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Xu Y, Zhang W, Ma X, Wu M, Jiang X. Retrospective analysis of interpretable machine learning in predicting ICU thrombocytopenia in geriatric ICU patients. Sci Rep 2024; 14:16738. [PMID: 39033248 PMCID: PMC11271295 DOI: 10.1038/s41598-024-67785-1] [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: 01/27/2024] [Accepted: 07/16/2024] [Indexed: 07/23/2024] Open
Abstract
We developed an interpretable machine learning algorithm that prospectively predicts the risk of thrombocytopenia in older critically ill patients during their stay in the intensive care unit (ICU), ultimately aiding clinical decision-making and improving patient care. Data from 2286 geriatric patients who underwent surgery and were admitted to the ICU of Dongyang People's Hospital between 2012 and 2021 were retrospectively analyzed. Integrated algorithms were developed, and four machine-learning algorithms were used. Selected characteristics included common demographic data, biochemical indicators, and vital signs. Eight key variables were selected using the Least Absolute Shrinkage and Selection Operator and Random Forest Algorithm. Thrombocytopenia occurred in 18.2% of postoperative geriatric patients, with a higher mortality rate. The C5.0 model showed the best performance, with an area under the receiver operating characteristic curve close to 0.85, along with unparalleled accuracy, precision, specificity, recall, and balanced accuracy scores of 0.88, 0.98, 0.89, 0.98, and 0.85, respectively. The support vector machine model excelled at predictively assessing thrombocytopenia severity, demonstrating an accuracy rate of 0.80 in the MIMIC database. Thus, our machine learning-based models have considerable potential in effectively predicting the risk and severity of postoperative thrombocytopenia in geriatric ICU patients for better clinical decision-making and patient care.
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Affiliation(s)
- Yingting Xu
- Intensive Care Unit, Affiliated Dongyang Hospital of Wenzhou Medical University, No. 60 Wuning West Road, Dongyang, Jinhua, Zhejiang, People's Republic of China
| | - Weimin Zhang
- Intensive Care Unit, Affiliated Dongyang Hospital of Wenzhou Medical University, No. 60 Wuning West Road, Dongyang, Jinhua, Zhejiang, People's Republic of China
| | - Xuchao Ma
- Intensive Care Unit, Affiliated Dongyang Hospital of Wenzhou Medical University, No. 60 Wuning West Road, Dongyang, Jinhua, Zhejiang, People's Republic of China
| | - Muying Wu
- Intensive Care Unit, Affiliated Dongyang Hospital of Wenzhou Medical University, No. 60 Wuning West Road, Dongyang, Jinhua, Zhejiang, People's Republic of China
| | - Xuandong Jiang
- Intensive Care Unit, Affiliated Dongyang Hospital of Wenzhou Medical University, No. 60 Wuning West Road, Dongyang, Jinhua, Zhejiang, People's Republic of China.
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Lüsebrink E, Lanz H, Binzenhöfer L, Hoffmann S, Höpler J, Kraft M, Gade N, Gmeiner J, Roden D, Saleh I, Hagl C, Nickenig G, Massberg S, Zimmer S, Jamin RN, Scherer C. Heparin-Induced Thrombocytopenia in Patients Suffering Cardiogenic Shock. Crit Care Explor 2024; 6:e1117. [PMID: 39042702 PMCID: PMC11265775 DOI: 10.1097/cce.0000000000001117] [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: 07/25/2024] Open
Abstract
OBJECTIVES Cardiogenic shock (CS) is associated with high mortality. Patients treated for CS mostly require heparin therapy, which may be associated with complications such as heparin-induced thrombocytopenia (HIT). HIT represents a serious condition associated with platelet decline and increased hypercoagulability and remains a poorly researched field in intensive care medicine. Primary purpose of this study was to: 1) determine HIT prevalence in CS, 2) assess the performance of common diagnostic tests for the workup of HIT, and 3) compare outcomes in CS patients with excluded and confirmed HIT. DESIGN Retrospective dual-center study including adult patients 18 years old or older with diagnosed CS and suspected HIT from January 2010 to November 2022. SETTING Cardiac ICU at the Ludwig-Maximilians University hospital in Munich and the university hospital of Bonn. PATIENTS AND INTERVENTIONS In this retrospective analysis, adult patients with diagnosed CS and suspected HIT were included. Differences in baseline characteristics, mortality, neurologic and safety outcomes between patients with excluded and confirmed HIT were evaluated. MEASUREMENTS AND MAIN RESULTS In cases of suspected HIT, positive screening antibodies were detected in 159 of 2808 patients (5.7%). HIT was confirmed via positive functional assay in 57 of 2808 patients, corresponding to a prevalence rate of 2.0%. The positive predictive value for anti-platelet factor 4/heparin screening antibodies was 35.8%. Total in-hospital mortality (58.8% vs. 57.9%; p > 0.999), 1-month mortality (47.1% vs. 43.9%; p = 0.781), and 12-month mortality (58.8% vs. 59.6%; p > 0.999) were similar between patients with excluded and confirmed HIT, respectively. Furthermore, no significant difference in neurologic outcome among survivors was found between groups (Cerebral Performance Category [CPC] score 1: 8.8% vs. 8.8%; p > 0.999 and CPC 2: 7.8% vs. 12.3%; p = 0.485). CONCLUSIONS HIT was a rare complication in CS patients treated with unfractionated heparin and was not associated with increased mortality. Also, HIT confirmation was not associated with worse neurologic outcome in survivors. Future studies should aim at developing more precise, standardized, and cost-effective strategies to diagnose HIT and prevent complications.
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Affiliation(s)
- Enzo Lüsebrink
- Medizinische Klinik und Poliklinik I, Klinikum der Universität München, Munich, Germany
- DZHK (German Center for Cardiovascular Research), partner site Munich Heart Alliance, Munich, Germany
| | - Hugo Lanz
- Medizinische Klinik und Poliklinik I, Klinikum der Universität München, Munich, Germany
- DZHK (German Center for Cardiovascular Research), partner site Munich Heart Alliance, Munich, Germany
| | - Leonhard Binzenhöfer
- Medizinische Klinik und Poliklinik I, Klinikum der Universität München, Munich, Germany
- DZHK (German Center for Cardiovascular Research), partner site Munich Heart Alliance, Munich, Germany
| | - Sabine Hoffmann
- Institute for Medical Information Processing, Biometry, and Epidemiology, Ludwig-Maximilians-Universität München, Munich, Germany
| | - Julia Höpler
- Institute for Medical Information Processing, Biometry, and Epidemiology, Ludwig-Maximilians-Universität München, Munich, Germany
| | - Marie Kraft
- Institute for Medical Information Processing, Biometry, and Epidemiology, Ludwig-Maximilians-Universität München, Munich, Germany
| | - Nils Gade
- Medizinische Klinik und Poliklinik I, Klinikum der Universität München, Munich, Germany
- DZHK (German Center for Cardiovascular Research), partner site Munich Heart Alliance, Munich, Germany
| | - Jonas Gmeiner
- Medizinische Klinik und Poliklinik I, Klinikum der Universität München, Munich, Germany
- DZHK (German Center for Cardiovascular Research), partner site Munich Heart Alliance, Munich, Germany
| | - Daniel Roden
- Medizinische Klinik und Poliklinik I, Klinikum der Universität München, Munich, Germany
- DZHK (German Center for Cardiovascular Research), partner site Munich Heart Alliance, Munich, Germany
| | - Inas Saleh
- Medizinische Klinik und Poliklinik I, Klinikum der Universität München, Munich, Germany
- DZHK (German Center for Cardiovascular Research), partner site Munich Heart Alliance, Munich, Germany
| | - Christian Hagl
- DZHK (German Center for Cardiovascular Research), partner site Munich Heart Alliance, Munich, Germany
- Herzchirurgische Klinik und Poliklinik, Klinikum der Universität München, Munich, Germany
| | - Georg Nickenig
- Medizinische Klinik und Poliklinik II, Universitätsklinikum Bonn, Bonn, Germany
| | - Steffen Massberg
- Medizinische Klinik und Poliklinik I, Klinikum der Universität München, Munich, Germany
- DZHK (German Center for Cardiovascular Research), partner site Munich Heart Alliance, Munich, Germany
| | - Sebastian Zimmer
- Medizinische Klinik und Poliklinik II, Universitätsklinikum Bonn, Bonn, Germany
| | - Raúl Nicolás Jamin
- Medizinische Klinik und Poliklinik II, Universitätsklinikum Bonn, Bonn, Germany
| | - Clemens Scherer
- Medizinische Klinik und Poliklinik I, Klinikum der Universität München, Munich, Germany
- DZHK (German Center for Cardiovascular Research), partner site Munich Heart Alliance, Munich, Germany
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Carini FC, Munshi L, Novitzky-Basso I, Dozois G, Heredia C, Damouras S, Ferreyro BL, Mehta S. Incidence of venous thromboembolic disease and risk of bleeding in critically ill patients with hematologic malignancies: A retrospective study. Med Intensiva 2024:S2173-5727(24)00141-3. [PMID: 38906793 DOI: 10.1016/j.medine.2024.06.003] [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: 03/15/2024] [Accepted: 05/27/2024] [Indexed: 06/23/2024]
Abstract
