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Ichikawa Y, Kawano K, Mori M, Numazaki A, Aramaki Y, Fukushima K, Isshiki Y, Sawada Y, Nakajima J, Oshima K. Sonoclot’s usefulness in prediction of cardiopulmonary arrest prognosis: A proof of concept study. Open Med (Wars) 2022; 17:414-422. [PMID: 35330808 PMCID: PMC8893265 DOI: 10.1515/med-2022-0447] [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: 12/10/2020] [Revised: 01/27/2022] [Accepted: 01/28/2022] [Indexed: 11/15/2022] Open
Abstract
Abstract
The aim of the present study was to evaluate the usefulness of measuring whole blood coagulation with Sonoclot to predict return of spontaneous circulation (ROSC) in patients with out-of-hospital cardiopulmonary arrest (OHCA). This was a prospective, observational clinical study on patients with OHCA who were transferred to our emergency department between August 2016 and July 2018. Patients were divided into two groups: patients with return of spontaneous circulation (ROSC[+] group) and those without (ROSC[−] group). We compared the activated clotting time (ACT), clot rate (CR), and platelet function (PF) as measured with Sonoclot, and the fibrinogen degradation products (FDP) level and D-dimer level between the two groups. We analyzed 87 patients: 37 in the ROSC(+) and 50 in the ROSC(−) groups. Regarding ACT, CR, PF, FDP, and D-dimer, we used receiver operating characteristic (ROC) curves to examine how well each factor predicts ROSC. The area under the ROC curve (AUC) of CR was higher than that of the FDP and D-dimer levels. Among patients with cardiogenic cardiac arrest, the AUC of CR was higher than the AUCs of other coagulation factors. In conclusion, viscoelastic blood coagulation measurements using Sonoclot may be useful for predicting ROSC in OHCA patients.
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Affiliation(s)
- Yumi Ichikawa
- Department of Emergency Medicine, Gunma University Graduate School of Medicine , 3-19-15 Showa-machi, Maebashi, 371-8511 , Gunma , Japan
- Emergency Medical Center, Gunma University Hospital , 3-19-15 Showa-machi, Maebashi, 371-8511 , Gunma , Japan
| | - Kei Kawano
- Emergency Medical Center, Gunma University Hospital , 3-19-15 Showa-machi, Maebashi, 371-8511 , Gunma , Japan
| | - Mizuki Mori
- Emergency Medical Center, Gunma University Hospital , 3-19-15 Showa-machi, Maebashi, 371-8511 , Gunma , Japan
| | - Ayumi Numazaki
- Emergency Medical Center, Gunma University Hospital , 3-19-15 Showa-machi, Maebashi, 371-8511 , Gunma , Japan
| | - Yuto Aramaki
- Emergency Medical Center, Gunma University Hospital , 3-19-15 Showa-machi, Maebashi, 371-8511 , Gunma , Japan
| | - Kazunori Fukushima
- Department of Emergency Medicine, Gunma University Graduate School of Medicine , 3-19-15 Showa-machi, Maebashi, 371-8511 , Gunma , Japan
- Emergency Medical Center, Gunma University Hospital , 3-19-15 Showa-machi, Maebashi, 371-8511 , Gunma , Japan
| | - Yuta Isshiki
- Department of Emergency Medicine, Gunma University Graduate School of Medicine , 3-19-15 Showa-machi, Maebashi, 371-8511 , Gunma , Japan
- Emergency Medical Center, Gunma University Hospital , 3-19-15 Showa-machi, Maebashi, 371-8511 , Gunma , Japan
| | - Yusuke Sawada
- Department of Emergency Medicine, Gunma University Graduate School of Medicine , 3-19-15 Showa-machi, Maebashi, 371-8511 , Gunma , Japan
- Emergency Medical Center, Gunma University Hospital , 3-19-15 Showa-machi, Maebashi, 371-8511 , Gunma , Japan
| | - Jun Nakajima
- Department of Emergency Medicine, Gunma University Graduate School of Medicine , 3-19-15 Showa-machi, Maebashi, 371-8511 , Gunma , Japan
- Emergency Medical Center, Gunma University Hospital , 3-19-15 Showa-machi, Maebashi, 371-8511 , Gunma , Japan
| | - Kiyohiro Oshima
- Department of Emergency Medicine, Gunma University Graduate School of Medicine , 3-19-15 Showa-machi, Maebashi, 371-8511 , Gunma , Japan
- Emergency Medical Center, Gunma University Hospital , 3-19-15 Showa-machi, Maebashi, 371-8511 , Gunma , Japan
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Notani N, Miyazaki M, Kanezaki S, Ishihara T, Sakamoto T, Abe T, Kataoka M, Tsumura H. The fibrinogen levels on admission is a predictive marker of the contrast extravasation on enhanced computed tomography in sacral fracture. Medicine (Baltimore) 2021; 100:e25056. [PMID: 33725892 PMCID: PMC7969224 DOI: 10.1097/md.0000000000025056] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/01/2020] [Accepted: 02/12/2021] [Indexed: 01/05/2023] Open
Abstract
