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Miao G, Cai Z, He X, Yang J, Zhang Y, Ma A, Zhao X, Tan M. Development of a predictive nomogram for 28-day mortality risk in non-traumatic or post-traumatic subarachnoid hemorrhage patients. Neurol Sci 2024; 45:2149-2163. [PMID: 37994964 DOI: 10.1007/s10072-023-07199-5] [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: 06/07/2023] [Accepted: 11/08/2023] [Indexed: 11/24/2023]
Abstract
OBJECTIVE Subarachnoid hemorrhage (SAH) is associated with high rates of mortality and permanent disability. At present, there are few definite clinical tools to predict prognosis in SAH patients. The current study aims to develop and assess a predictive nomogram model for estimating the 28-day mortality risk in both non-traumatic or post-traumatic SAH patients. METHODS The MIMIC-III database was searched to select patients with SAH based on ICD-9 codes. Patients were separated into non-traumatic and post-traumatic SAH groups. Using LASSO regression analysis, we identified independent risk factors associated with 28-day mortality and incorporated them into nomogram models. The performance of each nomogram was assessed by calculating various metrics, including the area under the curve (AUC), net reclassification improvement (NRI), integrated discrimination improvement (IDI), and decision curve analysis (DCA). RESULTS The study included 999 patients with SAH, with 631 in the non-traumatic group and 368 in the post-traumatic group. Logistic regression analysis revealed critical independent risk factors for 28-day mortality in non-traumatic SAH patients, including gender, age, glucose, platelet, sodium, BUN, WBC, PTT, urine output, SpO2, and heart rate and age, glucose, PTT, urine output, and body temperature for post-traumatic SAH patients. The prognostic nomograms outperformed the commonly used SAPSII and APSIII systems, as evidenced by superior AUC, NRI, IDI, and DCA results. CONCLUSION The study identified independent risk factors associated with the 28-day mortality risk and developed predictive nomogram models for both non-traumatic and post-traumatic SAH patients. The nomogram holds promise in guiding prognosis improvement strategies for patients with SAH.
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Affiliation(s)
- Guiqiang Miao
- Department of Orthopedics, Foshan Fosun Chancheng Hospital, Foshan, 528010, China
| | - Zhenbin Cai
- Department of Orthopedics, The First Affiliated Hospital of Jinan University, Guangzhou, 510630, China
| | - Xin He
- Clinical Laboratory Center, The First Affiliated Hospital of Jinan University, Guangzhou, 510630, China
| | - Jie Yang
- Department of Orthopedics, The First Affiliated Hospital of Jinan University, Guangzhou, 510630, China
| | - Yunlong Zhang
- Department of Orthopedics, The First Affiliated Hospital of Jinan University, Guangzhou, 510630, China
| | - Ao Ma
- Department of Orthopedics, The First Affiliated Hospital of Jinan University, Guangzhou, 510630, China
| | - Xiaodong Zhao
- Department of Orthopedics, Foshan Fosun Chancheng Hospital, Foshan, 528010, China.
| | - Minghui Tan
- Department of Orthopedics, The First Affiliated Hospital of Jinan University, Guangzhou, 510630, China.
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2
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Carpenter SL, Abshire TC, Killough E, Anderst JD. Evaluating for Suspected Child Abuse: Conditions That Predispose to Bleeding. Pediatrics 2022; 150:189508. [PMID: 36120799 DOI: 10.1542/peds.2022-059277] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Child abuse might be suspected when children present with cutaneous bruising, intracranial hemorrhage, or other manifestations of bleeding. In these cases, it is necessary to consider medical conditions that predispose to easy bleeding or bruising. When evaluating for the possibility of bleeding disorders and other conditions that predispose to hemorrhage, it is important for pediatricians to consider the child's presenting history, medical history, and physical examination findings before initiating a laboratory investigation. Many medical conditions can predispose to easy bleeding. Before ordering laboratory tests for a disease, it is useful to understand the biochemical basis and clinical presentation of the disorder, condition prevalence, and test characteristics. This technical report reviews the major medical conditions that predispose to bruising or bleeding and should be considered when evaluating for abusive injury.