OBJECTIVE Our objectives were to describe the use of thromboprophylaxis and the incidence of VTE/bleeding in critically ill patients with hematologic malignancies (HM). DESIGN Retrospective cohort study (2014-2022). SETTING Medic-Surgical Intensive Care Unit (ICU) in a tertiary care academic center. PATIENTS Adult patients admitted to ICU with a concomitant diagnosis of a hematological malignancy. INTERVENTIONS None. MAIN VARIABLES OF INTEREST We analyzed demographic data, use of thromboprophylaxis and secondary outcomes that included incidence of VTE (venous thromboembolism), bleeding, mortality, severity scores and organ support. We applied a multivariable logistic regression model to examine the risk of thrombosis in the ICU. RESULTS We included 862 ICU admissions (813 unique patients). Thromboprophylaxis was given during 65% of admissions (LMWH 14%, UFH 8%, and SCDs 43%); in 21% it was contraindicated due to thrombocytopenia; 14% of cases lacked documentation on prophylaxis. There were 38 unique incident cases of VTE (27 DVT, 11 PE), constituting 4.4% of ICU episodes. Most of VTE cases happened in patients with various degrees of thrombocytopenia. In the multivariable analysis, SOFA score on the first ICU day was independently associated (OR 0.85, 95% CI 0.76-0.96) with the risk of VTE. Bleeding occurred in 7.2% (minor) and 14.4% (major) of episodes; most frequent sites being CNS, abdomen/GI and pulmonary. CONCLUSIONS In this cohort of critically ill patients with HM, there was considerable variability in the utilization of DVT prophylaxis, with predominant use of SCDs. The incidence of VTE was 4.4% and major bleeding 14%. CLINICAL TRIAL REGISTRATION NCT05396157. Venous Thromboembolism in Hematologic Malignancy and Hematopoietic Cell Transplant Patients: a Retrospective Study (https://clinicaltrials.gov/).
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Affiliation(s)
- Federico C Carini
- Department of Medicine, Sinai Health System; Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, Ontario, Canada.
| | - Laveena Munshi
- Department of Medicine, Sinai Health System; Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Igor Novitzky-Basso
- Princess Margaret Cancer Centre, Department of Medical Oncology; University Health Network, Toronto, Ontario, Canada
| | - Graham Dozois
- Princess Margaret Cancer Centre, Department of Medical Oncology; University Health Network, Toronto, Ontario, Canada
| | - Camila Heredia
- Faculty of Health, York University, Toronto, Ontario, Canada
| | - Sotirios Damouras
- Department of Computer & Mathematical Sciences, University of Toronto Scarborough, Ontario, Canada
| | - Bruno L Ferreyro
- Department of Medicine, Sinai Health System; Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Sangeeta Mehta
- Department of Medicine, Sinai Health System; Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, Ontario, Canada
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Ye Q, Wang X, Xu X, Chen J, Christiani DC, Chen F, Zhang R, Wei Y. Serial platelet count as a dynamic prediction marker of hospital mortality among septic patients. BURNS & TRAUMA 2024; 12:tkae016. [PMID: 38882552 PMCID: PMC11179733 DOI: 10.1093/burnst/tkae016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/31/2023] [Revised: 02/04/2024] [Accepted: 03/14/2024] [Indexed: 06/18/2024]
Abstract
Background Platelets play a critical role in hemostasis and inflammatory diseases. Low platelet count and activity have been reported to be associated with unfavorable prognosis. This study aims to explore the relationship between dynamics in platelet count and in-hospital morality among septic patients and to provide real-time updates on mortality risk to achieve dynamic prediction. Methods We conducted a multi-cohort, retrospective, observational study that encompasses data on septic patients in the eICU Collaborative Research Database (eICU-CRD) and the Medical Information Mart for Intensive Care IV (MIMIC-IV) database. The joint latent class model (JLCM) was utilized to identify heterogenous platelet count trajectories over time among septic patients. We assessed the association between different trajectory patterns and 28-day in-hospital mortality using a piecewise Cox hazard model within each trajectory. We evaluated the performance of our dynamic prediction model through area under the receiver operating characteristic curve, concordance index (C-index), accuracy, sensitivity, and specificity calculated at predefined time points. Results Four subgroups of platelet count trajectories were identified that correspond to distinct in-hospital mortality risk. Including platelet count did not significantly enhance prediction accuracy at early stages (day 1 C-indexDynamic vs C-indexWeibull: 0.713 vs 0.714). However, our model showed superior performance to the static survival model over time (day 14 C-indexDynamic vs C-indexWeibull: 0.644 vs 0.617). Conclusions For septic patients in an intensive care unit, the rapid decline in platelet counts is a critical prognostic factor, and serial platelet measures are associated with prognosis.
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Affiliation(s)
- Qian Ye
- Department of Biostatistics, School of Public Health, Nanjing Medical University, 101 Longmian Avenue, Nanjing, Jiangsu 211166, China
| | - Xuan Wang
- Department of Biostatistics, School of Public Health, Nanjing Medical University, 101 Longmian Avenue, Nanjing, Jiangsu 211166, China
| | - Xiaoshuang Xu
- Department of Biostatistics, School of Public Health, Nanjing Medical University, 101 Longmian Avenue, Nanjing, Jiangsu 211166, China
| | - Jiajin Chen
- Department of Biostatistics, School of Public Health, Nanjing Medical University, 101 Longmian Avenue, Nanjing, Jiangsu 211166, China
| | - David C Christiani
- Department of Environmental Health, Harvard T.H. Chan School of Public Health, Harvard University, 655 Huntington Avenue, Boston, MA 02115, USA
- Pulmonary and Critical Care Division, Massachusetts General Hospital, Department of Medicine, Harvard Medical School, 55 Fruit Street, Boston, MA 02114, USA
| | - Feng Chen
- Department of Biostatistics, School of Public Health, Nanjing Medical University, 101 Longmian Avenue, Nanjing, Jiangsu 211166, China
- Jiangsu Key Lab of Cancer Biomarkers, Prevention and Treatment, Jiangsu Collaborative Innovation Center for Cancer Personalized Medicine, Nanjing Medical University, 101 Longmian Avenue, Nanjing, Jiangsu 211166, China
- China International Cooperation Center of Environment and Human Health, Nanjing Medical University, 101 Longmian Avenue, Nanjing, Jiangsu 211166, China
| | - Ruyang Zhang
- Department of Biostatistics, School of Public Health, Nanjing Medical University, 101 Longmian Avenue, Nanjing, Jiangsu 211166, China
| | - Yongyue Wei
- Department of Biostatistics, School of Public Health, Nanjing Medical University, 101 Longmian Avenue, Nanjing, Jiangsu 211166, China
- Center for Public Health and Epidemic Preparedness & Response, Peking University, Key Laboratory of Epidemiology of Major Diseases (Peking University), Ministry of Education, 38 Xueyuan Road, Haidian District, Beijing 100191, China
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Zhou P, Guo QQ, Wang FX, Zhou L, Hu HF, Deng Z. Nonlinear relationship between platelet count and 30-day in-hospital mortality in ICU acute respiratory failure patients: a multicenter retrospective cohort study. Eur J Med Res 2024; 29:312. [PMID: 38849948 PMCID: PMC11161993 DOI: 10.1186/s40001-024-01909-1] [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: 02/05/2024] [Accepted: 05/29/2024] [Indexed: 06/09/2024] Open
Abstract
BACKGROUND Limited evidence exists regarding the link between platelet count and 30-day in-hospital mortality in acute respiratory failure (ARF) patients. Thus, this study aims to investigate this association among ICU patients experiencing acute respiratory failure. METHODS We conducted a retrospective cohort study across multiple centers, utilizing data from the US eICU-CRD v2.0 database covering 22,262 patients with ARF in the ICU from 2014 to 2015. Our aim was to investigate the correlation between platelet count and 30-day in-hospital mortality using binary logistic regression, subgroup analyses, and smooth curve fitting. RESULTS The 30-day in-hospital mortality rate was 19.73% (4393 out of 22,262), with a median platelet count of 213 × 109/L. After adjusting for covariates, our analysis revealed an inverse association between platelet count and 30-day in-hospital mortality (OR = 0.99, 95% CI 0.99, 0.99). Subgroup analyses supported the robustness of these findings. Furthermore, a nonlinear relationship was identified between platelet count and 30-day in-hospital mortality, with the inflection point at 120 × 109/L. Below the inflection point, the effect size (OR) was 0.89 (0.87, 0.91), indicating a significant association. However, beyond this point, the relationship was not statistically significant. CONCLUSION This study establishes a clear negative association between platelet count and 30-day in-hospital mortality among ICU patients with ARF. Furthermore, we have identified a nonlinear relationship with saturation effects, indicating that among ICU patients with acute respiratory failure, the lowest 30-day in-hospital mortality rate occurs when the baseline platelet count is approximately 120 × 109/L.
