan Razazi
- Université Paris Est, Groupe de Recherche Clinique GR05 CARMAS, Institut Mondor de recherche biomédicale, INSERM, Créteil, France
- Service de Médecine Intensive Réanimation, Hôpitaux Universitaires Henri Mondor-Albert Chenevier, Département Médico-Universitaire Médecine, Assistance Publique-Hôpitaux de Paris, Créteil, France
| | - Ségolène Gendreau
- Université Paris Est, Groupe de Recherche Clinique GR05 CARMAS, Institut Mondor de recherche biomédicale, INSERM, Créteil, France
- Service de Médecine Intensive Réanimation, Hôpitaux Universitaires Henri Mondor-Albert Chenevier, Département Médico-Universitaire Médecine, Assistance Publique-Hôpitaux de Paris, Créteil, France
| | - Samia Baloul
- Unité de Recherche Clinique Henri Mondor, Hôpitaux Universitaires Henri Mondor-Albert Chenevier, Assistance Publique-Hôpitaux de Paris, Créteil, France
| | - Guillaume Voiriot
- Service de Médecine Intensive Réanimation, Hôpital Tenon, Département Médico-Universitaire APPROCHES, Assistance Publique-Hôpitaux de Paris (APHP), Sorbonne Université, Paris, France
- Université Paris Est, Groupe de Recherche Clinique GR05 CARMAS, Institut Mondor de recherche biomédicale, INSERM, Créteil, France
| | - Muriel Fartoukh
- Service de Médecine Intensive Réanimation, Hôpital Tenon, Département Médico-Universitaire APPROCHES, Assistance Publique-Hôpitaux de Paris (APHP), Sorbonne Université, Paris, France
- Université Paris Est, Groupe de Recherche Clinique GR05 CARMAS, Institut Mondor de recherche biomédicale, INSERM, Créteil, France
| | - Etienne Audureau
- Unité de Recherche Clinique Henri Mondor, Hôpitaux Universitaires Henri Mondor-Albert Chenevier, Assistance Publique-Hôpitaux de Paris, Créteil, France
| | - Armand Mekontso Dessap
- Université Paris Est, Groupe de Recherche Clinique GR05 CARMAS, Institut Mondor de recherche biomédicale, INSERM, Créteil, France
- Service de Médecine Intensive Réanimation, Hôpitaux Universitaires Henri Mondor-Albert Chenevier, Département Médico-Universitaire Médecine, Assistance Publique-Hôpitaux de Paris, Créteil, France
| |
Collapse
|
73
|
Yu S, Ma X, Li X. Phenotype-oriented anticoagulant therapy for sepsis: still a work in progress. Int J Hematol 2022; 116:48-54. [PMID: 35380387 DOI: 10.1007/s12185-022-03337-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2021] [Revised: 03/21/2022] [Accepted: 03/22/2022] [Indexed: 11/30/2022]
Abstract
Coagulation disorders ranging from subtle changes in coagulation parameters to fatal disseminated intravascular coagulation (DIC) are common in septic patients. Coagulation activation is considered to be one of the most important factors contributing to multiple organ dysfunction syndrome (MODS) in sepsis. Anticoagulant therapy is, therefore, necessary to prevent MODS, but eligibility criteria remain controversial. Sepsis is a highly heterogeneous syndrome, which could explain the negative results of clinical studies on the treatment of sepsis. Recently, sepsis has been subdivided into several phenotypes with different therapeutic outcomes. At present, septic patients with dysfunctional coagulation expressed as increased D-dimer and fibrin/fibrinogen degradation products (FDPs) are considered to be candidates for anticoagulant therapy. In this review, we aimed to describe the features of different septic phenotypes. We also discuss factors that contribute to controversies in this area, and challenges in defining which septic phenotypes are good candidates for anticoagulant therapy.
Collapse
Affiliation(s)
- Sihan Yu
- Department of Critical Care Medicine, The First Affiliated Hospital of China Medical University, North Nanjing Street 155, Shenyang, 110000, Liaoning Province, China
| | - Xiaochun Ma
- Department of Critical Care Medicine, The First Affiliated Hospital of China Medical University, North Nanjing Street 155, Shenyang, 110000, Liaoning Province, China
| | - Xu Li
- Department of Critical Care Medicine, The First Affiliated Hospital of China Medical University, North Nanjing Street 155, Shenyang, 110000, Liaoning Province, China.
| |
Collapse
|
74
|
Poletto F, Spiezia L, Simion C, Campello E, Dalla Valle F, Tormene D, Camporese G, Simioni P. Risk Factors of Venous Thromboembolism in Noncritically Ill Patients Hospitalized for Acute COVID-19 Pneumonia Receiving Prophylactic-Dose Anticoagulation. Viruses 2022; 14:v14040737. [PMID: 35458467 PMCID: PMC9025628 DOI: 10.3390/v14040737] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2022] [Revised: 03/26/2022] [Accepted: 03/29/2022] [Indexed: 02/01/2023] Open
Abstract
Background: Therapeutic/intermediate-dose heparin reduces the risk of thromboembolic events but increases the risk of major bleeding in patients hospitalized for acute COVID-19 pneumonia. Objectives: To prospectively assess the incidence of objectively proven venous thromboembolism (VTE) and identify predisposing risk factors in a cohort of hospitalized patients with acute COVID-19 pneumonia undergoing prophylactic-dose heparin. Patients and methods: All consecutive patients admitted for acute COVID-19 pneumonia to the General Internal Medicine Unit of Padova University Hospital, Italy between November 2020 and April 2021, and undergoing prophylactic-dose heparin, were enrolled. Demographic and clinical characteristics and laboratory and radiological findings were recorded on admission. Cases were patients who developed VTE during their hospital stay. Univariable and multivariable logistic regression analyses were used to ascertain the risk factors associated with developing in-hospital VTE. Results: 208 patients (median age: 77 years; M/F 98/110) were included; 37 (18%) developed in-hospital VTE during a median follow-up of 10 days (IQR, 4−18). VTE patients were significantly younger (p = 0.004), more obese (p = 0.002), and had a lower Padua prediction score (p < 0.03) and reduced PaO2/FIO2 ratio (p < 0.03) vs. controls. Radiological findings of bilateral pulmonary infiltrates were significantly more frequent in VTE patients than controls (p = 0.003). Multivariable regression showed that obesity (1.75, 95% CI 1.02−3.36; p = 0.04) and bilateral pulmonary infiltrates on X-rays (2.39, 95% CI 1.22−5.69; p = 0.04) were correlated with increased risk of in-hospital VTE. Conclusions: Obesity and bilateral pulmonary infiltrates on imaging may help clinicians to identify patients admitted to medical wards for acute COVID-19 pneumonia at risk of developing VTE despite prophylactic-dose heparin. Further studies are needed to evaluate whether the administration of therapeutic/intermediate-dose heparin may help prevent VTE episodes without further increasing the bleeding risk.
Collapse
Affiliation(s)
| | | | | | | | | | | | | | - Paolo Simioni
- Correspondence: ; Tel.: +39-049-8212-667; Fax: +39-049-8212-651
| |
Collapse
|
75
|
Biomarkers Predicting Tissue Pharmacokinetics of Antimicrobials in Sepsis: A Review. Clin Pharmacokinet 2022; 61:593-617. [PMID: 35218003 PMCID: PMC9095522 DOI: 10.1007/s40262-021-01102-1] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/13/2021] [Indexed: 02/07/2023]
Abstract
The pathophysiology of sepsis alters drug pharmacokinetics, resulting in inadequate drug exposure and target-site concentration. Suboptimal exposure leads to treatment failure and the development of antimicrobial resistance. Therefore, we seek to optimize antimicrobial therapy in sepsis by selecting the right drug and the correct dosage. A prerequisite for achieving this goal is characterization and understanding of the mechanisms of pharmacokinetic alterations. However, most infections take place not in blood but in different body compartments. Since tissue pharmacokinetic assessment is not feasible in daily practice, we need to tailor antibiotic treatment according to the specific patient’s pathophysiological processes. The complex pathophysiology of sepsis and the ineffectiveness of current targeted therapies suggest that treatments guided by biomarkers predicting target-site concentration could provide a new therapeutic strategy. Inflammation, endothelial and coagulation activation markers, and blood flow parameters might be indicators of impaired tissue distribution. Moreover, hepatic and renal dysfunction biomarkers can predict not only drug metabolism and clearance but also drug distribution. Identification of the right biomarkers can direct drug dosing and provide timely feedback on its effectiveness. Therefore, this might decrease antibiotic resistance and the mortality of critically ill patients. This article fills the literature gap by characterizing patient biomarkers that might be used to predict unbound plasma-to-tissue drug distribution in critically ill patients. Although all biomarkers must be clinically evaluated with the ultimate goal of combining them in a clinically feasible scoring system, we support the concept that the appropriate biomarkers could be used to direct targeted antibiotic dosing.
Collapse
|
76
|
Teimury A, Khameneh MT, Khaledi EM. Major coagulation disorders and parameters in COVID-19 patients. Eur J Med Res 2022; 27:25. [PMID: 35168674 PMCID: PMC8845229 DOI: 10.1186/s40001-022-00655-6] [Citation(s) in RCA: 26] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2021] [Accepted: 02/08/2022] [Indexed: 02/08/2023] Open
Abstract
Coronavirus disease 2019 (COVID-19), with a high prevalence rate, has rapidly infected millions of people around the world. Since viral infections can disrupt the coagulation and homeostasis cascades, various inflammatory and coagulation problems occur due to COVID-19 infection, similar to coronavirus epidemics in 2003 and 2004. According to multiple previous studies, in the present research, we reviewed the most commonly reported problems of COVID-19 patients, such as venous thromboembolism, pulmonary embolism, disseminated intravascular coagulation, etc. and investigated the causes in these patients. Coagulation and inflammatory markers, such as platelets and fibrinogen, C-reactive protein, lactate dehydrogenase, d-dimer, prothrombin time, etc., were also discussed, and the treatment options were briefly reviewed. In addition to coagulation treatments, regular examination of coagulation parameters and thrombotic complications can be helpful in the timely treatment of patients. Therefore, it is helpful to review the coagulation problems in COVID-19 patients. Although all mentioned problems and markers are important in COVID-19, some of them are more valuable in terms of diagnosis and prognosis.