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Affiliation(s)
- Shannon L Carpenter
- Division of Hematology/Oncology/BMT, Children's Mercy Hospital, Department of Pediatrics, University of Missouri Kansas City School of Medicine, Kansas City, Missouri
| | - Thomas C Abshire
- Senior Investigator Emeritus, Versiti Blood Research Institute, Department of Pediatrics, Medicine, and the CTSI of Southeast Wisconsin, Emeritus, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Emily Killough
- Division of Child Adversity and Resilience, Children's Mercy Hospital, Department of Pediatrics, University of Missouri Kansas City School of Medicine, Kansas City, Missouri
| | - James D Anderst
- Division of Child Adversity and Resilience, Children's Mercy Hospital, Department of Pediatrics, University of Missouri Kansas City School of Medicine, Kansas City, Missouri
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3
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Barg AA, Levy-Mendelovich S, Budnik I, Mandel-Shorer N, Dardik R, Avishai E, Brutman-Barazani T, Ifrah AD, Oren-Malek L, Yacobovich J, Gilad O, Nakav S, Fruchtman Y, Revel-Vilk S, Miskin H, Kenet G. Pediatric severe factor XI deficiency: A multicenter study. Pediatr Blood Cancer 2022; 69:e29545. [PMID: 34957695 DOI: 10.1002/pbc.29545] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2021] [Revised: 11/21/2021] [Accepted: 12/02/2021] [Indexed: 12/19/2022]
Abstract
BACKGROUND Factor XI (FXI) deficiency is a rare autosomal recessive bleeding disorder. Only scarce publications address its clinical features in children. The increased prevalence of FXI deficiency in Israel enabled data collection for this large multicenter cohort study. OBJECTIVE Some hemostatic challenges may be unique or more common in children, such as bleeding in the neonatal period or trauma-related injury. The current study was designed to explore the potential impact of these differences in children with severe FXI deficiency. METHODS Medical files of all children with FXI level under 15% followed at five tertiary centers were evaluated. The retrieved data comprised demographic and clinical characteristics, including bleeding episodes, surgical interventions, treatment strategies, as well as laboratory features. RESULTS Sixty children, whose median age at diagnosis was 4.2 years and their median FXI level was 4%, were included. Three children experienced triggered intracranial hemorrhage (ICH) and two children had major bleeds. No bleeding complications occurred in surgeries in which hemostatic treatment consisting mostly of tranexamic acid or fresh frozen plasma was applied (n = 45). In contrast, excessive bleeding was noted in 25% of surgical procedures performed without hemostatic preparation (p = .002). CONCLUSION This study's findings confirm the generally favorable outcome of this rare bleeding disorder, with no spontaneous bleeds or cases of perinatal ICH. Nonetheless, proper diagnosis and adequate hemostasis in the surgical setting are imperative. Unlike previous studies in adults, our pediatric study suggests an association between the severity of FXI deficiency and bleeding tendency.
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Affiliation(s)
- Assaf Arie Barg
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.,The Israeli National Hemophilia Center, Thrombosis Unit and Amalia Biron Research Institute of Thrombosis and Hemostasis, Sheba Medical Center, Tel Hashomer, Israel
| | - Sarina Levy-Mendelovich
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.,The Israeli National Hemophilia Center, Thrombosis Unit and Amalia Biron Research Institute of Thrombosis and Hemostasis, Sheba Medical Center, Tel Hashomer, Israel
| | - Ivan Budnik
- Department of Pathophysiology, Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russia
| | - Noa Mandel-Shorer
- Department of Paediatric Haematology-Oncology, Ruth Rappaport Children's Hospital, Rambam Health Care Campus, Technion-Israel Institute of Technology, Haifa, Israel
| | - Rima Dardik
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.,The Israeli National Hemophilia Center, Thrombosis Unit and Amalia Biron Research Institute of Thrombosis and Hemostasis, Sheba Medical Center, Tel Hashomer, Israel
| | - Einat Avishai
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.,The Israeli National Hemophilia Center, Thrombosis Unit and Amalia Biron Research Institute of Thrombosis and Hemostasis, Sheba Medical Center, Tel Hashomer, Israel
| | - Tami Brutman-Barazani
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.,The Israeli National Hemophilia Center, Thrombosis Unit and Amalia Biron Research Institute of Thrombosis and Hemostasis, Sheba Medical Center, Tel Hashomer, Israel
| | - Aviya Dvir Ifrah
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.,The Israeli National Hemophilia Center, Thrombosis Unit and Amalia Biron Research Institute of Thrombosis and Hemostasis, Sheba Medical Center, Tel Hashomer, Israel