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Affiliation(s)
- Pan Zhou
- Department of Emergency Medicine, Shenzhen Second People's Hospital/The First Affiliated Hospital of Shenzhen University Health Science Center, Shenzhen, 518035, China
| | - Qin-Qin Guo
- Department of Emergency Medicine, Shenzhen Second People's Hospital/The First Affiliated Hospital of Shenzhen University Health Science Center, Shenzhen, 518035, China
| | - Fang-Xi Wang
- Department of Emergency Medicine, Shenzhen Second People's Hospital/The First Affiliated Hospital of Shenzhen University Health Science Center, Shenzhen, 518035, China
| | - Li Zhou
- Department of Emergency Medicine, Shenzhen Second People's Hospital/The First Affiliated Hospital of Shenzhen University Health Science Center, Shenzhen, 518035, China
| | - Hao-Fei Hu
- Department of Nephrology, Shenzhen Second People's Hospital/The First Affiliated Hospital of Shenzhen University Health Science Center, Shenzhen, 518035, China.
| | - Zhe Deng
- Department of Emergency Medicine, Shenzhen Second People's Hospital/The First Affiliated Hospital of Shenzhen University Health Science Center, Shenzhen, 518035, China.
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Hariri G, Belossi V, Perol L, Missri L, Gabarre P, Bonny V, Urbina T, Baudel JL, Guidet B, Joffre J, Maury E, Dumas G, Ait-Oufella H. Prospective evaluation of bleeding risk among thrombocytopenic patients admitted in intensive care unit. J Crit Care 2024; 79:154405. [PMID: 37659243 DOI: 10.1016/j.jcrc.2023.154405] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2023] [Revised: 06/30/2023] [Accepted: 08/25/2023] [Indexed: 09/04/2023]
Abstract
PURPOSE Bleeding risk evaluation of thrombocytopenic patients admitted in ICU has been poorly investigated. METHODS A prospective observational study conducted in an 18-bed medical ICU. Consecutive patients with thrombocytopenia (<150 Giga/L) and no bleeding at admission were included. RESULTS Over one year, 91 patients were included, mainly men (63%), with an age of 61 [46-68] years and a SOFA score of 6 [3-8]. Twenty-three patients (25%) had an hemorrhagic event during ICU stay, mainly digestive (n = 9; 39%) and urological (n = 6; 26%). The time between ICU admission and bleeding was 8 [2-19] days. Almost half of bleeding events required vasopressor infusion and a hemostatic procedure. At admission, two variables were significantly different between the Bleeding and No-Bleeding groups: plasma urea level was significantly higher in the Bleeding group (9 [5.1; 13] vs. 13 [8.9; 31] mmol/L; p < 0.001) and the presence of skin purpura was associated with a 3-fold higher risk for bleeding during ICU stay (HR: 3.4 [1.3-8.3]; p < 0.05). In contrast, admission platelet count was not significantly different between the 2 groups (90 [32; 128] vs 62 [36; 103] G/L; p = 0.26). CONCLUSION Plasma urea levels and the presence of skin purpura are helpful in identifying thrombocytopenic patients at high-risk of bleeding during ICU stay.
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Affiliation(s)
- Geoffroy Hariri
- Service de Médecine intensive-Réanimation, Assistance Publique-Hôpitaux de Paris, Hôpital Saint-Antoine, Paris, France; Sorbonne Université, Paris, France; Sorbonne Université, Inserm, Institut Pierre Louis d'Epidémiologie et de Santé Publique, F75013, Paris, France
| | - Vincent Belossi
- Service de Médecine intensive-Réanimation, Assistance Publique-Hôpitaux de Paris, Hôpital Saint-Antoine, Paris, France; Sorbonne Université, Paris, France
| | - Louis Perol
- Service de Médecine intensive-Réanimation, Assistance Publique-Hôpitaux de Paris, Hôpital Saint-Antoine, Paris, France
| | - Louai Missri
- Service de Médecine intensive-Réanimation, Assistance Publique-Hôpitaux de Paris, Hôpital Saint-Antoine, Paris, France
| | - Paul Gabarre
- Service de Médecine intensive-Réanimation, Assistance Publique-Hôpitaux de Paris, Hôpital Saint-Antoine, Paris, France; Sorbonne Université, Paris, France
| | - Vincent Bonny
- Service de Médecine intensive-Réanimation, Assistance Publique-Hôpitaux de Paris, Hôpital Saint-Antoine, Paris, France; Sorbonne Université, Paris, France
| | - Tomas Urbina
- Service de Médecine intensive-Réanimation, Assistance Publique-Hôpitaux de Paris, Hôpital Saint-Antoine, Paris, France
| | - Jean-Luc Baudel
- Service de Médecine intensive-Réanimation, Assistance Publique-Hôpitaux de Paris, Hôpital Saint-Antoine, Paris, France
| | - Bertrand Guidet
- Service de Médecine intensive-Réanimation, Assistance Publique-Hôpitaux de Paris, Hôpital Saint-Antoine, Paris, France; Sorbonne Université, Paris, France; Sorbonne Université, Inserm, Institut Pierre Louis d'Epidémiologie et de Santé Publique, F75013, Paris, France
| | - Jeremie Joffre
- Service de Médecine intensive-Réanimation, Assistance Publique-Hôpitaux de Paris, Hôpital Saint-Antoine, Paris, France; Sorbonne Université, Paris, France
| | - Eric Maury
- Service de Médecine intensive-Réanimation, Assistance Publique-Hôpitaux de Paris, Hôpital Saint-Antoine, Paris, France; Sorbonne Université, Paris, France
| | - Guillaume Dumas
- Service de Médecine intensive-Réanimation, Assistance Publique-Hôpitaux de Paris, Hôpital Saint-Antoine, Paris, France; Sorbonne Université, Paris, France
| | - Hafid Ait-Oufella
- Service de Médecine intensive-Réanimation, Assistance Publique-Hôpitaux de Paris, Hôpital Saint-Antoine, Paris, France; Sorbonne Université, Paris, France; Inserm U970, Paris Research Cardiovascular Center, Paris, France.