Collapse
Affiliation(s)
- Azadeh Teimury
- Department of Cell and Molecular Biology, University of Kashan, Kashan, Iran
| | - Mahshid Taheri Khameneh
- Center of Excellence for Biodiversity, Faculty of Natural Sciences, University of Tabriz, Tabriz, Iran
| | | |
Collapse
|
77
|
Peng JC, Nie F, Li YJ, Xu QY, Xing SP, Li W, Gao Y. Favorable Outcomes of Anticoagulation With Unfractioned Heparin in Sepsis-Induced Coagulopathy: A Retrospective Analysis of MIMIC-III Database. Front Med (Lausanne) 2022; 8:773339. [PMID: 35047524 PMCID: PMC8761617 DOI: 10.3389/fmed.2021.773339] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2021] [Accepted: 11/11/2021] [Indexed: 11/13/2022] Open
Abstract
Backgrounds: Anticoagulation in sepsis-associated disseminated intravascular coagulation (DIC) remains uncertain. The aim of this study was to investigate whether unfractioned heparin (UFH) could improve clinical outcomes in patients with sepsis-induced coagulopathy (SIC). Methods: Septic patients with SIC were identified from the Medical Information Mart for Intensive Care (MIMIC)-III database. Cox-proportional hazards model, logistic regression model and linear regression were used to assess the associations between UFH administration and 28-day mortality, hospital mortality, occurrence of bleeding complications and length of stay, respectively. Propensity score matching (PSM) analysis was used to match the imbalance between patients in the UFH group and the control group. Patients were further stratified according to SIC score and Simplified Acute Physiology Score II (SAPS II). Results: A total of 1,820 septic patients with SIC were included in the data analysis. After PSM, 652 pairs of patients were matched between the patients in the UFH group and the control group. UFH was significantly associated with reduced 28-day mortality (HR, 0.323, 95% CI, 0.258–0.406; p < 0.001) and hospital mortality (HR, 0.380, 95% CI, 0.307–0.472; p < 0.001) without increasing the risks of intracranial hemorrhage (OR, 1.480, 95% CI, 0.955–2.294; p = 0.080) or gastrointestinal bleeding (OR, 1.094, 95% CI, 0.503–2.382; p = 0.820). For subgroup analysis, it didn't change the favorable results of UFH on mortality and UFH didn't increase the risk of hemorrhage in patients with severe disease. Conclusions: The analysis of MIMIC-III database indicated that anticoagulant therapy with UFH may be associated with a survival benefit in patients with SIC.
Collapse
Affiliation(s)
- Jiang-Chen Peng
- Department of Critical Care, Ren Ji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Fang Nie
- Department of Critical Care, Ren Ji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Yu-Jie Li
- Department of Critical Care, Ren Ji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Qiao-Yi Xu
- Department of Critical Care, Ren Ji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Shun-Peng Xing
- Department of Critical Care, Ren Ji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Wen Li
- Department of Critical Care, Ren Ji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Yuan Gao
- Department of Critical Care, Ren Ji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| |
Collapse
|
78
|
Are Baseline Levels of Gas6 and Soluble Mer Predictors of Mortality and Organ Damage in Patients with Sepsis? The Need-Speed Trial Database. Biomedicines 2022; 10:biomedicines10020198. [PMID: 35203408 PMCID: PMC8869255 DOI: 10.3390/biomedicines10020198] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2021] [Accepted: 01/14/2022] [Indexed: 12/04/2022] Open
Abstract
Soluble tyrosine kinase receptor Mer (sMer) and its ligand Growth arrest-specific protein 6 (Gas6) are predictors of mortality in patients with sepsis. Our aim is to clarify whether their measurement at emergency department (ED) presentation is useful in risk stratification. We re-analyzed data from the Need-Speed trial, evaluating mortality and the presence of organ damage according to baseline levels of sMer and Gas6. 890 patients were eligible; no association with 7- and 30-day mortality was observed for both biomarkers (p > 0.05). sMer and Gas6 levels were significantly higher in acute kidney injury (AKI) patients compared to non-AKI ones (9.8 [4.1–17.8] vs. 7.9 [3.8–12.9] ng/mL and 34.8 [26.4–47.5] vs. 29.8 [22.1–41.6] ng/mL, respectively, for sMer and Gas6), and Gas6 also emerged as an independent AKI predictor (odds ratio (OR) 1.01 [1.00–1.02]). Both sMer and Gas6 independently predicted thrombocytopenia in sepsis patients not treated with anticoagulants (OR 1.01 [1.00–1.02] and 1.04 [1.02–1.06], respectively). Moreover, sMer was an independent predictor of both prothrombin time-international normalized ratio (PT-INR) > 1.4 (OR 1.03 [1.00–1.05]) and sepsis-induced coagulopathy (SIC) (OR 1.05 [1.02–1.07]). An early measurement of the sMer and Gas6 plasma concentration could not predict mortality. However, the biomarkers were associated with AKI, thrombocytopenia, PT-INR derangement and SIC, suggesting a role in predicting sepsis-related organ damage.
Collapse
|
79
|
AYYILDIZ A, ÇOBANER N, YELKEN B. Sepsis induced coagulopathy score and D-dimer levels in COVID-19 patients followed in intensive care; what has changed in COVID era? JOURNAL OF HEALTH SCIENCES AND MEDICINE 2022. [DOI: 10.32322/jhsm.992132] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
|
80
|
Dechamps M, De Poortere J, Martin M, Gatto L, Daumerie A, Bouzin C, Octave M, Ginion A, Robaux V, Pirotton L, Bodart J, Gerard L, Montiel V, Campion A, Gruson D, Van Dievoet MA, Douxfils J, Haguet H, Morimont L, Derive M, Jolly L, Bertrand L, Dumoutier L, Castanares-Zapatero D, Laterre PF, Horman S, Beauloye C. Inflammation-Induced Coagulopathy Substantially Differs Between COVID-19 and Septic Shock: A Prospective Observational Study. Front Med (Lausanne) 2022; 8:780750. [PMID: 35111777 PMCID: PMC8801505 DOI: 10.3389/fmed.2021.780750] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2021] [Accepted: 12/24/2021] [Indexed: 12/12/2022] Open
Abstract
Critical COVID-19, like septic shock, is related to a dysregulated systemic inflammatory reaction and is associated with a high incidence of thrombosis and microthrombosis. Improving the understanding of the underlying pathophysiology of critical COVID-19 could help in finding new therapeutic targets already explored in the treatment of septic shock. The current study prospectively compared 48 patients with septic shock and 22 patients with critical COVID-19 regarding their clinical characteristics and outcomes, as well as key plasmatic soluble biomarkers of inflammation, coagulation, endothelial activation, platelet activation, and NETosis. Forty-eight patients with matched age, gender, and co-morbidities were used as controls. Critical COVID-19 patients exhibited less organ failure but a prolonged ICU length-of-stay due to a prolonged respiratory failure. Inflammatory reaction of critical COVID-19 was distinguished by very high levels of interleukin (IL)-1β and T lymphocyte activation (including IL-7 and CD40L), whereas septic shock displays higher levels of IL-6, IL-8, and a more significant elevation of myeloid response biomarkers, including Triggering Receptor Expressed on Myeloid cells-1 (TREM-1) and IL-1ra. Subsequent inflammation-induced coagulopathy of COVID-19 also differed from sepsis-induced coagulopathy (SIC) and was characterized by a marked increase in soluble tissue factor (TF) but less platelets, antithrombin, and fibrinogen consumption, and less fibrinolysis alteration. In conclusion, COVID-19 inflammation-induced coagulopathy substantially differs from SIC. Modulating TF release and activity should be evaluated in critical COVID-19 patients.
