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Koike M, Doi T, Morishita K, Uruno K, Kawasaki-Nabuchi M, Komuro K, Iwano H, Naraoka S, Nagahara D, Yuda S. Impact of Hemoglobin Level, White Blood Cell Count, Renal Dysfunction, and Staphylococcus as the Causative Organism on Prediction of In-Hospital Mortality from Infective Endocarditis. Int Heart J 2024; 65:199-210. [PMID: 38556331 DOI: 10.1536/ihj.23-360] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/02/2024]
Abstract
Infective endocarditis (IE) is a highly fatal disease in cases of delayed diagnosis and treatment, although its incidence is low. However, there have been few single-center studies in which the risk of in-hospital death from IE was stratified according to laboratory findings on admission and the organism responsible for IE. In this study, a total of 162 patients who were admitted to our hospital during the period from 2009 to 2021, who were suspected of having IE according to the modified Duke classification, and for whom IE was confirmed by transesophageal echocardiography were retrospectively analyzed. Patients were observed for a mean-period of 43.7 days with the primary endpoint being in-hospital death. The in-hospital death group had a lower level of hemoglobin (Hb), higher white blood cell (WBC) count, lower level of estimated glomerular filtration rate (eGFR), and higher frequency of Staphylococcus being the causative agent than those in the non-in-hospital death group. In overall multivariate analysis, Hb, WBC count, eGFR, and Staphylococcus as the causative agent were identified to be significant prognostic determinants. IE patients with Hb < 10.6 g/dL, WBC count > 1.4 × 104/μL, eGFR < 28.1 mL/minute/1.7 m2, and Staphylococcus as the causative agent had significantly and synergistically increased in-hospital death rates compared to those in other IE patients. Low level of Hb, high WBC count, low eGFR, and Staphylococcus as the causative agent of IE were independent predictors of in-hospital mortality, suggesting that these 4 parameters may be combined to additively stratify the risk of in-hospital mortality.
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Affiliation(s)
| | - Takahiro Doi
- Department of Cardiology, Teine Keijinkai Hospital
| | | | - Kosuke Uruno
- Department of Cardiology, Teine Keijinkai Hospital
| | | | - Kaoru Komuro
- Department of Cardiology, Teine Keijinkai Hospital
| | | | - Syuichi Naraoka
- Department of Cardiovascular Surgery, Teine Keijinkai Hospital
| | | | - Satoshi Yuda
- Department of Cardiology, Teine Keijinkai Hospital
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Abstract
INTRODUCTION Autoimmune hemolytic anemia (AIHA) is classified according to the direct antiglobulin test (DAT) and thermal characteristics of the autoantibody into warm and cold forms, and in primary versus secondary depending on the presence of associated conditions. AREAS COVERED AIHA displays a multifactorial pathogenesis, including genetic (association with congenital conditions and certain mutations), environmental (drugs, infections, including SARS-CoV-2, pollution, etc.), and miscellaneous factors (solid/hematologic neoplasms, systemic autoimmune diseases, etc.) contributing to tolerance breakdown. Several mechanisms, such as autoantibody production, complement activation, monocyte/macrophage phagocytosis, and bone marrow compensation are implicated in extra-/intravascular hemolysis. Treatment should be differentiated and sequenced according to AIHA type (i.e. steroids followed by rituximab for warm, rituximab alone or in association with bendamustine or fludarabine for cold forms). Several new drugs targeting B-cells/plasma cells, complement, and phagocytosis are in clinical trials. Finally, thrombosis and infections may complicate disease course burdening quality of life and increasing mortality. EXPERT OPINION Beyond warm and cold AIHA, a gray-zone still exists including mixed and DAT negative forms representing an unmet need. AIHA management is rapidly changing through an increasing knowledge of the pathogenic mechanisms, the refinement of diagnostic tools, and the development of novel targeted and combination therapies.