Sacral fracture is the most frequent posterior injury among unstable pelvic ring fractures and is prone to massive hemorrhage and hemodynamic instability. Contrast extravasation (CE) on computed tomography (CT) is widely used as an indicator of significant arterial bleeding. However, while CE is effective to detect significant arterial bleeding but negative result cannot completely rule out massive bleeding. Therefore, additional factors help to compensate CE for the prediction of early hemodynamically unstable condition.We evaluated the risk factors that predict CE on enhanced computed CT in patients with sacral fractures. Patients were classified into 2 groups: CE positive on enhanced CT of the pelvis [CE(+)] and CE negative [CE(-)]. We compared age, sex, injury severity score (ISS), systolic blood pressure (sBP), type of sacral fracture based on Denis classification, platelet (PLT), base excess, lactate, prothrombin time-international normalized ratio, hemoglobin (Hb), activated partial thromboplastin time, D-dimer, and fibrinogen between the 2 groups.A total of 82 patients were treated for sacral fracture, of whom 69 patients were enrolled. There were 17 patients (10 men and 7 women) in CE(+) and 52 patients (28 men and 24 women) in CE(-). Age, ISS, and blood transfusion within 24 hours were significantly higher in the CE(+) group than in the CE(-) group (P = .023, P < .001, P < .001). sBP, Hb, PLT, fibrinogen were significantly lower in the CE(+) group than in the CE(-) group (P < .001, P < .001, P < .001, P < .001). D-dimer and lactate were higher in the CE(+) group than in the CE(-) group (P = .036, P < .001) with significant differences. On multivariate analysis, the level of fibrinogen was an independent predictor of CE(+). The area under the curve value for fibrinogen was 0.88, and the optimal cut-off value for prediction was 199 mg/dL.The fibrinogen levels on admission can predict contrast extravasation on enhanced CT in patients with sacral fractures. The optimal cut-off value of fibrinogen for CE(+) prediction in sacral fracture was 199 mg/dL. The use of fibrinogen to predict CE(+) could lead to prompt and effective treatment of active arterial hemorrhage in sacral fracture.
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Affiliation(s)
- Naoki Notani
- Department of Orthopaedic Surgery, Faculty of Medicine
| | | | | | | | | | - Tetsutaro Abe
- Department of Orthopaedic Surgery, Faculty of Medicine
| | - Masashi Kataoka
- Physical Therapy Course of Study, Faculty of Welfare and Health Sciences, Oita University, Oita, Japan
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Zhang X, Zhang X, Xu J, Huang T, Wu Y, Yang Y, Zhou H, Wu Y. Identification of and solution for false D-dimer results. J Clin Lab Anal 2020; 34:e23216. [PMID: 31967356 PMCID: PMC7307351 DOI: 10.1002/jcla.23216] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2019] [Revised: 12/20/2019] [Accepted: 12/24/2019] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Clinically, D-dimer (DD) levels are mainly used to exclude diseases such as deep venous thrombosis (DVT). In clinical testing, DD assays can be subjected to interference that may cause false results, which directly affect the clinical diagnosis. Our hypothesis was that the 95% confidence intervals (CIs) of the fibrin degradation product (FDP)/DD and fibrinogen (Fib)/DD ratios were used to identify these false results and corrected via multiple dilutions. METHODS In total, 16 776 samples were divided into three groups according to the DD levels detected by Sysmex CS5100 and CA7000: Group A, DD ≥ 2.0 μg/mL fibrinogen equivalent unit (FEU); group B, 0.5 < DD < 2.0 μg/mL FEU; and group C, DD ≤ 0.5 μg/mL FEU. The 95% CIs of the FDP/DD and Fib/DD ratios were calculated. Six abnormal DD results were found according to the 95% CIs. For verification, we performed multiple dilutions, compared the results with those of other instruments, and tested the addition of heterophilic blocking reagent (HBR). RESULTS The median and 95% CI of the FDP/DD ratio were 3.76 and 2.25-8.15 in group A, 5.63 and 2.86-10.58 in group B, 10.23 and 0.91-47.71 in groups C, respectively. For the Fib/DD ratio, the 95% CIs was 0.02-2.21 in group A, 0.68-8.15 in group B, and 3.82-55.27 in groups C. Six abnormal results were identified after multiple dilutions, by comparison with other detection systems, and after HBR addition. CONCLUSIONS The FDP/DD ratio is more reliable for identifying false results. If the FDP/DD ratio falls outside the 95% CI, it should be verified by different methods.