Collapse
Affiliation(s)
- Mélanie Dechamps
- Pôle de Recherche Cardiovasculaire, Institut de Recherche Expérimentale et Clinique, Université Catholique de Louvain, Brussels, Belgium
- Department of Cardiovascular Intensive Care, Cliniques Universitaires Saint-Luc, Brussels, Belgium
| | - Julien De Poortere
- Pôle de Recherche Cardiovasculaire, Institut de Recherche Expérimentale et Clinique, Université Catholique de Louvain, Brussels, Belgium
| | - Manon Martin
- Computational Biology and Bioinformatics Unit, de Duve Institute, Université Catholique de Louvain, Brussels, Belgium
| | - Laurent Gatto
- Computational Biology and Bioinformatics Unit, de Duve Institute, Université Catholique de Louvain, Brussels, Belgium
| | - Aurélie Daumerie
- IREC Imaging Platform, Institut de Recherche Expérimentale et Clinique, Université Catholique de Louvain, Brussels, Belgium
| | - Caroline Bouzin
- IREC Imaging Platform, Institut de Recherche Expérimentale et Clinique, Université Catholique de Louvain, Brussels, Belgium
| | - Marie Octave
- Pôle de Recherche Cardiovasculaire, Institut de Recherche Expérimentale et Clinique, Université Catholique de Louvain, Brussels, Belgium
| | - Audrey Ginion
- Pôle de Recherche Cardiovasculaire, Institut de Recherche Expérimentale et Clinique, Université Catholique de Louvain, Brussels, Belgium
| | - Valentine Robaux
- Pôle de Recherche Cardiovasculaire, Institut de Recherche Expérimentale et Clinique, Université Catholique de Louvain, Brussels, Belgium
| | - Laurence Pirotton
- Pôle de Recherche Cardiovasculaire, Institut de Recherche Expérimentale et Clinique, Université Catholique de Louvain, Brussels, Belgium
| | - Julie Bodart
- Pôle de Recherche Cardiovasculaire, Institut de Recherche Expérimentale et Clinique, Université Catholique de Louvain, Brussels, Belgium
| | - Ludovic Gerard
- Department of Intensive Care, Cliniques Universitaires Saint-Luc, Brussels, Belgium
- Pôle de Pneumologie, Institut de Recherche Expérimentale et Clinique, Université Catholique de Louvain, Brussels, Belgium
| | - Virginie Montiel
- Department of Intensive Care, Cliniques Universitaires Saint-Luc, Brussels, Belgium
| | - Alessandro Campion
- Pôle de Recherche Cardiovasculaire, Institut de Recherche Expérimentale et Clinique, Université Catholique de Louvain, Brussels, Belgium
| | - Damien Gruson
- Department of Clinical Biology, Cliniques Universitaires Saint-Luc, Brussels, Belgium
| | | | - Jonathan Douxfils
- Department of Pharmacy, Namur Research Institute for Life Sciences, Namur, Belgium
- Qualiblood, s.a., Namur, Belgium
| | - Hélène Haguet
- Department of Pharmacy, Namur Research Institute for Life Sciences, Namur, Belgium
- Qualiblood, s.a., Namur, Belgium
| | - Laure Morimont
- Department of Pharmacy, Namur Research Institute for Life Sciences, Namur, Belgium
- Qualiblood, s.a., Namur, Belgium
| | | | | | - Luc Bertrand
- Pôle de Recherche Cardiovasculaire, Institut de Recherche Expérimentale et Clinique, Université Catholique de Louvain, Brussels, Belgium
| | - Laure Dumoutier
- Experimental Medicine Unit, de Duve Institute, Université Catholique de Louvain, Brussels, Belgium
| | - Diego Castanares-Zapatero
- Pôle de Recherche Cardiovasculaire, Institut de Recherche Expérimentale et Clinique, Université Catholique de Louvain, Brussels, Belgium
- Department of Intensive Care, Cliniques Universitaires Saint-Luc, Brussels, Belgium
| | | | - Sandrine Horman
- Pôle de Recherche Cardiovasculaire, Institut de Recherche Expérimentale et Clinique, Université Catholique de Louvain, Brussels, Belgium
| | - Christophe Beauloye
- Pôle de Recherche Cardiovasculaire, Institut de Recherche Expérimentale et Clinique, Université Catholique de Louvain, Brussels, Belgium
- Division of Cardiology, Cliniques Universitaires Saint-Luc, Brussels, Belgium
- *Correspondence: Christophe Beauloye
| |
Collapse
|
81
|
Kapoor M, Panda PK, Saini LK, Bahurupi Y. Disseminated Intravascular Coagulation Score and Sepsis-induced Coagulopathy Score in Prediction of COVID-19 Severity: A Retrospective Analysis. Indian J Crit Care Med 2022; 25:1357-1363. [PMID: 35027794 PMCID: PMC8693109 DOI: 10.5005/jp-journals-10071-24056] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
Background The novel disseminated intravascular coagulation (DIC) score (platelet count, prolonged prothrombin time, D-dimer, and fibrinogen) and sepsis-induced coagulopathy (SIC) score (platelet count, international normalized ratio, and sequential organ failure assessment score) are markers of coagulopathy, which, for the first time, are explored in line with the coronavirus disease-2019 (COVID-19) disease outcomes. The correlation of D-dimer with these findings is also studied. Materials and methods A retrospective analysis of hospital-based records of 168 COVID-19 patients was done. Data including D-dimer, routine investigations, DIC, and SIC scorings (all within 3 days of admission) were collected and correlated with the outcomes. The study was conducted in a tertiary care center catering to North India's population. Results Higher DIC score (1.59 ± 1.18 vs 0.96 ± 1.18), SIC score (1.60 ± 0.89 vs 0.63 ± 0.99), and D-dimer titers (1321.33 ± 1627.89 vs 583·66 ± 777.71 ng/mL) were significantly associated with severe COVID-19 disease (p <0.05). DIC score and SIC score ≥1, and D-dimer ≥1315 ng/mL for severe disease; DIC score ≥1, SIC score ≥2, and D-dimer ≥600 ng/mL for pulmonary embolism (PE); and DIC score and SIC score ≥1, and D-dimer level ≥990 ng/mL for mortality were the respective cutoff values we found from our study. Conclusion Higher DIC scores, SIC scores, and D-dimer values are associated with severe COVID-19 disease, inhospital mortality, and PE risk. They can serve as easily accessible early markers of severe disease and prioritize hospital admissions in the presently overburdened scenario and may be used to develop prognostic prediction models. How to cite this article Kapoor M, Panda PK, Saini LK, Bahurupi Y. Disseminated Intravascular Coagulation Score and Sepsis-induced Coagulopathy Score in Prediction of COVID-19 Severity: A Retrospective Analysis. Indian J Crit Care Med 2021;25(12):1357–1363.
Collapse
Affiliation(s)
- Mayank Kapoor
- Department of Internal Medicine, All India Institute of Medical Sciences, Rishikesh, Uttarakhand, India
| | - Prasan Kumar Panda
- Department of Internal Medicine, All India Institute of Medical Sciences, Rishikesh, Uttarakhand, India
| | - Lokesh Kumar Saini
- Department of Pulmonary Medicine, All India Institute of Medical Sciences, Rishikesh, Uttarakhand, India
| | - Yogesh Bahurupi
- Department of Community and Family Medicine, All India Institute of Medical Sciences, Rishikesh, Uttarakhand, India
| |
Collapse
|
82
|
Hamad AS. Non-vitamin K antagonist oral anticoagulants for COVID-19 thrombosis. JOURNAL OF ACUTE DISEASE 2022. [DOI: 10.4103/2221-6189.362812] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
|
83
|
S. Aleidan F, Albilal S, Alammari M, Al Sulaiman K, Alassiri M, Abdel Gadir A. Does carbapenem-resistant enterobacteriaceae infection drive venous thromboembolism in patients admitted to intensive care units receiving prophylactic anticoagulants? JOURNAL OF APPLIED HEMATOLOGY 2022. [DOI: 10.4103/joah.joah_151_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
|
84
|
Schupp T, Weidner K, Rusnak J, Jawhar S, Forner J, Dulatahu F, Brück LM, Hoffmann U, Bertsch T, Müller J, Weiß C, Akin I, Behnes M. Diagnostic and Prognostic Significance of the Prothrombin Time/International Normalized Ratio in Sepsis and Septic Shock. Clin Appl Thromb Hemost 2022; 28:10760296221137893. [PMID: 36503298 DOI: 10.1177/10760296221137893] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
OBJECTIVE The study investigates the diagnostic and prognostic significance of the prothrombin time/international normalized ratio (PT/INR) in patients with sepsis and septic shock. BACKGROUND Sepsis may be complicated by disseminated intravascular coagulation (DIC). While the status of coagulopathy of septic patients is represented within the sepsis-3 definition by assessing the platelet count, less data regarding the prognostic impact of the PT/INR in patients admitted with sepsis and septic shock is available. METHODS Consecutive patients with sepsis and septic shock from 2019 to 2021 were included. Blood samples were retrieved from day of disease onset (ie, day 0), as well as on day 1, 2, 4, 6 and 9 thereafter. Firstly, the diagnostic value of the PT/INR in comparison to the activated partial thromboplastin time (aPTT) was tested for septic shock compared to sepsis without shock. Secondly, the prognostic value of the PT/INR for 30-day all-cause mortality was tested. Statistical analyses included univariable t-tests, Spearman's correlations, C-statistics, Kaplan-Meier analyses and Cox proportional regression analyses. RESULTS 338 patients were included (56% sepsis without shock, 44% septic shock). The overall rate of all-cause mortality at 30 days was 52%. With an area under the curve (AUC) of 0.682 (p= .001) on day 0, the PT/INR revealed moderate discrimination of septic shock and sepsis without shock. Furthermore, PT/ INR was able to discriminate non-survivors and survivors at 30 days (AUC = 0.612; p = .001). Patients with a PT/INR >1.5 had higher rates of 30-day all-cause mortality than patients with lower values (mortality rate 73% vs 48%; log rank p = .001; HR = 2.129; 95% CI 1.494-3.033; p = .001), even after multivariable adjustment (HR = 1.793; 95% CI 1.343-2.392; p = .001). Increased risk of 30-day all-cause mortality was observed irrespective of concomitant thrombocytopenia. CONCLUSION The PT/INR revealed moderate diagnostic accuracy for septic shock but was associated with reliable prognostic accuracy with regard to 30-day all-cause mortality in patients admitted with sepsis and septic shock.