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Affiliation(s)
- B Fattizzo
- Hematology Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy.,Department of Oncology and Hemato-oncology, University of Milan, Milan, Italy
| | - W Barcellini
- Hematology Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
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Barcellini W, Giannotta J, Fattizzo B. Autoimmune hemolytic anemia in adults: primary risk factors and diagnostic procedures. Expert Rev Hematol 2020; 13:585-597. [PMID: 32274943 DOI: 10.1080/17474086.2020.1754791] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
INTRODUCTION Autoimmune hemolytic anemia (AIHA) is due to autoantibodies against erythrocytes that may arise either because of primary tolerance breakage or along with several associated conditions, including genetic predispositions, congenital syndromes, environmental triggers, autoimmune diseases, immunodeficiencies, and neoplasms. AREAS COVERED This review evaluated the risk of AIHA development in associated conditions and summarized disease-intrinsic risk factors for relapse and outcome. Diagnostic procedures were analyzed to properly identify primary and secondary forms. A Medline including clinical trials, meta-analyses, guidelines, consensus, and case reports, published in the last 30 years were performed. EXPERT OPINION The several associated conditions listed above constitute a risk for AIHA development and should be considered since disease course and therapy may be different. Particularly, AIHA developing after transplant or novel checkpoint inhibitors is an emerging complex entity whose proper therapy is still an unmet need. Concerning intrinsic risk factors, the severity of anemia at onset correlated with the recurrence of relapses, refractoriness, and fatal outcome. This finding reflects the presence of several mechanisms involved in AIHA, i.e. highly pathogenic antibodies, complement activation, and failure of marrow compensation. With the advent of novel target therapies (complement and various tyrosine kinase inhibitors), a risk-adapted therapy for AIHA is becoming fundamental.
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Affiliation(s)
- Wilma Barcellini
- Hematology Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico , Milan, Italy
| | - Juri Giannotta
- Hematology Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico , Milan, Italy.,Università degli Studi di Milano , Milan, Italy
| | - Bruno Fattizzo
- Hematology Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico , Milan, Italy.,Università degli Studi di Milano , Milan, Italy
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Kumanomido J, Ohe M, Nakao E, Kurokawa Y, Ito S, Hori K, Honda A, Obuchi A, Haraguchi G, Nishihara M, Fukami K, Fukumoto Y. Cryoballoon Ablation Induced Hyperkalemia due to Possible Cold Agglutinin Disease. Intern Med 2019; 58:3421-3425. [PMID: 31391395 PMCID: PMC6928517 DOI: 10.2169/internalmedicine.2888-19] [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] [Indexed: 11/06/2022] Open
Abstract
Cryoballoon ablation is a well-established therapeutic tool for paroxysmal atrial fibrillation (PAF). We herein report a rare case of a 69-year-old man with PAF undergoing hemodialysis due to chronic kidney disease who developed hyperkalemia caused by possible cold agglutinin disease during cryoballoon ablation therapy. During the procedure, his electrocardiogram showed wide QRS when we finished cryoablation therapy. We detected hyperkalemia and performed urgent hemodialysis. We should bear in mind that cold agglutinin disease can occur during cryoballoon ablation.