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Affiliation(s)
- Xian‐Yan Zhang
- Department of Laboratory MedicineThe First Affiliated Hospital of Shantou University Medical CollegeShantouChina
- Laboratory of Molecular CardiologyThe First Affiliated Hospital of Shantou University Medical CollegeShantouChina
- Laboratory of Molecular Imagingthe First Affiliated Hospital of Shantou University Medical CollegeShantouChina
| | - Xue‐Xuan Zhang
- Department of Laboratory MedicineThe First Affiliated Hospital of Shantou University Medical CollegeShantouChina
| | - Jia‐Long Xu
- Department of Laboratory MedicineThe First Affiliated Hospital of Shantou University Medical CollegeShantouChina
| | - Teng‐Yi Huang
- Department of Laboratory MedicineThe Second Affiliated Hospital of Shantou University Medical CollegeShantouChina
| | - Ying Wu
- Department of Laboratory MedicineThe First Affiliated Hospital of Shantou University Medical CollegeShantouChina
| | - Ye‐Ru Yang
- Department of Laboratory MedicineThe First Affiliated Hospital of Shantou University Medical CollegeShantouChina
| | - Huan‐Bin Zhou
- Department of Laboratory MedicineThe First Affiliated Hospital of Shantou University Medical CollegeShantouChina
| | - Ying‐E Wu
- Department of Laboratory MedicineThe First Affiliated Hospital of Shantou University Medical CollegeShantouChina
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Aoki M, Ogura T, Hagiwara S, Nakamura M, Oshima K. Prediction of arterial extravasation in pelvic fracture patients with stable hemodynamics using coagulation biomarkers. World J Emerg Surg 2019; 14:14. [PMID: 30930958 PMCID: PMC6425576 DOI: 10.1186/s13017-019-0234-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2018] [Accepted: 03/08/2019] [Indexed: 11/28/2022] Open
Abstract
Background Determining the presence of an active arterial hemorrhage in the acute phase is important as a treatment strategy in patients with pelvic fracture. The purpose of this study was to evaluate whether coagulation biomarkers could predict arterial extravasation, especially in pelvic fracture patients with stable hemodynamics. Methods We studied patients with a pelvic fracture who had a systolic blood pressure above 90 mmHg and lactate level less than 5.0 mmol/L on hospital arrival. Patients were divided into two groups: those with arterial extravasation on enhanced computed tomography (CT) or angiography (extravasation [+] group) and those without arterial extravasation (extravasation [−] group). Coagulation biomarkers measured on arrival were statistically compared between the two groups. Predictive ability of arterial extravasation using coagulation biomarkers was evaluated by receiver-operating characteristic analyses provided area under the receiver-operating characteristic curves (AUROC) and diagnostic indicators with optimal cutoff point including sensitivity, specificity, positive and negative predictive values, and diagnostic odds ratio (DOR). Results Sixty patients were analyzed. Fibrin degradation products (FDP), D-dimer, prothrombin time–international normalized ratio (PT–INR), and the ratio of FDP to fibrinogen were significantly higher in the extravasation (+) group than in the extravasation (−) group (FDP, 242 μg/mL [145–355] vs. 96 μg/mL [58–153]; D-dimer, 81 μg/mL [41–140] vs. 39 μg/mL [21–75]; PT–INR, 1.09 [1.05–1.24] vs. 1.02 [0.98–1.08]; and ratio of FDP to fibrinogen, 1.06 [0.85–2.01] vs. 0.46 [0.25–0.74]). The highest AUROC was with a ratio of FDP to fibrinogen of 0.777 (95% confidence interval, 0.656–0.898), and the highest predictive ability in terms of DOR was with a ratio of FDP to fibrinogen (sensitivity, 0.76; specificity, 0.76; DOR 9.90). Conclusion Coagulation biomarker could predict of arterial extravasation in pelvic fracture patients with stable hemodynamics. Electronic supplementary material The online version of this article (10.1186/s13017-019-0234-5) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Makoto Aoki
- 1Department of Emergency Medicine, Gunma University Graduate School of Medicine, Gunma, Japan
| | - Takayuki Ogura
- Advanced Medical Emergency Department and Critical Care Center, Japan Red Cross Maebashi Hospital, Gunma, Japan
| | - Shuichi Hagiwara
- 1Department of Emergency Medicine, Gunma University Graduate School of Medicine, Gunma, Japan