| | - Liat Oren-Malek
- Department of Paediatric Haematology-Oncology, Ruth Rappaport Children's Hospital, Rambam Health Care Campus, Technion-Israel Institute of Technology, Haifa, Israel
| | - Joanne Yacobovich
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.,Department of Paediatric Haematology Oncology, Schneider Children's Medical Center of Israel, Petah Tikva, Israel
| | - Oded Gilad
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.,Department of Paediatric Haematology Oncology, Schneider Children's Medical Center of Israel, Petah Tikva, Israel
| | - Sigal Nakav
- The Coagulation Laboratory, Rabin Medical Center, Beilinson Hospital, Petah Tikva, Israel
| | - Yariv Fruchtman
- Paediatric Haemato-Oncology Department, Saban Paediatric Medical Center, Soroka University Medical Center, Beer-Sheva, Israel
| | - Shoshana Revel-Vilk
- Paediatric Haematology Oncology Unit, Shaare Zedek Medical Center, Jerusalem, Israel.,Faculty of Medicine, Hebrew University, Jerusalem, Israel
| | - Hagit Miskin
- Paediatric Haematology Oncology Unit, Shaare Zedek Medical Center, Jerusalem, Israel.,Faculty of Medicine, Hebrew University, Jerusalem, Israel
| | - Gili Kenet
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.,The Israeli National Hemophilia Center, Thrombosis Unit and Amalia Biron Research Institute of Thrombosis and Hemostasis, Sheba Medical Center, Tel Hashomer, Israel
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Mancarella C, Marini A, Severino R, Missori P, Santoro C, Paolini S. Factor XI deficiency and delayed hemorrhages after resection of choroid plexus papilloma: illustrative case. JOURNAL OF NEUROSURGERY: CASE LESSONS 2021; 2:CASE21333. [PMID: 35855483 PMCID: PMC9281435 DOI: 10.3171/case21333] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/31/2021] [Accepted: 09/09/2021] [Indexed: 11/06/2022]
Abstract
BACKGROUND Factor XI deficiency, also known as hemophilia C, is a rare inherited bleeding disorder that may leave routine coagulation parameters within normal range. Depending on the mutation subtype, prolonged activated partial thromboplastin time may occasionally be found. The disease has an autosomal transmission, with an estimated prevalence in the general population of approximately 1 in 1 million. Heterozygosis accounts for partial deficits, but the tendency to bleed is unrelated to the measured activity of factor XI. Diagnosis usually follows unexpected hemorrhages occurring spontaneously or after trauma or surgical procedures. OBSERVATIONS Few cases have been reported in the neurosurgical literature, all occurring spontaneously or after head trauma. Owing to its subtle features, the true incidence of the disease is probably underestimated. The authors report a case of a patient with previously undiagnosed factor XI deficiency who underwent uncomplicated resection of a fourth-ventricle papilloma and experienced delayed, severe hemorrhagic complications. LESSONS The known association between choroid plexus tumors and intracranial bleeding raised differential diagnosis issues. This report may serve to help to investigate delayed hemorrhages after cranial surgery.
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Affiliation(s)
| | | | - Rocco Severino
- Department of Neurosurgery, IRCCS Neuromed, Pozzilli (IS), Italy
| | - Paolo Missori
- Department of Human Neurosciences, Sapienza University of Rome, Rome, Italy; and
| | - Cristina Santoro
- Hematology, Hemophilia and Thrombosis Center, University Hospital Policlinico Umberto I, Rome, Italy
| | - Sergio Paolini
- Department of Neurosurgery, IRCCS Neuromed, Pozzilli (IS), Italy
- Department of Human Neurosciences, Sapienza University of Rome, Rome, Italy; and
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Espinosa-Rodríguez EE, López-Gutiérrez M, Tresserras-Giné G, Pesa-Vendrell N, Martínez-Pérez M. First case of delayed traumatic intracerebral hemorrhage in a patient with undiagnosed factor XI deficiency: diagnosis and management review. Brain Inj 2020; 34:1541-1547. [PMID: 32816559 DOI: 10.1080/02699052.2020.1807057] [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: 10/23/2022]
Abstract
Factor XI (FXI) deficiency, also known as hemophilia C, is included in the rare bleeding disorders (RBDs). It is distinct from other coagulation factor deficiencies because it rarely presents as spontaneous hemorrhage, but rather as bleeding after trauma or surgery; in addition, the severity of bleeding does not correlate with FXI levels. Most delayed traumatic intracerebral hemorrhage (DTICH) occurs during the first 72 hours of the trauma. Factors that contribute to its formation include local or systemic coagulopathy, among others. Hemorrhagic cases of FXI deficiency related to the central nervous system (CNS) are very rare, with only 13 reported cases. To the best of our knowledge, this is the first reported case of a DTICH in a patient with undiagnosed FXI deficiency.