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Torbic H, Tonelli AR. Sotatercept for Pulmonary Arterial Hypertension in the Inpatient Setting. J Cardiovasc Pharmacol Ther 2024; 29:10742484231225310. [PMID: 38361351 DOI: 10.1177/10742484231225310] [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: 02/17/2024]
Abstract
Patients with pulmonary arterial hypertension (PAH) who are admitted to the hospital pose a challenge to the multidisciplinary healthcare team due to the complexity of the pathophysiology of their disease state and PAH-specific medication considerations. Pulmonary arterial hypertension is a progressive disease that may lead to death as a result of right ventricular (RV) failure. During acute on chronic RV failure it is critical to decrease the pulmonary vascular resistance with the goal of improving RV function and prognosis; therefore, aggressive PAH-treatment based on disease risk stratification is essential. Pulmonary arterial hypertension treatment for acute on chronic RV failure can be impacted by end-organ damage, hemodynamic instability, drug interactions, and PAH medications dosage and delivery. Sotatercept, a first in class activin signaling inhibitor that works on the bone morphogenetic protein/activin pathway is on track for Food and Drug Administration approval for the treatment of PAH based on results of recent trials in where the medication led to clinical and hemodynamic improvements, even when added to traditional PAH-specific therapies. The purpose of this review is to highlight important considerations when starting or continuing sotatercept in patients admitted to the hospital with PAH.
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Affiliation(s)
- Heather Torbic
- Department of Pharmacy, Cleveland Clinic, Cleveland, OH, USA
| | - Adriano R Tonelli
- Department of Pulmonary, Allergy and Critical Care Medicine, Cleveland Clinic, Cleveland, OH, USA
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Moneke I, Kalbhenn J. Successful Bridge to Lung Transplant in a Patient With Cystic Fibrosis Colonized With Pan-Resistant Burkholderia Multivorans. J Cardiothorac Vasc Anesth 2023; 37:2603-2606. [PMID: 37775342 DOI: 10.1053/j.jvca.2023.09.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/10/2023] [Revised: 08/28/2023] [Accepted: 09/02/2023] [Indexed: 10/01/2023]
Affiliation(s)
- Isabelle Moneke
- Department of Thoracic Surgery, Medical Center-University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany.
| | - Johannes Kalbhenn
- Department of Anesthesia and Critical Care Medicine, Medical Center-University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
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Ma JW, Hu SY, Hsieh MS, Lee YC, Huang SC, Chen KJ, Chang YZ, Tsai YC. PEAL Score to Predict the Mortality Risk of Cardiogenic Shock in the Emergency Department: An Observational Study. J Pers Med 2023; 13:1614. [PMID: 38003929 PMCID: PMC10672116 DOI: 10.3390/jpm13111614] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2023] [Revised: 11/12/2023] [Accepted: 11/14/2023] [Indexed: 11/26/2023] Open
Abstract
BACKGROUND The in-hospital mortality of cardiogenic shock (CS) remains high (28% to 45%). As a result, several studies developed prediction models to assess the mortality risk and provide guidance on treatment, including CardShock and IABP-SHOCK II scores, which performed modestly in external validation studies, reflecting the heterogeneity of the CS populations. Few articles established predictive scores of CS based on Asian people with a higher burden of comorbidities than Caucasians. We aimed to describe the clinical characteristics of a contemporary Asian population with CS, identify risk factors, and develop a predictive scoring model. METHODS A retrospective observational study was conducted between 2014 and 2019 to collect the patients who presented with all-cause CS in the emergency department of a single medical center in Taiwan. We divided patients into subgroups of CS related to acute myocardial infarction (AMI-CS) or heart failure (HF-CS). The outcome was all-cause 30-day mortality. We built the prediction model based on the hazard ratio of significant variables, and the cutoff point of each predictor was determined using the Youden index. We also assessed the discrimination ability of the risk score using the area under a receiver operating characteristic curve. RESULTS We enrolled 225 patients with CS. One hundred and seven patients (47.6%) were due to AMI-CS, and ninety-eight patients among them received reperfusion therapy. Forty-nine patients (21.8%) eventually died within 30 days. Fifty-three patients (23.55%) presented with platelet counts < 155 × 103/μL, which were negatively associated with a 30-day mortality of CS in the restrictive cubic spline plot, even within the normal range of platelet counts. We identified four predictors: platelet counts < 200 × 103/μL (HR 2.574, 95% CI 1.379-4.805, p = 0.003), left ventricular ejection fraction (LVEF) < 40% (HR 2.613, 95% CI 1.020-6.692, p = 0.045), age > 71 years (HR 2.452, 95% CI 1.327-4.531, p = 0.004), and lactate > 2.7 mmol/L (HR 1.967, 95% CI 1.069-3.620, p = 0.030). The risk score ended with a maximum of 5 points and showed an AUC (95% CI) of 0.774 (0.705-0.843) for all patients, 0.781 (0.678-0.883), and 0.759 (0.662-0.855) for AMI-CS and HF-CS sub-groups, respectively, all p < 0.001. CONCLUSIONS Based on four parameters, platelet counts, LVEF, age, and lactate (PEAL), this model showed a good predictive performance for all-cause mortality at 30 days in the all patients, AMI-CS, and HF-CS subgroups. The restrictive cubic spline plot showed a significantly negative correlation between initial platelet counts and 30-day mortality risk in the AMI-CS and HF-CS subgroups.
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Affiliation(s)
- Jen-Wen Ma
- Department of Emergency Medicine, Taichung Veterans General Hospital, Taichung 407219, Taiwan; (J.-W.M.); (K.-J.C.); (Y.-C.T.)
- Department of Post-Baccalaureate Medicine, College of Medicine, National Chung Hsing University, Taichung 402, Taiwan
- Institute of Medicine, School of Medicine, Chung Shan Medical University, Taichung 40201, Taiwan
- School of Medicine, Chung Shan Medical University, Taichung 40201, Taiwan;
| | - Sung-Yuan Hu
- Department of Emergency Medicine, Taichung Veterans General Hospital, Taichung 407219, Taiwan; (J.-W.M.); (K.-J.C.); (Y.-C.T.)
- Department of Post-Baccalaureate Medicine, College of Medicine, National Chung Hsing University, Taichung 402, Taiwan
- Institute of Medicine, School of Medicine, Chung Shan Medical University, Taichung 40201, Taiwan
- School of Medicine, Chung Shan Medical University, Taichung 40201, Taiwan;
- School of Medicine, National Yang Ming Chiao Tung University, Taipei 11217, Taiwan;
| | - Ming-Shun Hsieh
- School of Medicine, National Yang Ming Chiao Tung University, Taipei 11217, Taiwan;
- Department of Emergency Medicine, Taipei Veterans General Hospital, Taoyuan Branch, Taoyuan 330, Taiwan
- Department of Emergency Medicine, Taipei Veterans General Hospital, Taipei 11217, Taiwan;
| | - Yi-Chen Lee
- Department of Emergency Medicine, Taipei Veterans General Hospital, Taipei 11217, Taiwan;
| | - Shih-Che Huang
- School of Medicine, Chung Shan Medical University, Taichung 40201, Taiwan;
- Department of Emergency Medicine, Chung Shan Medical University Hospital, Taichung 40201, Taiwan
- Lung Cancer Research Center, Chung Shan Medical University Hospital, Taichung 40201, Taiwan
| | - Kuan-Ju Chen
- Department of Emergency Medicine, Taichung Veterans General Hospital, Taichung 407219, Taiwan; (J.-W.M.); (K.-J.C.); (Y.-C.T.)
- Center for Cardiovascular Medicine, Taichung Veterans General Hospital, Taichung 407219, Taiwan
| | - Yan-Zin Chang
- Institute of Medicine, School of Medicine, Chung Shan Medical University, Taichung 40201, Taiwan
- Department of Clinical Laboratory, Drug Testing Center, Chung Shan Medical University Hospital, Taichung 40201, Taiwan
| | - Yi-Chun Tsai
- Department of Emergency Medicine, Taichung Veterans General Hospital, Taichung 407219, Taiwan; (J.-W.M.); (K.-J.C.); (Y.-C.T.)