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Affiliation(s)
- Jun Kumanomido
- Division of Cardiovascular Medicine, Department of Internal Medicine, Kurume University School of Medicine, Japan
| | - Masatsugu Ohe
- Division of Cardiovascular Medicine, Department of Internal Medicine, Kurume University School of Medicine, Japan
| | - Eichi Nakao
- Division of Cardiovascular Medicine, Department of Internal Medicine, Kurume University School of Medicine, Japan
| | - Yuka Kurokawa
- Division of Nephrology, Department of Medicine, Kurume University School of Medicine, Japan
| | - Shogo Ito
- Division of Cardiovascular Medicine, Department of Internal Medicine, Kurume University School of Medicine, Japan
| | - Kensuke Hori
- Division of Cardiovascular Medicine, Department of Internal Medicine, Kurume University School of Medicine, Japan
| | - Akihiro Honda
- Division of Cardiovascular Medicine, Department of Internal Medicine, Kurume University School of Medicine, Japan
| | - Aya Obuchi
- Division of Cardiovascular Medicine, Department of Internal Medicine, Kurume University School of Medicine, Japan
| | - Go Haraguchi
- Division of Cardiovascular Medicine, Department of Internal Medicine, Kurume University School of Medicine, Japan
| | - Michihide Nishihara
- Division of Cardiovascular Medicine, Department of Internal Medicine, Kurume University School of Medicine, Japan
| | - Kei Fukami
- Division of Nephrology, Department of Medicine, Kurume University School of Medicine, Japan
| | - Yoshihiro Fukumoto
- Division of Cardiovascular Medicine, Department of Internal Medicine, Kurume University School of Medicine, Japan
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Zhao S, Zhang Y, Huang G, Luo W, Li Y, Xiao Y, Zhou M, Li Y, Lai J, Li Y, Li B. Increased CD8 +CD27 +perforin + T cells and decreased CD8 +CD70 + T cells may be immune biomarkers for aplastic anemia severity. Blood Cells Mol Dis 2019; 77:34-42. [PMID: 30953940 DOI: 10.1016/j.bcmd.2019.03.009] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2019] [Revised: 03/28/2019] [Accepted: 03/29/2019] [Indexed: 01/17/2023]
Abstract
OBJECTIVES Aplastic anemia (AA) is T cell immune-mediated autoimmune disease. Aberrant T cell activation involves an imbalance in T cell homeostasis in AA. However, whether the T cell activation molecule CD27 and its ligand CD70 participate in the immune pathogenesis of AA remains ill defined. METHODS The frequencies of CD27/CD70 and perforin/granzyme B in different T cell subsets were detected in AA patients and healthy individuals by flow cytometry. RESULTS We first time demonstrate a significantly elevated proportion of CD27+ and significantly decreased CD70+ T cells from AA. Changed frequency of CD27+ and CD70+ in different T cell subsets appeared to be associated with AA severity. In very severe aplastic anemia (VSAA) and severe aplastic anemia (SAA), increased CD8+CD27+ T cells present with a cytotoxic effector phenotype by elevating perforin proportion. CONCLUSIONS Elevated proportion of CD27 in T cells may contribute to distinct immune pathogenesis for different severities of AA. The CD8+CD27+perforin+ T cells combined with CD8+CD70+ T cells may serve as an immune biomarker for AA severity estimation.
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Affiliation(s)
- Suwen Zhao
- Key Laboratory for Regenerative Medicine of Ministry of Education, Institute of Hematology, School of Medicine, Jinan University, Guangzhou, China
| | - Yuping Zhang
- Department of Hematology, Guangzhou First Municipal People's Hospital, The Second Affiliated Hospital of South China University of Technology, Guangzhou, China
| | - Guixuan Huang
- Institute of Hematology, School of Medicine, Jinan University, Guangzhou, China
| | | | - Yan Li
- Department of Cardiology, First Affiliated Hospital, Jinan University, Guangzhou, China
| | - Yankai Xiao
- Key Laboratory for Regenerative Medicine of Ministry of Education, Institute of Hematology, School of Medicine, Jinan University, Guangzhou, China
| | - Ming Zhou
- Department of Hematology, Guangzhou First Municipal People's Hospital, The Second Affiliated Hospital of South China University of Technology, Guangzhou, China
| | - Yumiao Li
- Department of Hematology, Guangzhou First Municipal People's Hospital, The Second Affiliated Hospital of South China University of Technology, Guangzhou, China
| | - Jing Lai
- Department of Hematology, First Affiliated Hospital, Jinan University, Guangzhou, China
| | - Yangqiu Li
- Key Laboratory for Regenerative Medicine of Ministry of Education, Institute of Hematology, School of Medicine, Jinan University, Guangzhou, China; Institute of Hematology, School of Medicine, Jinan University, Guangzhou, China; Department of Hematology, First Affiliated Hospital, Jinan University, Guangzhou, China.
| | - Bo Li
- Key Laboratory for Regenerative Medicine of Ministry of Education, Institute of Hematology, School of Medicine, Jinan University, Guangzhou, China; Institute of Hematology, School of Medicine, Jinan University, Guangzhou, China.
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