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Affiliation(s)
| | | | - Gloria Tresserras-Giné
- Department of Neurosurgery, Institute of Medicine and Surgery Barcelona (IMECBA) , Barcelona, Spain
| | - Nuria Pesa-Vendrell
- Department of Anesthesia, Hospital Universitari General de Catalunya , Barcelona, Spain
| | - Melcior Martínez-Pérez
- Department of Intensive Care, Hospital Universitari General de Catalunya , Barcelona, Spain
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Lazzerini PE, Capecchi PL, Nizzi C, Finizola F, Morgioni E, Bracco S, Laghi-Pasini F. Cerebellar haemorrhage, factor XI deficiency and concomitant risk factors. QJM 2015; 108:829-31. [PMID: 25638785 DOI: 10.1093/qjmed/hcv025] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- P E Lazzerini
- From the Department of Medical Sciences, Surgery and Neurosciences, University of Siena, Italy and
| | - P L Capecchi
- From the Department of Medical Sciences, Surgery and Neurosciences, University of Siena, Italy and
| | - C Nizzi
- From the Department of Medical Sciences, Surgery and Neurosciences, University of Siena, Italy and
| | - F Finizola
- From the Department of Medical Sciences, Surgery and Neurosciences, University of Siena, Italy and
| | - E Morgioni
- From the Department of Medical Sciences, Surgery and Neurosciences, University of Siena, Italy and
| | - S Bracco
- Neuroimaging and Neurointervention Unit, University Hospital of Siena, Siena, Italy
| | - F Laghi-Pasini
- From the Department of Medical Sciences, Surgery and Neurosciences, University of Siena, Italy and
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7
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Carpenter SL, Abshire TC, Anderst JD. Evaluating for suspected child abuse: conditions that predispose to bleeding. Pediatrics 2013; 131:e1357-73. [PMID: 23530171 DOI: 10.1542/peds.2013-0196] [Citation(s) in RCA: 47] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Child abuse might be suspected when children present with cutaneous bruising, intracranial hemorrhage, or other manifestations of bleeding. In these cases, it is necessary to consider medical conditions that predispose to easy bleeding/bruising. When evaluating for the possibility of bleeding disorders and other conditions that predispose to hemorrhage, the pediatrician must consider the child's presenting history, medical history, and physical examination findings before initiating a laboratory investigation. Many medical conditions can predispose to easy bleeding. Before ordering laboratory tests for a disease, it is useful to understand the biochemical basis and clinical presentation of the disorder, condition prevalence, and test characteristics. This technical report reviews the major medical conditions that predispose to bruising/bleeding and should be considered when evaluating for abusive injury.
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8
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A surgical case of cerebral hemorrhage in a patient with factor XI deficiency. Blood Coagul Fibrinolysis 2012; 23:456-8. [PMID: 22527292 DOI: 10.1097/mbc.0b013e328353a5e3] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
A 63-year-old man suddenly presented with right hemiplegia and was taken to our hospital. Computed tomography (CT) scan revealed subcortical hemorrhage of the left parietal lobe. He had no medical history except hypertension; thus, it initially appeared to be a typical hypertensive hemorrhage. However, blood analysis showed an abnormally elevated activated partial thromboplastin time. One hour after admission, his Glasgow Coma Scale fell from 14 to 11. We performed an echo-guided stereotaxic removal of the hematoma. He improved immediately and was diagnosed with congenital factor XI (FXI) deficiency a few days after surgery. FXI deficiency, described as hemophilic syndrome C, rarely manifests as spontaneous bleeding, but surgical intervention has been known to manifest as bleeding. This case highlights the importance of evaluation of coagulopathies in patients with intracerebral hemorrhage before surgery, and, in cases wherein blood analysis results suggest coexisting coagulation disorders, less invasive surgical methods would likely lead to good outcomes.
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