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10
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Raasveld SJ, van den Oord C, Schenk J, van den Bergh WM, Oude Lansink-Hartgring A, van der Velde F, Maas JJ, van de Berg P, Lorusso R, Delnoij TSR, Dos Reis Miranda D, Scholten E, Taccone FS, Dauwe DF, De Troy E, Hermans G, Pappalardo F, Fominskiy E, Ivancan V, Bojčić R, de Metz J, van den Bogaard B, Donker DW, Meuwese CL, De Bakker M, Reddi B, Henriques JPS, Broman LM, Dongelmans DA, Vlaar APJ. The interaction of thrombocytopenia, hemorrhage, and platelet transfusion in venoarterial extracorporeal membrane oxygenation: a multicenter observational study. Crit Care 2023; 27:321. [PMID: 37605277 PMCID: PMC10441744 DOI: 10.1186/s13054-023-04612-5] [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: 06/08/2023] [Accepted: 08/14/2023] [Indexed: 08/23/2023] Open
Abstract
BACKGROUND Thrombocytopenia, hemorrhage and platelet transfusion are common in patients supported with venoarterial extracorporeal membrane oxygenation (VA ECMO). However, current literature is limited to small single-center experiences with high degrees of heterogeneity. Therefore, we aimed to ascertain in a multicenter study the course and occurrence rate of thrombocytopenia, and to assess the association between thrombocytopenia, hemorrhage and platelet transfusion during VA ECMO. METHODS This was a sub-study of a multicenter (N = 16) study on transfusion practices in patients on VA ECMO, in which a retrospective cohort (Jan-2018-Jul-2019) focusing on platelets was selected. The primary outcome was thrombocytopenia during VA ECMO, defined as mild (100-150·109/L), moderate (50-100·109/L) and severe (< 50·109/L). Secondary outcomes included the occurrence rate of platelet transfusion, and the association between thrombocytopenia, hemorrhage and platelet transfusion, assessed through mixed-effect models. RESULTS Of the 419 patients included, median platelet count at admission was 179·109/L. During VA ECMO, almost all (N = 398, 95%) patients developed a thrombocytopenia, of which a significant part severe (N = 179, 45%). One or more platelet transfusions were administered in 226 patients (54%), whereas 207 patients (49%) suffered a hemorrhagic event during VA ECMO. In non-bleeding patients, still one in three patients received a platelet transfusion. The strongest association to receive a platelet transfusion was found in the presence of severe thrombocytopenia (adjusted OR 31.8, 95% CI 17.9-56.5). After including an interaction term of hemorrhage and thrombocytopenia, this even increased up to an OR of 110 (95% CI 34-360). CONCLUSIONS Thrombocytopenia has a higher occurrence than is currently recognized. Severe thrombocytopenia is strongly associated with platelet transfusion. Future studies should focus on the etiology of severe thrombocytopenia during ECMO, as well as identifying indications and platelet thresholds for transfusion in the absence of bleeding. TRIAL REGISTRATION This study was registered at the Netherlands Trial Registry at February 26th, 2020 with number NL8413 and can currently be found at https://trialsearch.who.int/Trial2.aspx?TrialID=NL8413.
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Affiliation(s)
- Senta Jorinde Raasveld
- Department of Critical Care, Amsterdam University Medical Centers, Location Academic Medical Centers, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands
| | - Claudia van den Oord
- Department of Critical Care, Amsterdam University Medical Centers, Location Academic Medical Centers, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands
| | - Jimmy Schenk
- Department of Critical Care, Amsterdam University Medical Centers, Location Academic Medical Centers, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands
- Department of Epidemiology and Data Science, Amsterdam University Medical Centre, Amsterdam Public Health, University of Amsterdam, Location AMC, Amsterdam, The Netherlands
| | - Walter M van den Bergh
- Department of Critical Care, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | | | | | - Jacinta J Maas
- Adult Intensive Care Unit, Leiden University Medical Center, Leiden, The Netherlands
| | - Pablo van de Berg
- Adult Intensive Care Unit, Catharina Hospital Eindhoven, Eindhoven, The Netherlands
| | - Roberto Lorusso
- Cardiothoracic Surgery Department, Heart and Vascular Center, Maastricht University Medical Center, and Cardiovascular Research Institute Maastricht (CARIM), Maastricht, The Netherlands
| | - Thijs S R Delnoij
- Department of Cardiology, Maastricht University Medical Center, Maastricht, The Netherlands
- Department of Intensive Care, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Dinis Dos Reis Miranda
- Adult Intensive Care Unit, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Erik Scholten
- Department of Intensive Care, St. Antonius Hospital, Nieuwegein, The Netherlands
| | - Fabio Silvio Taccone
- Department of Intensive Care, Université Libre de Bruxelles, Hôpital Erasme Bruxelles, Brussels, Belgium
| | - Dieter F Dauwe
- Surgical Intensive Care Unit, Department of Intensive Care Medicine, University Hospital Leuven, Leuven, Belgium
| | - Erwin De Troy
- Surgical Intensive Care Unit, Department of Intensive Care Medicine, University Hospital Leuven, Leuven, Belgium
| | - Greet Hermans
- Medical Intensive Care Unit, Department of General Internal Medicine, University Hospitals Leuven, Herestraat 49, 3000, Leuven, Belgium
- Laboratory of Intensive Care Medicine, Department of Cellular and Molecular Medicine, KU Leuven, Herestraat 49, 3000, Leuven, Belgium
| | - Federico Pappalardo
- Department of CardioThoracic and Vascular Anesthesia and Intensive Care, AO SS Antonio e Biagio e Cesare Arrigo, Alessandria, Italy
| | - Evgeny Fominskiy
- Department of Anesthesia and Intensive Care, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Višnja Ivancan
- Department of Anesthesia and Intensive Care, University Hospital Centre Zagreb, Zagreb, Croatia
| | - Robert Bojčić
- Department of Anesthesia and Intensive Care, University Hospital Centre Zagreb, Zagreb, Croatia
| | - Jesse de Metz
- Department of Intensive Care, OLVG, Amsterdam, The Netherlands
| | | | - Dirk W Donker
- Intensive Care Center, University Medical Center Utrecht (UMCU), Utrecht, The Netherlands
- Cardiovascular and Respiratory Physiology, TechMed Centre, University of Twente, Enschede, The Netherlands
| | - Christiaan L Meuwese
- Adult Intensive Care Unit, Erasmus University Medical Center, Rotterdam, The Netherlands
- Intensive Care Center, University Medical Center Utrecht (UMCU), Utrecht, The Netherlands
| | - Martin De Bakker
- Department of Critical Care, Royal Adelaide Hospital, Adelaide, Australia
| | - Benjamin Reddi
- Department of Critical Care, Royal Adelaide Hospital, Adelaide, Australia
| | - José P S Henriques
- Department of Cardiology, Amsterdam University Medical Centers, Location Academic Medical Centers, Amsterdam, The Netherlands
| | - Lars Mikael Broman
- ECMO Center Karolinska, Karolinska University Hospital, Stockholm, Sweden
| | - Dave A Dongelmans
- Department of Critical Care, Amsterdam University Medical Centers, Location Academic Medical Centers, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands
| | - Alexander P J Vlaar
- Department of Critical Care, Amsterdam University Medical Centers, Location Academic Medical Centers, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands.
