Activated Clotting Time as a Marker of Inflammation in Hospitalized Patients

Fatty Liver Index Independently Predicts All-Cause Mortality in Patients With Antineutrophil Cytoplasmic Antibody-Associated Vasculitis but No Substantial Liver Disease

Background

This study investigated whether the fatty liver index (FLI) could predict all-cause mortality and cerebrovascular accident (CVA) during follow-up in patients with antineutrophil cytoplasmic antibody (ANCA)-associated vasculitis (AAV) without substantial liver disease.

Methods

The medical records of 75 AAV patients with AAV were retrospectively reviewed. An equation for the FLI is as follows: FLI = (e0.953×loge(triglycerides)+0.139×BMI+0.718×loge(GGT)+0.053×waistcircumference–15.745)/(1 + e0.953×loge(triglycerides)+0.139×BMI+0.718×loge(GGT)+0.053×waistcircumference–15.745) × 100. The cut-offs of the FLI were obtained using the receiver operator characteristic (ROC) curve analysis.

Results

The mean age at AAV diagnosis was 59.1 years and 42.7% were male. Eight patients (10.7%) died and 8 patients had CVA during follow-up. When the cut-offs of the FLI for all-cause mortality and CVA were set as the FLI ≥ 33.59 and the FLI ≥ 32.31, AAV patients with the FLI over each cut-off exhibited a higher risk for all-cause mortality or CVA than those without (RR 8.633 and 8.129), respectively. In addition, AAV patients with the FLI over each cut-off exhibited a significantly lower cumulative patients’ survival rate or CVA-free survival rate than those without, respectively. In the multivariable Cox analysis, only the FLI ≥ 33.59 at AAV diagnosis was an independent predictor of all-cause mortality during follow-up in AAV patients (HR 10.448).

Conclusion

The FLI at AAV diagnosis can be a potential independent predictor of all-cause mortality and CVA during follow-up in AAV patients. We suggest that physicians measure the FLI at AAV diagnosis and pay more attention to those with a high FLI value for prevention of future mortality and CVA.

Comparison of anticoagulation strategies for veno-venous ECMO support in acute respiratory failure

BACKGROUND

Extracorporeal membrane oxygenation (ECMO) support in acute respiratory failure may be lifesaving, but bleeding and thromboembolic complications are common. The optimal anticoagulation strategy balancing these factors remains to be determined. This retrospective study compared two institutional anticoagulation management strategies focussing on oxygenator changes and both bleeding and thromboembolic events.

METHODS

We conducted a retrospective observational cohort study between 04/2015 and 02/2020 in two ECMO referral centres in Germany in patients receiving veno-venous (VV)-ECMO support for acute respiratory failure for > 24 h. One centre routinely applied low-dose heparinization aiming for a partial thromboplastin time (PTT) of 35-40 s and the other routinely used a high-dose therapeutic heparinization strategy aiming for an activated clotting time (ACT) of 140-180 s. We assessed number of and time to ECMO oxygenator changes, 15-day freedom from oxygenator change, major bleeding events, thromboembolic events, 30-day ICU mortality, activated clotting time and partial thromboplastin time and administration of blood products. Primary outcome was the occurrence of oxygenator changes depending on heparinization strategy; main secondary outcomes were the occurrence of severe bleeding events and occurrence of thromboembolic events. The transfusion strategy was more liberal in the low-dose centre.

RESULTS

Of 375 screened patients receiving VV-ECMO support, 218 were included in the analysis (117 high-dose group; 101 low-dose group). Disease severity measured by SAPS II score was 46 (IQR 36-57) versus 47 (IQR 37-55) and ECMO runtime was 8 (IQR 5-12) versus 11 (IQR 7-17) days (P = 0.003). There were 14 oxygenator changes in the high-dose group versus 48 in the low-dose group. Freedom from oxygenator change at 15 days was 73% versus 55% (adjusted HR 3.34 [95% confidence interval 1.2-9.4]; P = 0.023). Severe bleeding events occurred in 23 (19.7%) versus 14 (13.9%) patients (P = 0.256) and thromboembolic events occurred in 8 (6.8%) versus 19 (19%) patients (P = 0.007). Mortality at 30 days was 33.3% versus 30.7% (P = 0.11).

CONCLUSIONS

In this retrospective study, ECMO management with high-dose heparinization was associated with lower rates of oxygenator changes and thromboembolic events when compared to a low-dose heparinization strategy. Prospective, randomized trials are needed to determine the optimal anticoagulation strategy in patients receiving ECMO support.