Collapse
Affiliation(s)
- Tobias Schupp
- Department of Cardiology, Angiology, Haemostaseology and Medical Intensive Care, 36642University Medical Centre Mannheim, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany.,European Center for AngioScience (ECAS) and German Center for Cardiovascular Research (DZHK) partner site Heidelberg/Mannheim, Mannheim, Germany
| | - Kathrin Weidner
- Department of Cardiology, Angiology, Haemostaseology and Medical Intensive Care, 36642University Medical Centre Mannheim, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany.,European Center for AngioScience (ECAS) and German Center for Cardiovascular Research (DZHK) partner site Heidelberg/Mannheim, Mannheim, Germany
| | - Jonas Rusnak
- Department of Cardiology, Angiology, Haemostaseology and Medical Intensive Care, 36642University Medical Centre Mannheim, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany.,European Center for AngioScience (ECAS) and German Center for Cardiovascular Research (DZHK) partner site Heidelberg/Mannheim, Mannheim, Germany
| | - Schanas Jawhar
- Department of Cardiology, Angiology, Haemostaseology and Medical Intensive Care, 36642University Medical Centre Mannheim, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany.,European Center for AngioScience (ECAS) and German Center for Cardiovascular Research (DZHK) partner site Heidelberg/Mannheim, Mannheim, Germany
| | - Jan Forner
- Department of Cardiology, Angiology, Haemostaseology and Medical Intensive Care, 36642University Medical Centre Mannheim, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany.,European Center for AngioScience (ECAS) and German Center for Cardiovascular Research (DZHK) partner site Heidelberg/Mannheim, Mannheim, Germany
| | - Floriana Dulatahu
- Department of Cardiology, Angiology, Haemostaseology and Medical Intensive Care, 36642University Medical Centre Mannheim, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany.,European Center for AngioScience (ECAS) and German Center for Cardiovascular Research (DZHK) partner site Heidelberg/Mannheim, Mannheim, Germany
| | - Lea Marie Brück
- Department of Cardiology, Angiology, Haemostaseology and Medical Intensive Care, 36642University Medical Centre Mannheim, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany.,European Center for AngioScience (ECAS) and German Center for Cardiovascular Research (DZHK) partner site Heidelberg/Mannheim, Mannheim, Germany
| | - Ursula Hoffmann
- Department of Cardiology, Angiology, Haemostaseology and Medical Intensive Care, 36642University Medical Centre Mannheim, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany.,European Center for AngioScience (ECAS) and German Center for Cardiovascular Research (DZHK) partner site Heidelberg/Mannheim, Mannheim, Germany
| | - Thomas Bertsch
- Institute of Clinical Chemistry, Laboratory Medicine and Transfusion Medicine, Nuremberg General Hospital, Paracelsus Medical University, Nuremberg, Germany
| | - Julian Müller
- Clinic for Interventional Electrophysiology, Heart Centre Bad Neustadt, Bad Neustadt a. d. Saale, Germany.,Department of Cardiology and Angiology, Philipps-University Marburg, Marburg, Germany
| | - Christel Weiß
- Department of Statistical Analysis, Faculty of Medicine Mannheim, University of Heidelberg, Mannheim, Germany
| | - Ibrahim Akin
- Department of Cardiology, Angiology, Haemostaseology and Medical Intensive Care, 36642University Medical Centre Mannheim, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany.,European Center for AngioScience (ECAS) and German Center for Cardiovascular Research (DZHK) partner site Heidelberg/Mannheim, Mannheim, Germany
| | - Michael Behnes
- Department of Cardiology, Angiology, Haemostaseology and Medical Intensive Care, 36642University Medical Centre Mannheim, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany.,European Center for AngioScience (ECAS) and German Center for Cardiovascular Research (DZHK) partner site Heidelberg/Mannheim, Mannheim, Germany
| |
Collapse
|
85
|
Mori K, Tsujita Y, Yamane T, Eguchi Y. Decreasing Plasma Fibrinogen Levels in the Intensive Care Unit Are Associated with High Mortality Rates In Patients With Sepsis-Induced Coagulopathy. Clin Appl Thromb Hemost 2022; 28:10760296221101386. [PMID: 35549920 PMCID: PMC9112680 DOI: 10.1177/10760296221101386] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Plasma fibrinogen levels increase in response to infection, but they could also decrease due to degradation as in severe coagulopathy. We evaluated 60 septic patients with their CRP levels over 5.00 mg/dL. The patients were classified into three groups based on the ratio of the maximum or minimum fibrinogen concentration within day 3 to the initial concentration on day 0: down-, flat, and uptrend groups (n = 15, 30, and 15, respectively). Both down- and flat trend groups showed reduced inflammatory markers on day 3, and the degree of platelet loss (103/μL) and the mortality rate (%) were more remarkable in the downtrend group ( - 108 vs - 42 [p = 0.026] and 46.7 vs 10.0 [p = 0.027]). On day 0, in total 12 and 9 patients were diagnosed with non-overt DIC in the down- and uptrend groups, of which 5 (41.7%) and 1 (11.1%) died within 28 days after admission. In conclusion, decreasing fibrinogen levels in the ICU are associated with high mortality in patients with sepsis followed by decreasing platelet counts, even when they are diagnosed with non-overt DIC.
Collapse
Affiliation(s)
- Keisuke Mori
- School of Medicine, 13051Shiga University of Medical Science, Otsu, Shiga, Japan
| | - Yasuyuki Tsujita
- Emergency and Intensive Care Unit, 469340Shiga University of Medical Science Hospital, Otsu, Shiga, Japan
| | - Tetsunobu Yamane
- Emergency and Intensive Care Unit, 469340Shiga University of Medical Science Hospital, Otsu, Shiga, Japan
| | - Yutaka Eguchi
- Department of Critical and Intensive Care Medicine, 13051Shiga University of Medical Science, Otsu, Shiga, Japan
| |
Collapse
|
86
|
Peters-Sengers H, Butler JM, Uhel F, Schultz MJ, Bonten MJ, Cremer OL, Scicluna BP, van Vught LA, van der Poll T. Source-specific host response and outcomes in critically ill patients with sepsis: a prospective cohort study. Intensive Care Med 2022; 48:92-102. [PMID: 34902047 PMCID: PMC8667541 DOI: 10.1007/s00134-021-06574-0] [Citation(s) in RCA: 35] [Impact Index Per Article: 17.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2021] [Accepted: 10/31/2021] [Indexed: 01/15/2023]
Abstract
PURPOSE There is limited knowledge on how the source of infection impacts the host response to sepsis. We aimed to compare the host response in sepsis patients with a single, known source at admission (< 24 h) to the intensive care unit. METHODS From the molecular diagnosis and risk stratification of sepsis (MARS) prospective cohort, we measured 16 plasma host response biomarkers reflective of key host response pathways in 621 sepsis patients. In a subgroup (n = 335), blood leukocyte transcriptomes were compared between the sources. Differences in clinical patient profiles and survival were compared in the whole sepsis cohort (n = 2019). RESULTS The plasma biomarker cohort was categorized into sepsis originating from the respiratory tract (n = 334, 53.8%), abdomen (n = 159, 25.6%), urinary tract (n = 44, 7.1%), cardiovascular (n = 41, 6.6%), central nervous system (CNS) (n = 18, 2.9%), or skin (n = 25, 4%). This analysis revealed stronger inflammatory and cytokine responses, loss of vascular integrity and coagulation activation in abdominal sepsis relative to respiratory. Endothelial cell activation was prominent in urinary, cardiovascular and skin infections, while CNS infection was associated with the least host response aberrations. The leukocyte transcriptional response showed the largest overlap between abdominal and pulmonary infections (76% in common); notable differences between the sources were detected regarding hemostasis, cytokine signaling, innate and adaptive immune, and metabolic transcriptional pathways. After adjustment for confounders, the source of infection remained an independent contributor to 30-day mortality (unadjusted p = 0.001, adjusted p = 0.028). CONCLUSION Sepsis heterogeneity is partly explained by source-specific host response dysregulations and should be considered when selecting patients for trials testing immune modulatory drugs.