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11
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Boulet N, Lefrant JY, Mimoz O, Roger C, Pirracchio R. Platelet Transfusion before CVC Placement in Patients with Thrombocytopenia. Anaesth Crit Care Pain Med 2023:101271. [PMID: 37356619 DOI: 10.1016/j.accpm.2023.101271] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2023] [Accepted: 06/20/2023] [Indexed: 06/27/2023]
Affiliation(s)
- Nicolas Boulet
- UR-UM103 IMAGINE, Univ Montpellier, Division of Anesthesia Critical Care, Pain and Emergency Medicine, Nîmes University Hospital, Montpellier, France.
| | - Jean Yves Lefrant
- UR-UM103 IMAGINE, Univ Montpellier, Division of Anesthesia Critical Care, Pain and Emergency Medicine, Nîmes University Hospital, Montpellier, France.
| | - Olivier Mimoz
- Services des Urgences Adultes and SAMU 86, Centre Hospitalier Universitaire de Poitiers, Poitiers 86021, France; Université de Poitiers, Inserm U1070, Poitiers, France.
| | - Claire Roger
- UR-UM103 IMAGINE, Univ Montpellier, Division of Anesthesia Critical Care, Pain and Emergency Medicine, Nîmes University Hospital, Montpellier, France.
| | - Romain Pirracchio
- Department of Anesthesia and Perioperative Medicine, Zuckerberg San Francisco General Hospital and Trauma Center, University of California San Francisco, San Francisco, CA, United States; Division of Biostatistics, School of Public Health, University of California Berkeley, Berkeley, CA, United States.
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12
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Jeon YH, Jeon Y, Jung HY, Choi JY, Park SH, Kim CD, Kim YL, Cho JH, Lim JH. Platelet-to-Lymphocyte Ratio and In-Hospital Mortality in Patients With AKI Receiving Continuous Kidney Replacement Therapy: A Retrospective Observational Cohort Study. Kidney Med 2023; 5:100642. [PMID: 37235040 PMCID: PMC10205757 DOI: 10.1016/j.xkme.2023.100642] [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] [Indexed: 05/28/2023] Open
Abstract
Rationale & Objective The platelet-to-lymphocyte ratio (PLR) is a marker of inflammation and a predictor of mortality in a variety of diseases. However, the effectiveness of PLR as a predictor of mortality in patients with severe acute kidney injury (AKI) is uncertain. We evaluated the association between the PLR and mortality in critically ill patients with severe AKI who underwent continuous kidney replacement therapy (CKRT). Study Design Retrospective cohort study. Setting & Participants A total of 1,044 patients who underwent CKRT in a single center, from February 2017 to March 2021. Exposures PLR. Outcomes In-hospital mortality. Analytical Approach The study patients were classified into quintiles according to the PLR values. A Cox proportional hazards model was used to investigate the association between PLR and mortality. Results The PLR value was associated with in-hospital mortality in a nonlinear manner, showing a higher mortality at both ends of the PLR. The Kaplan-Meier curve revealed the highest mortality with the first and fifth quintiles, whereas the lowest mortality occurred with the third quintile. Compared with the third quintile, the first (adjusted HR, 1.94; 95% CI, 1.44-2.62; P < 0.001) and fifth (adjusted HR, 1.60; 95% CI, 1.18-2.18; P = 0.002) quintiles of the PLR group had a significantly higher in-hospital mortality rate. The first and fifth quintiles showed a consistently increased risk of 30- and 90-day mortality rates compared with those of the third quintile. In the subgroup analysis, the lower and higher PLR values were predictors of in-hospital mortality in patients with older age, of female sex, and with hypertension, diabetes, and higher Sequential Organ Failure Assessment score. Limitations There may be bias owing to the single-center retrospective nature of this study. We only had PLR values at the time of initiation of CKRT. Conclusions Both the lower and higher PLR values were independent predictors of in-hospital mortality in critically ill patients with severe AKI who underwent CKRT.
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Affiliation(s)
- You Hyun Jeon
- Division of Nephrology, Department of Internal Medicine, Kyungpook National University School of Medicine, Kyungpook National University Hospital, Daegu, South Korea
| | - Yena Jeon
- Department of Statistics, Kyungpook National University, Daegu, South Korea
| | - Hee-Yeon Jung
- Division of Nephrology, Department of Internal Medicine, Kyungpook National University School of Medicine, Kyungpook National University Hospital, Daegu, South Korea
| | - Ji-Young Choi
- Division of Nephrology, Department of Internal Medicine, Kyungpook National University School of Medicine, Kyungpook National University Hospital, Daegu, South Korea
| | - Sun-Hee Park
- Division of Nephrology, Department of Internal Medicine, Kyungpook National University School of Medicine, Kyungpook National University Hospital, Daegu, South Korea
| | - Chan-Duck Kim
- Division of Nephrology, Department of Internal Medicine, Kyungpook National University School of Medicine, Kyungpook National University Hospital, Daegu, South Korea
| | - Yong-Lim Kim
- Division of Nephrology, Department of Internal Medicine, Kyungpook National University School of Medicine, Kyungpook National University Hospital, Daegu, South Korea
| | - Jang-Hee Cho
- Division of Nephrology, Department of Internal Medicine, Kyungpook National University School of Medicine, Kyungpook National University Hospital, Daegu, South Korea
| | - Jeong-Hoon Lim
- Division of Nephrology, Department of Internal Medicine, Kyungpook National University School of Medicine, Kyungpook National University Hospital, Daegu, South Korea
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13
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van Baarle FLF, van de Weerdt EK, van der Velden WJFM, Ruiterkamp RA, Tuinman PR, Ypma PF, van den Bergh WM, Demandt AMP, Kerver ED, Jansen AJG, Westerweel PE, Arbous SM, Determann RM, van Mook WNKA, Koeman M, Mäkelburg ABU, van Lienden KP, Binnekade JM, Biemond BJ, Vlaar APJ. Platelet Transfusion before CVC Placement in Patients with Thrombocytopenia. N Engl J Med 2023; 388:1956-1965. [PMID: 37224197 DOI: 10.1056/nejmoa2214322] [Citation(s) in RCA: 21] [Impact Index Per Article: 21.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
BACKGROUND Transfusion guidelines regarding platelet-count thresholds before the placement of a central venous catheter (CVC) offer conflicting recommendations because of a lack of good-quality evidence. The routine use of ultrasound guidance has decreased CVC-related bleeding complications. METHODS In a multicenter, randomized, controlled, noninferiority trial, we randomly assigned patients with severe thrombocytopenia (platelet count, 10,000 to 50,000 per cubic millimeter) who were being treated on the hematology ward or in the intensive care unit to receive either one unit of prophylactic platelet transfusion or no platelet transfusion before ultrasound-guided CVC placement. The primary outcome was catheter-related bleeding of grade 2 to 4; a key secondary outcome was grade 3 or 4 bleeding. The noninferiority margin was an upper boundary of the 90% confidence interval of 3.5 for the relative risk. RESULTS We included 373 episodes of CVC placement involving 338 patients in the per-protocol primary analysis. Catheter-related bleeding of grade 2 to 4 occurred in 9 of 188 patients (4.8%) in the transfusion group and in 22 of 185 patients (11.9%) in the no-transfusion group (relative risk, 2.45; 90% confidence interval [CI], 1.27 to 4.70). Catheter-related bleeding of grade 3 or 4 occurred in 4 of 188 patients (2.1%) in the transfusion group and in 9 of 185 patients (4.9%) in the no-transfusion group (relative risk, 2.43; 95% CI, 0.75 to 7.93). A total of 15 adverse events were observed; of these events, 13 (all grade 3 catheter-related bleeding [4 in the transfusion group and 9 in the no-transfusion group]) were categorized as serious. The net savings of withholding prophylactic platelet transfusion before CVC placement was $410 per catheter placement. CONCLUSIONS The withholding of prophylactic platelet transfusion before CVC placement in patients with a platelet count of 10,000 to 50,000 per cubic millimeter did not meet the predefined margin for noninferiority and resulted in more CVC-related bleeding events than prophylactic platelet transfusion. (Funded by ZonMw; PACER Dutch Trial Register number, NL5534.).