| | - Mitsunobu Nakamura
- Advanced Medical Emergency Department and Critical Care Center, Japan Red Cross Maebashi Hospital, Gunma, Japan
| | - Kiyohiro Oshima
- 1Department of Emergency Medicine, Gunma University Graduate School of Medicine, Gunma, Japan
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High fibrin/fibrinogen degradation product to fibrinogen ratio is associated with 28-day mortality and massive transfusion in severe trauma. Eur J Trauma Emerg Surg 2017; 44:291-298. [DOI: 10.1007/s00068-017-0844-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2017] [Accepted: 09/14/2017] [Indexed: 10/18/2022]
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Hagiwara S, Aoki M, Murata M, Kaneko M, Ichikawa Y, Nakajima J, Isshiki Y, Sawada Y, Tamura J, Oshima K. FDP/fibrinogen ratio reflects the requirement of packed red blood cell transfusion in patients with blunt trauma. Am J Emerg Med 2017; 35:1106-1110. [PMID: 28291703 DOI: 10.1016/j.ajem.2017.03.009] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2016] [Revised: 02/01/2017] [Accepted: 03/07/2017] [Indexed: 11/27/2022] Open
Abstract
PURPOSE To find factors that predict the requirement of packed red blood cells (pRBC) transfusion in patients with blunt trauma on arrival at the hospital. METHODS We conducted blood tests in trauma patients whose trauma severity was suspected as being 3 and over in the Abbreviated Injury Scale. Patients were divided into the blood transfusion (BT) and control groups according to the requirement of pRBC transfusion within 24h after arrival. RESULTS We analyzed 347 patients (BT group, n=14; control group, n=333). On univariate analysis, there were significant differences in Glasgow Coma Scale (GCS), rate of positive FAST (focused assessment with sonography for trauma) finding, hematocrit, international normalized ratio of prothrombin time, activated partial thromboplastin time, fibrinogen (Fib), and level of fibrin degradation products (FDP). On multivariable analysis, positive FAST finding, GCS, Fib, and FDP influenced the requirement of pRBC transfusion. In the area under the receiver operating characteristic curve analysis, Fib and FDP were markers that predicted the requirement of pRBC transfusion. The FDP/Fib ratio had a better correlation with the requirement of pRBC transfusion than FDP or Fib. CONCLUSIONS The FDP/Fib ratio can be easily measured and may be a predictor of the need for pRBC transfusion.
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Affiliation(s)
- Shuichi Hagiwara
- Department of Emergency Medicine, Gunma University Graduate School of Medicine, Japan; Emergency Medical Care Center, Gunma University Hospital, Japan.
| | - Makoto Aoki
- Department of Emergency Medicine, Gunma University Graduate School of Medicine, Japan; Emergency Medical Care Center, Gunma University Hospital, Japan
| | - Masato Murata
- Department of Emergency Medicine, Gunma University Graduate School of Medicine, Japan; Emergency Medical Care Center, Gunma University Hospital, Japan
| | - Minoru Kaneko
- Department of Emergency Medicine, Gunma University Graduate School of Medicine, Japan; Emergency Medical Care Center, Gunma University Hospital, Japan
| | - Yumi Ichikawa
- Department of Emergency Medicine, Gunma University Graduate School of Medicine, Japan; Emergency Medical Care Center, Gunma University Hospital, Japan
| | - Jun Nakajima
- Department of Emergency Medicine, Gunma University Graduate School of Medicine, Japan; Emergency Medical Care Center, Gunma University Hospital, Japan
| | - Yuta Isshiki
- Department of Emergency Medicine, Gunma University Graduate School of Medicine, Japan; Emergency Medical Care Center, Gunma University Hospital, Japan
| | - Yusuke Sawada
- Department of Emergency Medicine, Gunma University Graduate School of Medicine, Japan; Emergency Medical Care Center, Gunma University Hospital, Japan
| | - Jun'ichi Tamura
- Department of General Medicine, Gunma University Graduate School of Medicine, Japan; Emergency Medical Care Center, Gunma University Hospital, Japan
| | - Kiyohiro Oshima
- Department of Emergency Medicine, Gunma University Graduate School of Medicine, Japan; Emergency Medical Care Center, Gunma University Hospital, Japan
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