Collapse
Affiliation(s)
- Hessel Peters-Sengers
- grid.7177.60000000084992262Center for Experimental and Molecular Medicine, Amsterdam University Medical Centers, Location Academic Medical Center, University of Amsterdam, Room T1.240, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands ,grid.509540.d0000 0004 6880 3010The Amsterdam Institute for Infection and Immunity, Amsterdam University Medical Centers, Amsterdam, The Netherlands
| | - Joe M. Butler
- grid.7177.60000000084992262Center for Experimental and Molecular Medicine, Amsterdam University Medical Centers, Location Academic Medical Center, University of Amsterdam, Room T1.240, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands ,grid.509540.d0000 0004 6880 3010The Amsterdam Institute for Infection and Immunity, Amsterdam University Medical Centers, Amsterdam, The Netherlands
| | - Fabrice Uhel
- grid.7177.60000000084992262Center for Experimental and Molecular Medicine, Amsterdam University Medical Centers, Location Academic Medical Center, University of Amsterdam, Room T1.240, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands ,grid.509540.d0000 0004 6880 3010The Amsterdam Institute for Infection and Immunity, Amsterdam University Medical Centers, Amsterdam, The Netherlands
| | - Marcus J. Schultz
- grid.7177.60000000084992262Department of Intensive Care Medicine, Amsterdam University Medical Centers, Location Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands ,grid.7177.60000000084992262Laboratory of Experimental Intensive Care and Anesthesiology (L.E.I.C.A), Amsterdam University Medical Centers, Location Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands ,grid.10223.320000 0004 1937 0490Mahidol-Oxford Tropical Medicine Research Unit (MORU), Mahidol University, Bangkok, Thailand ,grid.4991.50000 0004 1936 8948Nuffield Department of Medicine, University of Oxford, Oxford, UK
| | - Marc J. Bonten
- grid.7692.a0000000090126352Department of Medical Microbiology, University Medical Center Utrecht, Utrecht, The Netherlands ,grid.7692.a0000000090126352Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Olaf L. Cremer
- grid.7692.a0000000090126352Department of Intensive Care Medicine, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Brendon P. Scicluna
- grid.7177.60000000084992262Center for Experimental and Molecular Medicine, Amsterdam University Medical Centers, Location Academic Medical Center, University of Amsterdam, Room T1.240, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands ,grid.509540.d0000 0004 6880 3010The Amsterdam Institute for Infection and Immunity, Amsterdam University Medical Centers, Amsterdam, The Netherlands ,grid.7177.60000000084992262Department of Clinical Epidemiology, Biostatistics and Bioinformatics, Amsterdam UMC, Location Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - Lonneke A. van Vught
- grid.7177.60000000084992262Center for Experimental and Molecular Medicine, Amsterdam University Medical Centers, Location Academic Medical Center, University of Amsterdam, Room T1.240, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands ,grid.509540.d0000 0004 6880 3010The Amsterdam Institute for Infection and Immunity, Amsterdam University Medical Centers, Amsterdam, The Netherlands
| | - Tom van der Poll
- grid.7177.60000000084992262Center for Experimental and Molecular Medicine, Amsterdam University Medical Centers, Location Academic Medical Center, University of Amsterdam, Room T1.240, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands ,grid.509540.d0000 0004 6880 3010The Amsterdam Institute for Infection and Immunity, Amsterdam University Medical Centers, Amsterdam, The Netherlands ,grid.7177.60000000084992262Division of Infectious Diseases, Amsterdam University Medical Centers, Location Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | | |
Collapse
|
87
|
Prevalence and Trajectory of COVID-19-Associated Hypercoagulability Using Serial Thromboelastography in a South African Population. Crit Care Res Pract 2021; 2021:3935098. [PMID: 34956676 PMCID: PMC8694947 DOI: 10.1155/2021/3935098] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2021] [Accepted: 11/23/2021] [Indexed: 01/21/2023] Open
Abstract
Introduction The coagulation abnormalities resulting from severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) have been attributed to inflammation and subsequent cytokine storm. Thromboelastography (TEG) is a point-of-care test used to assess clot formation and degradation in whole blood and is an indicator of the overall real-time coagulopathic state of the patient. Methods A single-centre, prospective, observational cohort study was conducted in South Africa, analysing the coagulation patterns of 41 patients with hypoxia related to SARS-CoV-2 using serial thromboelastography (TEG) on admission, after 48 hours, and at resolution of hypoxia/day 10. Results: Two-thirds (n = 26) were women. The median age was 61 (IQR 50–67), and the majority (88%) were Black patients. Almost half (22) of the patients were critically ill and ventilated, with median SOFA and SAPS2 scores of 3 and 22 (IQR2-4 and 18–30), respectively. The prevalence of hypercoagulability was 0.54 (95% CI 0.46–0.62), whilst 29/41 (0.71, CI 0.64–0.78)) met the definition of hypofibrinolysis. Differences between the hypercoagulable (HC) and non-hypercoagulable groups remained apparent at 48 hours after anticoagulation. At this time point, the K time was significantly lower (p ˂ 0,01), and the α-angle (p ˂ 0,01) and maximum amplitude (MA) (p ˂ 0,01) were significantly higher in the HC cohort. At resolution of hypoxia, or day 10, only MA was significantly higher in the hypercoagulable group compared to the non-hypercoagulable group (p = 0.01). The initial impairment in fibrinolysis (Ly30), α angle, and MA were significantly associated with mortality, with p values of 0.006, 0.031, and 0.04, respectively. Conclusions In this South African population, hypercoagulability was a highly prevalent phenomenon in COVID-19 disease. It was typified by hypofibrinolysis and a persistently elevated MA, despite anticoagulation therapy.
Collapse
|
88
|
Cui R, Hua W, Qu K, Yang H, Tong Y, Li Q, Wang H, Ma Y, Liu S, Lin T, Zhang J, Sun J, Liu C. An Interpretable Early Dynamic Sequential Predictor for Sepsis-Induced Coagulopathy Progression in the Real-World Using Machine Learning. Front Med (Lausanne) 2021; 8:775047. [PMID: 34926518 PMCID: PMC8678506 DOI: 10.3389/fmed.2021.775047] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2021] [Accepted: 11/08/2021] [Indexed: 11/17/2022] Open
Abstract
Sepsis-associated coagulation dysfunction greatly increases the mortality of sepsis. Irregular clinical time-series data remains a major challenge for AI medical applications. To early detect and manage sepsis-induced coagulopathy (SIC) and sepsis-associated disseminated intravascular coagulation (DIC), we developed an interpretable real-time sequential warning model toward real-world irregular data. Eight machine learning models including novel algorithms were devised to detect SIC and sepsis-associated DIC 8n (1 ≤ n ≤ 6) hours prior to its onset. Models were developed on Xi'an Jiaotong University Medical College (XJTUMC) and verified on Beth Israel Deaconess Medical Center (BIDMC). A total of 12,154 SIC and 7,878 International Society on Thrombosis and Haemostasis (ISTH) overt-DIC labels were annotated according to the SIC and ISTH overt-DIC scoring systems in train set. The area under the receiver operating characteristic curve (AUROC) were used as model evaluation metrics. The eXtreme Gradient Boosting (XGBoost) model can predict SIC and sepsis-associated DIC events up to 48 h earlier with an AUROC of 0.929 and 0.910, respectively, and even reached 0.973 and 0.955 at 8 h earlier, achieving the highest performance to date. The novel ODE-RNN model achieved continuous prediction at arbitrary time points, and with an AUROC of 0.962 and 0.936 for SIC and DIC predicted 8 h earlier, respectively. In conclusion, our model can predict the sepsis-associated SIC and DIC onset up to 48 h in advance, which helps maximize the time window for early management by physicians.
Collapse
Affiliation(s)
- Ruixia Cui
- Department of Hepatobiliary Surgery, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China.,Department of SICU, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Wenbo Hua
- School of Mathematics and Statistics, Xi'an Jiaotong University, Xi'an, China
| | - Kai Qu
- Department of Hepatobiliary Surgery, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Heran Yang
- School of Mathematics and Statistics, Xi'an Jiaotong University, Xi'an, China
| | - Yingmu Tong
- Department of Hepatobiliary Surgery, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China.,Department of SICU, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Qinglin Li
- Department of Hepatobiliary Surgery, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China.,Department of SICU, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Hai Wang
- Department of Hepatobiliary Surgery, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China.,Department of SICU, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Yanfen Ma
- Department of Clinical Laboratory, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Sinan Liu
- Department of Hepatobiliary Surgery, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China.,Department of SICU, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Ting Lin
- Department of Hepatobiliary Surgery, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China.,Department of SICU, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Jingyao Zhang
- Department of Hepatobiliary Surgery, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China.,Department of SICU, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China.,Biobank, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Jian Sun
- School of Mathematics and Statistics, Xi'an Jiaotong University, Xi'an, China
| | - Chang Liu
- Department of Hepatobiliary Surgery, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China.,Department of SICU, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China.,Biobank, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| |
Collapse
|
89
|
Hosseini SF, Behnam-Roudsari S, Alavinia G, Emami A, Toghyani A, Moradi S, Zadeh MM, Mohseni S, Shafiee MA. Diagnostic and prognostic value of Sepsis-Induced coagulopathy and International Society on Thrombosis and Hemostasis scoring systems in COVID-19-associated disseminated intravascular coagulopathy. JOURNAL OF RESEARCH IN MEDICAL SCIENCES : THE OFFICIAL JOURNAL OF ISFAHAN UNIVERSITY OF MEDICAL SCIENCES 2021; 26:102. [PMID: 34899940 PMCID: PMC8607173 DOI: 10.4103/jrms.jrms_1295_20] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/07/2020] [Revised: 12/30/2020] [Accepted: 03/25/2021] [Indexed: 01/08/2023]
Abstract
BACKGROUND The coronavirus disease 2019 (COVID-19) presents various phenotypes from asymptomatic involvement to death. Disseminated intravascular coagulopathy (DIC) is among the poor prognostic complications frequently observed in critical illness. To improve mortality, a timely diagnosis of DIC is essential. The International Society on Thrombosis and Hemostasis (ISTH) introduced a scoring system to detect overt DIC (score ≥5) and another category called sepsis-induced coagulopathy (SIC) to identify the initial stages of DIC (score ≥4). This study aimed to determine whether clinicians used these scoring systems while assessing COVID-19 patients and the role of relevant biomarkers in disease severity and outcome. MATERIALS AND METHODS An exhaustive search was performed according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses, using Medline, Embase, Cochrane, CINAHL, and PubMed until August 2020. Studies considering disease severity or outcome with at least two relevant biomarkers were included. For all studies, the definite, maximum, and minimum ISTH/SIC scores were calculated. RESULTS A total of 37 papers and 12,463 cases were reviewed. Studies considering ISTH/SIC criteria to detect DIC suggested a higher rate of ISTH ≥5 and SIC ≥4 in severe cases and nonsurvivors compared with nonsevere cases and survivors. The calculated ISTH scores were dominantly higher in severe infections and nonsurvivors. Elevated D-dimer was the most consistent abnormality on admission. CONCLUSION Higher ISTH and SIC scores positively correlate with disease severity and death. In addition, more patients with severe disease and nonsurvivors met the ISTH and SIC scores for DIC. Given the high prevalence of coagulopathy in COVID-19 infection, dynamic monitoring of relevant biomarkers in the form of ISTH and SIC scoring systems is of great importance to timely detect DIC in suspicious patients.