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Affiliation(s)
- Floor L F van Baarle
- From the Departments of Intensive Care Medicine (F.L.F.B., E.K.W., J.M.B., A.P.J.V.) and Hematology (B.J.B.) and the Laboratory of Experimental Intensive Care and Anesthesiology (F.L.F.B., E.K.W., A.P.J.V.), Amsterdam University Medical Centers location University of Amsterdam, the Department of Intensive Care Medicine, Amsterdam University Medical Centers location Vrije Universiteit Amsterdam (P.R.T.), and the Departments of Oncology (E.D.K.) and Intensive Care Medicine (R.M.D.), OLVG, Amsterdam, the Department of Hematology, Radboud University Medical Center, Nijmegen (W.J.F.M.V., R.A.R.), the Departments of Hematology (P.F.Y.) and Intensive Care Medicine (M.K.), Haga Ziekenhuis, the Hague, the Departments of Critical Care (W.M.B.) and Hematology (A.B.U.M.), University Medical Center Groningen, University of Groningen, Groningen, the Departments of Hematology (A.M.P.D.) and Intensive Care Medicine (W.N.K.A.M.), Maastricht University Medical Center, Maastricht, the Department of Hematology, Erasmus Medical Center, University Medical Center Rotterdam, Rotterdam (A.J.G.J.), the Department of Internal Medicine, Albert Schweitzer Ziekenhuis, Dordrecht (P.E.W.), the Department of Intensive Care Medicine, Leiden University Medical Center, Leiden (S.M.A.), and the Department of Interventional Radiology, St. Antonius Ziekenhuis, Nieuwegein (K.P.L.) - all in the Netherlands
| | - Emma K van de Weerdt
- From the Departments of Intensive Care Medicine (F.L.F.B., E.K.W., J.M.B., A.P.J.V.) and Hematology (B.J.B.) and the Laboratory of Experimental Intensive Care and Anesthesiology (F.L.F.B., E.K.W., A.P.J.V.), Amsterdam University Medical Centers location University of Amsterdam, the Department of Intensive Care Medicine, Amsterdam University Medical Centers location Vrije Universiteit Amsterdam (P.R.T.), and the Departments of Oncology (E.D.K.) and Intensive Care Medicine (R.M.D.), OLVG, Amsterdam, the Department of Hematology, Radboud University Medical Center, Nijmegen (W.J.F.M.V., R.A.R.), the Departments of Hematology (P.F.Y.) and Intensive Care Medicine (M.K.), Haga Ziekenhuis, the Hague, the Departments of Critical Care (W.M.B.) and Hematology (A.B.U.M.), University Medical Center Groningen, University of Groningen, Groningen, the Departments of Hematology (A.M.P.D.) and Intensive Care Medicine (W.N.K.A.M.), Maastricht University Medical Center, Maastricht, the Department of Hematology, Erasmus Medical Center, University Medical Center Rotterdam, Rotterdam (A.J.G.J.), the Department of Internal Medicine, Albert Schweitzer Ziekenhuis, Dordrecht (P.E.W.), the Department of Intensive Care Medicine, Leiden University Medical Center, Leiden (S.M.A.), and the Department of Interventional Radiology, St. Antonius Ziekenhuis, Nieuwegein (K.P.L.) - all in the Netherlands
| | - Walter J F M van der Velden
- From the Departments of Intensive Care Medicine (F.L.F.B., E.K.W., J.M.B., A.P.J.V.) and Hematology (B.J.B.) and the Laboratory of Experimental Intensive Care and Anesthesiology (F.L.F.B., E.K.W., A.P.J.V.), Amsterdam University Medical Centers location University of Amsterdam, the Department of Intensive Care Medicine, Amsterdam University Medical Centers location Vrije Universiteit Amsterdam (P.R.T.), and the Departments of Oncology (E.D.K.) and Intensive Care Medicine (R.M.D.), OLVG, Amsterdam, the Department of Hematology, Radboud University Medical Center, Nijmegen (W.J.F.M.V., R.A.R.), the Departments of Hematology (P.F.Y.) and Intensive Care Medicine (M.K.), Haga Ziekenhuis, the Hague, the Departments of Critical Care (W.M.B.) and Hematology (A.B.U.M.), University Medical Center Groningen, University of Groningen, Groningen, the Departments of Hematology (A.M.P.D.) and Intensive Care Medicine (W.N.K.A.M.), Maastricht University Medical Center, Maastricht, the Department of Hematology, Erasmus Medical Center, University Medical Center Rotterdam, Rotterdam (A.J.G.J.), the Department of Internal Medicine, Albert Schweitzer Ziekenhuis, Dordrecht (P.E.W.), the Department of Intensive Care Medicine, Leiden University Medical Center, Leiden (S.M.A.), and the Department of Interventional Radiology, St. Antonius Ziekenhuis, Nieuwegein (K.P.L.) - all in the Netherlands
| | - Roelof A Ruiterkamp
- From the Departments of Intensive Care Medicine (F.L.F.B., E.K.W., J.M.B., A.P.J.V.) and Hematology (B.J.B.) and the Laboratory of Experimental Intensive Care and Anesthesiology (F.L.F.B., E.K.W., A.P.J.V.), Amsterdam University Medical Centers location University of Amsterdam, the Department of Intensive Care Medicine, Amsterdam University Medical Centers location Vrije Universiteit Amsterdam (P.R.T.), and the Departments of Oncology (E.D.K.) and Intensive Care Medicine (R.M.D.), OLVG, Amsterdam, the Department of Hematology, Radboud University Medical Center, Nijmegen (W.J.F.M.V., R.A.R.), the Departments of Hematology (P.F.Y.) and Intensive Care Medicine (M.K.), Haga Ziekenhuis, the Hague, the Departments of Critical Care (W.M.B.) and Hematology (A.B.U.M.), University Medical Center Groningen, University of Groningen, Groningen, the Departments of Hematology (A.M.P.D.) and Intensive Care Medicine (W.N.K.A.M.), Maastricht University Medical Center, Maastricht, the Department of Hematology, Erasmus Medical Center, University Medical Center Rotterdam, Rotterdam (A.J.G.J.), the Department of Internal Medicine, Albert Schweitzer Ziekenhuis, Dordrecht (P.E.W.), the Department of Intensive Care Medicine, Leiden University Medical Center, Leiden (S.M.A.), and the Department of Interventional Radiology, St. Antonius Ziekenhuis, Nieuwegein (K.P.L.) - all in the Netherlands
| | - Pieter R Tuinman
- From the Departments of Intensive Care Medicine (F.L.F.B., E.K.W., J.M.B., A.P.J.V.) and Hematology (B.J.B.) and the Laboratory of Experimental Intensive Care and Anesthesiology (F.L.F.B., E.K.W., A.P.J.V.), Amsterdam University Medical Centers location University of Amsterdam, the Department of Intensive Care Medicine, Amsterdam University Medical Centers location Vrije Universiteit Amsterdam (P.R.T.), and the Departments of Oncology (E.D.K.) and Intensive Care Medicine (R.M.D.), OLVG, Amsterdam, the Department of Hematology, Radboud University Medical Center, Nijmegen (W.J.F.M.V., R.A.R.), the Departments of Hematology (P.F.Y.) and Intensive Care Medicine (M.K.), Haga Ziekenhuis, the Hague, the Departments of Critical Care (W.M.B.) and Hematology (A.B.U.M.), University Medical Center Groningen, University of Groningen, Groningen, the Departments of Hematology (A.M.P.D.) and Intensive Care Medicine (W.N.K.A.M.), Maastricht University Medical Center, Maastricht, the Department of Hematology, Erasmus Medical Center, University Medical Center Rotterdam, Rotterdam (A.J.G.J.), the Department of Internal Medicine, Albert Schweitzer Ziekenhuis, Dordrecht (P.E.W.), the Department of Intensive Care Medicine, Leiden University Medical Center, Leiden (S.M.A.), and the Department of Interventional Radiology, St. Antonius Ziekenhuis, Nieuwegein (K.P.L.) - all in the Netherlands
| | - Paula F Ypma