Collapse
Affiliation(s)
- Sayyideh Forough Hosseini
- Department of Medicine, Division of General Internal Medicine, Toronto General Hospital, Toronto, Canada
| | - Sahar Behnam-Roudsari
- Department of Medicine, Division of General Internal Medicine, Toronto General Hospital, Toronto, Canada
| | - Ghazal Alavinia
- Department of Medicine, Division of General Internal Medicine, Toronto General Hospital, Toronto, Canada
| | - Anahita Emami
- Department of Medicine, Division of General Internal Medicine, Toronto General Hospital, Toronto, Canada
| | - Arash Toghyani
- Department of Internal Medicine, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Sanaz Moradi
- Department of Medicine, Division of General Internal Medicine, Toronto General Hospital, Toronto, Canada
| | - Mahtab Mojtahed Zadeh
- Department of Medicine, Division of General Internal Medicine, Toronto General Hospital, Toronto, Canada
| | - Sana Mohseni
- Department of Medicine, Division of General Internal Medicine, Toronto General Hospital, Toronto, Canada
| | - Mohammad Ali Shafiee
- Department of Medicine, Division of General Internal Medicine, Toronto General Hospital, Toronto, Canada
| |
Collapse
|
90
|
Kingren MS, Starr ME, Saito H. Divergent Sepsis Pathophysiology in Older Adults. Antioxid Redox Signal 2021; 35:1358-1375. [PMID: 34210173 PMCID: PMC8905233 DOI: 10.1089/ars.2021.0056] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/26/2021] [Revised: 06/25/2021] [Accepted: 06/27/2021] [Indexed: 12/12/2022]
Abstract
Significance: Both incidence and mortality rates of sepsis significantly increase with advanced age, and the majority of sepsis patients are late middle-aged or older. With the proportion of older adults rapidly increasing in developed countries, age-dependent sepsis vulnerability is an urgent medical issue. Due to an increasing life expectancy, postsepsis complications and health care costs are expected to increase as well. Recent Advances: Older patients suffer from higher sepsis incidence and mortality rates, likely resulting from frequent comorbidities, increased coagulation, dysgylcemia, and altered immune responses. Critical Issues: Despite a large number of ongoing clinical and basic research studies, there is currently no effective therapeutic strategy targeting older patients with severe sepsis. The disparity between clinical and basic studies is a problem, and this is largely due to the use of animal models lacking clinical relevance. Although the majority of sepsis cases occur in older adults, most laboratory animals used for sepsis research are very young. Further, despite the wide use of combination fluid and antibiotic treatment in intensive care unit (ICU) patients, most animal research does not include such treatment. Future Directions: Because sepsis is a systemic disease with multiple organ dysfunction, combined therapy approaches, not those targeting single pathways or single organs, are essential. As for preclinical research, it is critical to confirm new findings using aged animal models with clinically relevant ICU-like medical treatments. Antioxid. Redox Signal. 35, 1358-1375.
Collapse
Affiliation(s)
- Meagan S. Kingren
- Aging and Critical Care Research Laboratory, Departments of University of Kentucky, Lexington, Kentucky, USA
- Pharmacology and Nutritional Sciences, University of Kentucky, Lexington, Kentucky, USA
| | - Marlene E. Starr
- Aging and Critical Care Research Laboratory, Departments of University of Kentucky, Lexington, Kentucky, USA
- Pharmacology and Nutritional Sciences, University of Kentucky, Lexington, Kentucky, USA
- Surgery, University of Kentucky, Lexington, Kentucky, USA
| | - Hiroshi Saito
- Aging and Critical Care Research Laboratory, Departments of University of Kentucky, Lexington, Kentucky, USA
- Pharmacology and Nutritional Sciences, University of Kentucky, Lexington, Kentucky, USA
- Surgery, University of Kentucky, Lexington, Kentucky, USA
- Physiology, University of Kentucky, Lexington, Kentucky, USA
| |
Collapse
|
91
|
Xiang L, Ren H, Wang Y, Zhang J, Qian J, Li B, An K, Fu L. Clinical value of pediatric sepsis-induced coagulopathy score in diagnosis of sepsis-induced coagulopathy and prognosis in children. J Thromb Haemost 2021; 19:2930-2937. [PMID: 34407568 DOI: 10.1111/jth.15500] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2021] [Revised: 07/21/2021] [Accepted: 08/16/2021] [Indexed: 11/28/2022]
Abstract
BACKGROUND In adults, sepsis-induced coagulopathy (SIC) is diagnosed by the SIC score, known as sepsis-3. There is no pediatric SIC (pSIC) score at present. OBJECTIVES We proposed a pSIC scoring method and evaluated the diagnostic efficacy of the score in the diagnosis of SIC in children. PATIENTS/METHODS Patient data were retrospectively analyzed from Shanghai Children's Medical Center between February 2014 and January 2015. The pSIC score was modified from the SIC score. The area under ROC curve (AU-ROC) was used to compare the prognostic values of pSIC with other scores for pediatric sepsis-induced disseminated intravascular coagulation (DIC) to arrive at a 28-day outcome. RESULTS AND CONCLUSIONS There were 54 patients in the pSIC group and 37 in the non-pSIC group. The Kaplan-Meier survival curve analysis showed that the 28-day prognosis was better in the non-pSIC than in the pSIC group (p < .001). The AU-ROC of the pSIC score in predicting 28-day mortality in sepsis was 0.716, with the optimal cutoff value of >3 inferior to that of pediatric sequential organ failure (0.716 vs. 0.921, p < .001). The AU-ROC of pSIC in predicting nonovert DIC was 0.845 and the optimal cutoff value was >3. The AU-ROC of pSIC in predicting overt DIC was 0.901, with the best optimal cutoff value of >4. The pSIC score can be used to diagnose SIC in children, screen potential nonovert DIC, and assess the severity of sepsis, organ dysfunction, and 28-day outcome in children.
Collapse
Affiliation(s)
- Long Xiang
- Department of Critical Care Medicine, Shanghai Children's Medical Center, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Hong Ren
- Department of Critical Care Medicine, Shanghai Children's Medical Center, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Ying Wang
- Department of Critical Care Medicine, Shanghai Children's Medical Center, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Jian Zhang
- Department of Critical Care Medicine, Shanghai Children's Medical Center, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Juan Qian
- Department of Critical Care Medicine, Shanghai Children's Medical Center, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Biru Li
- Department of Critical Care Medicine, Shanghai Children's Medical Center, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Kang An
- Department of Critical Care Medicine, Shanghai Children's Medical Center, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Lijun Fu
- Department of Cardiology, Shanghai Children's Medical Center, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| |
Collapse
|
92
|
Larsen JB, Aggerbeck MA, Granfeldt A, Schmidt M, Hvas A, Adelborg K. Disseminated intravascular coagulation diagnosis: Positive predictive value of the ISTH score in a Danish population. Res Pract Thromb Haemost 2021; 5:e12636. [PMID: 34938938 PMCID: PMC8660681 DOI: 10.1002/rth2.12636] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2021] [Revised: 11/01/2021] [Accepted: 11/10/2021] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND The diagnostic accuracy of the ISTH's disseminated intravascular coagulation (DIC) score remains to be investigated in contemporary patient populations. OBJECTIVE To examine the positive predictive value (PPV) of an ISTH DIC score ≥5 for identifying patients with overt DIC in a Danish hospital laboratory information system database. MATERIALS AND METHODS A population-based cross-sectional validation study in the Central Denmark Region (2015-2018). Patients with a DIC score ≥5 were identified from the hospital laboratory information system database. Only patients with a potential underlying cause of DIC were included in the analyses. Cases were adjudicated by the authors as the gold standard for DIC diagnosis. The diagnosis of overt DIC was assigned on the basis of clinical signs of microthrombosis and/or bleeding and available laboratory records. PPVs with 95% confidence intervals (CIs) were computed. RESULTS Medical records of 225 patients were included. The overall PPV for overt DIC was 68% (95% CI, 61-74) and for overt + subclinical DIC, 83% (95% CI, 77%-88%) and increased with higher scores from 47% (95% CI, 35-59) for DIC score 5 to 88 (95% CI, 79-94) for DIC score ≥7. PPV was higher among intensive care patients and patient with sepsis, low antithrombin activity, prolonged activated partial thromboplastin time, or high Sequential Organ Failure Assessment score. CONCLUSION The accuracy of ISTH DIC score ≥5 was moderate for overt DIC but increased with increasing scores and depended on the underlying cause of DIC. This new knowledge provides guidance to physicians and enables DIC research using laboratory-based data.
Collapse
Affiliation(s)
- Julie Brogaard Larsen
- Department of Clinical BiochemistryThrombosis and Haemostasis Research UnitAarhus University HospitalAarhusDenmark
| | - Mathies Appel Aggerbeck
- Department of Clinical BiochemistryThrombosis and Haemostasis Research UnitAarhus University HospitalAarhusDenmark
| | - Asger Granfeldt
- Department of Anaesthesiology and Intensive CareAarhus University HospitalAarhusDenmark
| | - Morten Schmidt
- Department of CardiologyAarhus University HospitalAarhusDenmark
- Department of Clinical EpidemiologyAarhus University HospitalAarhusDenmark
| | - Anne‐Mette Hvas
- Department of Clinical BiochemistryThrombosis and Haemostasis Research UnitAarhus University HospitalAarhusDenmark
- Department of Clinical MedicineAarhus UniversityAarhusDenmark
| | - Kasper Adelborg
- Department of Clinical BiochemistryThrombosis and Haemostasis Research UnitAarhus University HospitalAarhusDenmark
- Department of Clinical EpidemiologyAarhus University HospitalAarhusDenmark
- Department of Clinical MedicineAarhus UniversityAarhusDenmark
| |
Collapse
|
93
|
Sarkar M, Madabhavi IV, Quy PN, Govindagoudar MB. COVID-19 and coagulopathy. THE CLINICAL RESPIRATORY JOURNAL 2021; 15:1259-1274. [PMID: 34399021 PMCID: PMC8444678 DOI: 10.1111/crj.13438] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/29/2020] [Revised: 06/22/2021] [Accepted: 08/10/2021] [Indexed: 02/07/2023]
Abstract
The SARS-CoV-2 is a new coronavirus responsible for the COVID-19 disease and has caused the pandemic worldwide. A large number of cases have overwhelmed the healthcare system worldwide. The COVID-19 infection has been associated with a heightened risk of thromboembolic complications. Various mechanisms are leading to the high thrombotic risk in COVID-19 patients such as inflammation, endotheliitis, hyperviscosity, and hypercoagulability. We searched PubMed, EMBASE, and CINAHL from January 2020 to December 2020. We used the following search terms: COVID-19, coagulopathy, and thrombosis. We reviewed the epidemiology, clinical features, mechanisms, and treatment of COVID-19-associated coagulopathy.
Collapse
Affiliation(s)
- Malay Sarkar
- Department of pulmonary medicineIndira Gandhi Medical CollegeShimlaHimachal PradeshIndia
| | - Irappa V. Madabhavi
- Department of Medical and Pediatric OncologyKerudi Cancer HospitalBagalkotKarnatakaIndia
- Department of Medical OncologyJ N Medical CollegeBelagaviKarnatakaIndia
- Department of Medical OncologyNanjappa HospitalShimogaKarnatakaIndia
| | - Pham Nguyen Quy
- Department of Medical OncologyKyoto Miniren Central HospitalKyotoJapan
| | - Manjunath B. Govindagoudar
- Department of Pulmonary and Critical CarePt B D Sharma Postgraduate Institute of Medical SciencesRohtakHaryanaIndia
| |
Collapse
|
94
|
Arisz RA, Meijer P, Péquériaux NCV, van de Leur SJ, Lukens MV, de Maat MPM, Hollestelle MJ. Impact of COVID-19 pandemic on the quality of test output in haemostasis laboratories. Int J Lab Hematol 2021; 44:407-413. [PMID: 34806301 PMCID: PMC9011814 DOI: 10.1111/ijlh.13760] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2021] [Revised: 10/15/2021] [Accepted: 10/21/2021] [Indexed: 12/15/2022]
Abstract
Introduction The high incidence of thrombotic events in patients with COVID‐19 affects health care worldwide and results in an increased workload in haemostasis laboratories due to more frequent testing of D‐dimer, haemostatic parameters and anti‐Xa tests. However, the impact of this increase in assay requests on the quality of performance in haemostasis laboratories remains unclear. In this study, the impact of the COVID‐19 pandemic on the quality of performance and management of haemostasis laboratories was evaluated. Methods The impact on the quality of performance was studied using external quality assessment data from 2019 to 2020 derived from ECAT surveys. A questionnaire was sent to Dutch haemostasis laboratories to identify challenges and management strategies. Furthermore, the number of assays performed in 2019 and 2020 was supplied by four Dutch hospitals, located in regions with different disease incidence. Results No differences in response rate nor the quality of the measurements were observed between the EQA surveys in 2019 and 2020. The questionnaire results showed a large increase of >25% in the number of test requests for anti‐Xa, D‐dimer and fibrinogen assays in 2020 compared to 2019. Extreme peaks in test requests were also observed in the four evaluated hospitals. Additionally, 84% of the respondents indicated that they had experienced increased work pressure, and increased sick leave was observed in 71% of the participating laboratories. Conclusions The enormous increase in test requests, especially for D‐dimer assays and anti‐Xa activity, did not affect the quality of performance within haemostatic laboratories during the COVID‐19 pandemic.
Collapse
Affiliation(s)
- Ryanne A Arisz
- Department of Hematology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, Netherlands
| | - Piet Meijer
- ECAT Foundation (External quality Control for Assays and Tests), Voorschoten, Netherlands
| | - Nathalie C V Péquériaux
- Department of Clinical Chemistry and Hematology, Jeroen Bosch Hospital, 's-Hertogenbosch, Netherlands
| | | | - Michaël V Lukens
- Department of Laboratory Medicine, University Medical Center Groningen, University of Groningen, Groningen, Netherlands
| | - Moniek P M de Maat
- Department of Hematology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, Netherlands
| | - Martine J Hollestelle
- ECAT Foundation (External quality Control for Assays and Tests), Voorschoten, Netherlands
| |
Collapse
|
95
|
Neuenfeldt FS, Weigand MA, Fischer D. Coagulopathies in Intensive Care Medicine: Balancing Act between Thrombosis and Bleeding. J Clin Med 2021; 10:5369. [PMID: 34830667 PMCID: PMC8623639 DOI: 10.3390/jcm10225369] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2021] [Revised: 11/10/2021] [Accepted: 11/16/2021] [Indexed: 11/23/2022] Open
Abstract
Patient Blood Management advocates an individualized treatment approach, tailored to each patient's needs, in order to reduce unnecessary exposure to allogeneic blood products. The optimization of hemostasis and minimization of blood loss is of high importance when it comes to critical care patients, as coagulopathies are a common phenomenon among them and may significantly impact morbidity and mortality. Treating coagulopathies is complex as thrombotic and hemorrhagic conditions may coexist and the medications at hand to modulate hemostasis can be powerful. The cornerstones of coagulation management are an appropriate patient evaluation, including the individual risk of bleeding weighed against the risk of thrombosis, a proper diagnostic work-up of the coagulopathy's etiology, treatment with targeted therapies, and transfusion of blood product components when clinically indicated in a goal-directed manner. In this article, we will outline various reasons for coagulopathy in critical care patients to highlight the aspects that need special consideration. The treatment options outlined in this article include anticoagulation, anticoagulant reversal, clotting factor concentrates, antifibrinolytic agents, desmopressin, fresh frozen plasma, and platelets. This article outlines concepts with the aim of the minimization of complications associated with coagulopathies in critically ill patients. Hereditary coagulopathies will be omitted in this review.
Collapse
Affiliation(s)
| | | | - Dania Fischer
- Department of Anaesthesiology, Heidelberg University Hospital, 69120 Heidelberg, Germany; (F.S.N.); (M.A.W.)
| |
Collapse
|
96
|
Prouse G, Ettorre L, Mongelli F, Demundo D, van den Berg JC, Catanese C, Fumagalli L, Usai C, Spinedi L, Riva F, Bertoni MV, Giovannacci L. SOFA Score as a Reliable Tool to Detect High Risk for Venous Thrombosis in Patients With Critical Stage SARS-CoV-2. Front Cardiovasc Med 2021; 8:729298. [PMID: 34778398 PMCID: PMC8581480 DOI: 10.3389/fcvm.2021.729298] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2021] [Accepted: 09/28/2021] [Indexed: 12/22/2022] Open
Abstract
Background: Severe acute respiratory syndrome from coronavirus-2 (SARS-CoV-2) has been associated with an increased risk of venous thromboembolism (VTE). Different anticoagulation protocols have been applied in several studies in the absence of clear evidence. A reliable deep venous thrombosis (DVT) indicator in critical patients with SARS-CoV-2 could guide the anticoagulation treatment; however, it has not yet been identified, and clinical applicability of the most common markers is debatable. The aim of our study was to determine the actual incidence of DVT in critically ill SARS-CoV-2 patients and to find a reliable tool to identify patients who might benefit from therapeutic-intensity anticoagulation. Methods: From March 1, 2020 to May 31, 2020, all patients admitted to the intensive care unit (ICU) for SARS-CoV-2 at Ospedale Regionale di Locarno, Locarno, Switzerland, were prospectively enrolled and screened daily with ultrasound for DVT. Following international consensus, a higher-intensity thromboprophylaxis was administered to all patients who were not at increased risk for bleeding. Sepsis-induced coagulopathy (SIC) and sequential organ failure assessment (SOFA) scores were calculated and time-to-DVT event in a COX proportional-hazard regression model was performed. A receiver operating characteristic (ROC) curve was used to determine sensitivity and specificity and the Youden's Index to establish the best threshold. Results: A total of 96 patients were enrolled. Deep venous thrombosis was detected in 37% of patients. Sepsis-induced coagulopathy and SOFA scores were both correlated to DVT. A SIC score of 1 vs. ≥2 showed a close association with DVT, with sensitivity, specificity, and positive and negative predictive values of 90.0, 48.1, and 49.1, and 89.7%, respectively. Most significantly though, a SOFA score of 1 or 2 points was shown to be the most accurate value in predicting the absence of DVT, indicating no need for therapeutic-intensity anticoagulation. Its sensitivity, specificity, and positive and negative predictive values were 87.9, 100, and 100, and 93.7%, respectively. The D-dimer test showed lower sensitivity and specificity whereas platelet count and aPTT were not found to be correlated to DVT. Conclusions: Patients with SOFA scores of 1 or 2 are at low risk of developing DVT and do not require therapeutic-intensity anticoagulation. Conversely, patients with scores ≥3 are at high risk of developing DVT.
Collapse
Affiliation(s)
- Giorgio Prouse
- Service of Vascular Surgery, Centro Vascolare Ticino, Ospedali Regionali di Lugano, Bellinzona e Locarno, Switzerland
| | - Ludovica Ettorre
- Service of Vascular Surgery, Centro Vascolare Ticino, Ospedali Regionali di Lugano, Bellinzona e Locarno, Switzerland
| | - Francesco Mongelli
- Department of Surgery, Ospedale Regionale di Lugano, Lugano, Switzerland
| | - Daniela Demundo
- Istituto di Imaging Della Svizzera Italiana, Ente Ospedaliero Cantonale, Lugano, Switzerland
| | - Jos C van den Berg
- Istituto di Imaging Della Svizzera Italiana, Ente Ospedaliero Cantonale, Lugano, Switzerland
| | - Carola Catanese
- Istituto di Imaging Della Svizzera Italiana, Ente Ospedaliero Cantonale, Lugano, Switzerland
| | - Luca Fumagalli
- Department of Surgery, Ospedale Regionale di Lugano, Lugano, Switzerland
| | - Corrado Usai
- Istituto di Imaging Della Svizzera Italiana, Ente Ospedaliero Cantonale, Lugano, Switzerland
| | - Luca Spinedi
- Service of Angiology, Ospedale Regionale di Locarno, Locarno, Switzerland
| | - Francesca Riva
- Service of Vascular Surgery, Centro Vascolare Ticino, Ospedali Regionali di Lugano, Bellinzona e Locarno, Switzerland
| | | | - Luca Giovannacci
- Service of Vascular Surgery, Centro Vascolare Ticino, Ospedali Regionali di Lugano, Bellinzona e Locarno, Switzerland
| |
Collapse
|
97
|
Prediction of 90-Day Mortality among Sepsis Patients Based on a Nomogram Integrating Diverse Clinical Indices. BIOMED RESEARCH INTERNATIONAL 2021; 2021:1023513. [PMID: 34722755 PMCID: PMC8550845 DOI: 10.1155/2021/1023513] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/04/2021] [Accepted: 10/08/2021] [Indexed: 12/29/2022]
Abstract
Background Sepsis is prevalent among intensive care units and is a frequent cause of death. Several studies have identified individual risk factors or potential predictors of sepsis-associated mortality, without defining an integrated predictive model. The present work was aimed at defining a nomogram for reliably predicting mortality. Methods We carried out a retrospective, single-center study based on 231 patients with sepsis who were admitted to our intensive care unit between May 2018 and October 2020. Patients were randomly split into training and validation cohorts. In the training cohort, multivariate logistic regression and a stepwise algorithm were performed to identify risk factors, which were then integrated into a predictive nomogram. Nomogram performance was assessed against the training and validation cohorts based on the area under receiver operating characteristic curves (AUC), calibration plots, and decision curve analysis. Results Among the 161 patients in the training cohort and 70 patients in the validation cohort, 90-day mortality was 31.6%. Older age and higher values for the international normalized ratio, lactate level, and thrombomodulin level were associated with greater risk of 90-day mortality. The nomogram showed an AUC of 0.810 (95% CI 0.739 to 0.881) in the training cohort and 0.813 (95% CI 0.708 to 0.917) in the validation cohort. The nomogram also performed well based on the calibration curve and decision curve analysis. Conclusion This nomogram may help identify sepsis patients at elevated risk of 90-day mortality, which may help clinicians allocate resources appropriately to improve patient outcomes.
Collapse
|
98
|
Moore P, Esmail F, Qin S, Nand S, Berg S. Hypercoagulability of COVID-19 and Neurological Complications: A Review. J Stroke Cerebrovasc Dis 2021; 31:106163. [PMID: 34763262 PMCID: PMC8547944 DOI: 10.1016/j.jstrokecerebrovasdis.2021.106163] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2021] [Revised: 10/02/2021] [Accepted: 10/03/2021] [Indexed: 12/13/2022] Open
Abstract
The SARS-CoV-2 virus, which causes Coronavirus disease 2019 (COVID-19), has resulted in millions of worldwide deaths. When the SARS-CoV-2 virus emerged from Wuhan, China in December 2019, reports of patients with COVID-19 revealed that hospitalized patients had acute changes in mental status, cognition, and encephalopathy. Neurologic complications can be a consequence from overall severity of the systemic infection, direct viral invasion of the SARS-CoV-2 virus in the central nervous system, and possible immune mediated mechanisms. We will examine the landscape regarding this topic in this review in addition to current understandings of COVID-19 and hemostasis, treatment, and prevention, as well as vaccination.
Collapse
Affiliation(s)
- Patrick Moore
- Loyola University Medical Center Department of Internal Medicine Division of Hematology and Oncology, United States.
| | - Fatema Esmail
- Loyola University Medical Center Department of Internal Medicine Division of Hematology and Oncology, United States.
| | - Shuai Qin
- Loyola University Medical Center Department of Internal Medicine Division of Hematology and Oncology, United States.
| | - Sucha Nand
- Loyola University Medical Center Department of Internal Medicine Division of Hematology and Oncology, United States; Loyola University Medical Center Department of Internal Medicine Neurology, Division of Hematology and Oncology, Loyola University Chicago Professor of Internal Medicine, United States.
| | - Stephanie Berg
- Loyola University Medical Center Department of Internal Medicine Division of Hematology and Oncology and Department of Cancer Biology, Loyola University Chicago Assistant Professor of Medicine, United States.
| |
Collapse
|
99
|
Berrichi S, Bouayed Z, Benbouchta K, Kossir A, Bkiyar H, Ismaili N, Ouafi NE, Housni B. Incidental diagnosis of a large cardiac thrombus swinging through an interatrial communication in a COVID-19 patient: Case report and literature review. Ann Med Surg (Lond) 2021; 71:102967. [PMID: 34691408 PMCID: PMC8524807 DOI: 10.1016/j.amsu.2021.102967] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2021] [Revised: 10/14/2021] [Accepted: 10/15/2021] [Indexed: 12/13/2022] Open
Abstract
Introduction The hypercoagulability state induced by COVID-19 has been well established and various forms of subsequent thromboembolic events have been reported throughout literature including multiple cases of intracardiac thrombi, four of which in our center alone, this case being the fifth. Case report We report the case of a 38-year-old male with no prior cardiovascular history who -subsequently to a COVID-19 infection-developped a right atrial thrombosis associated to a pulmonary embolism, and in whom cardiography revealed an interatrial communication. Management relied upon curative doses of low molecular weight heparin (LMWH) with favourable outcome. Discussion In our discussion, we lay out the various physiopathological mechanisms incriminated throughout literature in the genesis of a hypercoagulability state distinctive of COVID-19, before highlighting the incidence of an interatrial communication (whether a Potent Foramen Ovale or Atrial Septal Defect) discovered in patients with COVID-19, and the potential paradoxical embolization risks they imply as well as reported cases. A mention of hemostatic parameters monitored was also warranted. Finally we discuss the guidelines in terms of prophylactic and therapeutic anticoagulation in hospitalized patients before discussing cardiac thrombosis's therapeutic options. Conclusion Our case highlights various key points which could change the prognosis of COVID-19 patients, whether related to the underdiagnosis of interatrial abnormalities or with regards to the diagnosis to thromboembolic events, but also the indisputable place of anticoagulation in COVID-19 management. Thromboembolic events complicating COVID-19 have been well described and are attributed to a hypercoagulability state distinctive of COVID-19. A pre-existing Potent Foramen Ovale (PFO) or Atrial septal Defect (ASD) in COVID-19 patients is unknown as only a handful of studies covered the subject. The association of a cardiac thrombosis with a pulmonary embolism and interatrial communication exposes patients to risks of paradoxical embolization and subsequent arterial thrombotic events. Prophylactic and curatrive anticoagulation is unrefutably a key pillar in the management of COVID-19.
Collapse
Affiliation(s)
- Samia Berrichi
- Anesthesia and Resuscitation Department, MOHAMMED VI University Hospital Center, Oujda, Morocco
| | - Zakaria Bouayed
- Anesthesia and Resuscitation Department, MOHAMMED VI University Hospital Center, Oujda, Morocco
| | - Karima Benbouchta
- Cardiology Department, Mohammed VI University Hospital, Oujda, Morocco
| | - Amine Kossir
- Cardiology Department, Mohammed VI University Hospital, Oujda, Morocco
| | - Houssam Bkiyar
- Anesthesia and Resuscitation Department, MOHAMMED VI University Hospital Center, Oujda, Morocco
| | - Nabila Ismaili
- Cardiology Department, Mohammed VI University Hospital, Oujda, Morocco.,Laboratory of Epidemiology, Clinical Research, and Public Health, Faculty of Medicine and Pharmacy, Oujda, Morocco
| | - Noha El Ouafi
- Cardiology Department, Mohammed VI University Hospital, Oujda, Morocco.,Laboratory of Epidemiology, Clinical Research, and Public Health, Faculty of Medicine and Pharmacy, Oujda, Morocco
| | - Brahim Housni
- Anesthesia and Resuscitation Department, MOHAMMED VI University Hospital Center, Oujda, Morocco.,Simulation Center, Faculty of Medicine and Pharmacy, Oujda, Morocco
| |
Collapse
|
100
|
Jacobi J. The pathophysiology of sepsis - 2021 update: Part 2, organ dysfunction and assessment. Am J Health Syst Pharm 2021; 79:424-436. [PMID: 34651652 DOI: 10.1093/ajhp/zxab393] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
DISCLAIMER In an effort to expedite the publication of articles, AJHP is posting manuscripts online as soon as possible after acceptance. Accepted manuscripts have been peer-reviewed and copyedited, but are posted online before technical formatting and author proofing. These manuscripts are not the final version of record and will be replaced with the final article (formatted per AJHP style and proofed by the authors) at a later time. PURPOSE This is the second article in a 2-part series discussing the pathophysiology of sepsis. Part 1 of the series reviewed the immunologic response and overlapping pathways of inflammation and coagulation that contribute to the widespread organ dysfunction. In this article (part 2), major organ systems and their dysfunction in sepsis are reviewed, with discussion of scoring systems used to identify patterns and abnormal vital signs and laboratory values associated with sepsis. SUMMARY Sepsis is a dysregulated host response to infection that produces significant morbidity, and patients with shock due to sepsis have circulatory and cellular and metabolic abnormalities that lead to a higher mortality. Cardiovascular dysfunction produces vasodilation, reduced cardiac output and hypotension/shock requiring fluids, vasopressors, and advanced hemodynamic monitoring. Respiratory dysfunction may require mechanical ventilation and attention to volume status. Renal dysfunction is a frequent manifestation of sepsis. Hematologic dysfunction produces low platelets and either elevation or reduction of leucocytes, so consideration of the neutrophil:lymphocyte ratio may be useful. Procoagulant and antifibrinolytic activity leads to coagulation that is stimulated by inflammation. Hepatic dysfunction manifest as elevated bilirubin is often a late finding in sepsis and may cause reductions in production of essential proteins. Neurologic dysfunction may result from local endothelial injury and systemic inflammation through activity of the vagus nerve. CONCLUSION Timely recognition and team response with efficient use of therapies can improve patient outcome, and pharmacists with a complete understanding of the pathophysiologic mechanisms and treatments are valuable members of that team.
Collapse
|