- From the Departments of Intensive Care Medicine (F.L.F.B., E.K.W., J.M.B., A.P.J.V.) and Hematology (B.J.B.) and the Laboratory of Experimental Intensive Care and Anesthesiology (F.L.F.B., E.K.W., A.P.J.V.), Amsterdam University Medical Centers location University of Amsterdam, the Department of Intensive Care Medicine, Amsterdam University Medical Centers location Vrije Universiteit Amsterdam (P.R.T.), and the Departments of Oncology (E.D.K.) and Intensive Care Medicine (R.M.D.), OLVG, Amsterdam, the Department of Hematology, Radboud University Medical Center, Nijmegen (W.J.F.M.V., R.A.R.), the Departments of Hematology (P.F.Y.) and Intensive Care Medicine (M.K.), Haga Ziekenhuis, the Hague, the Departments of Critical Care (W.M.B.) and Hematology (A.B.U.M.), University Medical Center Groningen, University of Groningen, Groningen, the Departments of Hematology (A.M.P.D.) and Intensive Care Medicine (W.N.K.A.M.), Maastricht University Medical Center, Maastricht, the Department of Hematology, Erasmus Medical Center, University Medical Center Rotterdam, Rotterdam (A.J.G.J.), the Department of Internal Medicine, Albert Schweitzer Ziekenhuis, Dordrecht (P.E.W.), the Department of Intensive Care Medicine, Leiden University Medical Center, Leiden (S.M.A.), and the Department of Interventional Radiology, St. Antonius Ziekenhuis, Nieuwegein (K.P.L.) - all in the Netherlands
| | - Walter M van den Bergh
- From the Departments of Intensive Care Medicine (F.L.F.B., E.K.W., J.M.B., A.P.J.V.) and Hematology (B.J.B.) and the Laboratory of Experimental Intensive Care and Anesthesiology (F.L.F.B., E.K.W., A.P.J.V.), Amsterdam University Medical Centers location University of Amsterdam, the Department of Intensive Care Medicine, Amsterdam University Medical Centers location Vrije Universiteit Amsterdam (P.R.T.), and the Departments of Oncology (E.D.K.) and Intensive Care Medicine (R.M.D.), OLVG, Amsterdam, the Department of Hematology, Radboud University Medical Center, Nijmegen (W.J.F.M.V., R.A.R.), the Departments of Hematology (P.F.Y.) and Intensive Care Medicine (M.K.), Haga Ziekenhuis, the Hague, the Departments of Critical Care (W.M.B.) and Hematology (A.B.U.M.), University Medical Center Groningen, University of Groningen, Groningen, the Departments of Hematology (A.M.P.D.) and Intensive Care Medicine (W.N.K.A.M.), Maastricht University Medical Center, Maastricht, the Department of Hematology, Erasmus Medical Center, University Medical Center Rotterdam, Rotterdam (A.J.G.J.), the Department of Internal Medicine, Albert Schweitzer Ziekenhuis, Dordrecht (P.E.W.), the Department of Intensive Care Medicine, Leiden University Medical Center, Leiden (S.M.A.), and the Department of Interventional Radiology, St. Antonius Ziekenhuis, Nieuwegein (K.P.L.) - all in the Netherlands
| | - Astrid M P Demandt
- From the Departments of Intensive Care Medicine (F.L.F.B., E.K.W., J.M.B., A.P.J.V.) and Hematology (B.J.B.) and the Laboratory of Experimental Intensive Care and Anesthesiology (F.L.F.B., E.K.W., A.P.J.V.), Amsterdam University Medical Centers location University of Amsterdam, the Department of Intensive Care Medicine, Amsterdam University Medical Centers location Vrije Universiteit Amsterdam (P.R.T.), and the Departments of Oncology (E.D.K.) and Intensive Care Medicine (R.M.D.), OLVG, Amsterdam, the Department of Hematology, Radboud University Medical Center, Nijmegen (W.J.F.M.V., R.A.R.), the Departments of Hematology (P.F.Y.) and Intensive Care Medicine (M.K.), Haga Ziekenhuis, the Hague, the Departments of Critical Care (W.M.B.) and Hematology (A.B.U.M.), University Medical Center Groningen, University of Groningen, Groningen, the Departments of Hematology (A.M.P.D.) and Intensive Care Medicine (W.N.K.A.M.), Maastricht University Medical Center, Maastricht, the Department of Hematology, Erasmus Medical Center, University Medical Center Rotterdam, Rotterdam (A.J.G.J.), the Department of Internal Medicine, Albert Schweitzer Ziekenhuis, Dordrecht (P.E.W.), the Department of Intensive Care Medicine, Leiden University Medical Center, Leiden (S.M.A.), and the Department of Interventional Radiology, St. Antonius Ziekenhuis, Nieuwegein (K.P.L.) - all in the Netherlands
| | - Emile D Kerver
- From the Departments of Intensive Care Medicine (F.L.F.B., E.K.W., J.M.B., A.P.J.V.) and Hematology (B.J.B.) and the Laboratory of Experimental Intensive Care and Anesthesiology (F.L.F.B., E.K.W., A.P.J.V.), Amsterdam University Medical Centers location University of Amsterdam, the Department of Intensive Care Medicine, Amsterdam University Medical Centers location Vrije Universiteit Amsterdam (P.R.T.), and the Departments of Oncology (E.D.K.) and Intensive Care Medicine (R.M.D.), OLVG, Amsterdam, the Department of Hematology, Radboud University Medical Center, Nijmegen (W.J.F.M.V., R.A.R.), the Departments of Hematology (P.F.Y.) and Intensive Care Medicine (M.K.), Haga Ziekenhuis, the Hague, the Departments of Critical Care (W.M.B.) and Hematology (A.B.U.M.), University Medical Center Groningen, University of Groningen, Groningen, the Departments of Hematology (A.M.P.D.) and Intensive Care Medicine (W.N.K.A.M.), Maastricht University Medical Center, Maastricht, the Department of Hematology, Erasmus Medical Center, University Medical Center Rotterdam, Rotterdam (A.J.G.J.), the Department of Internal Medicine, Albert Schweitzer Ziekenhuis, Dordrecht (P.E.W.), the Department of Intensive Care Medicine, Leiden University Medical Center, Leiden (S.M.A.), and the Department of Interventional Radiology, St. Antonius Ziekenhuis, Nieuwegein (K.P.L.) - all in the Netherlands
| | - A J Gerard Jansen
- From the Departments of Intensive Care Medicine (F.L.F.B., E.K.W., J.M.B., A.P.J.V.) and Hematology (B.J.B.) and the Laboratory of Experimental Intensive Care and Anesthesiology (F.L.F.B., E.K.W., A.P.J.V.), Amsterdam University Medical Centers location University of Amsterdam, the Department of Intensive Care Medicine, Amsterdam University Medical Centers location Vrije Universiteit Amsterdam (P.R.T.), and the Departments of Oncology (E.D.K.) and Intensive Care Medicine (R.M.D.), OLVG, Amsterdam, the Department of Hematology, Radboud University Medical Center, Nijmegen (W.J.F.M.V., R.A.R.), the Departments of Hematology (P.F.Y.) and Intensive Care Medicine (M.K.), Haga Ziekenhuis, the Hague, the Departments of Critical Care (W.M.B.) and Hematology (A.B.U.M.), University Medical Center Groningen, University of Groningen, Groningen, the Departments of Hematology (A.M.P.D.) and Intensive Care Medicine (W.N.K.A.M.), Maastricht University Medical Center, Maastricht, the Department of Hematology, Erasmus Medical Center, University Medical Center Rotterdam, Rotterdam (A.J.G.J.), the Department of Internal Medicine, Albert Schweitzer Ziekenhuis, Dordrecht (P.E.W.), the Department of Intensive Care Medicine, Leiden University Medical Center, Leiden (S.M.A.), and the Department of Interventional Radiology, St. Antonius Ziekenhuis, Nieuwegein (K.P.L.) - all in the Netherlands
| | - Peter E Westerweel
- From the Departments of Intensive Care Medicine (F.L.F.B., E.K.W., J.M.B., A.P.J.V.) and Hematology (B.J.B.) and the Laboratory of Experimental Intensive Care and Anesthesiology (F.L.F.B., E.K.W., A.P.J.V.), Amsterdam University Medical Centers location University of Amsterdam, the Department of Intensive Care Medicine, Amsterdam University Medical Centers location Vrije Universiteit Amsterdam (P.R.T.), and the Departments of Oncology (E.D.K.) and Intensive Care Medicine (R.M.D.), OLVG, Amsterdam, the Department of Hematology, Radboud University Medical Center, Nijmegen (W.J.F.M.V., R.A.R.), the Departments of Hematology (P.F.Y.) and Intensive Care Medicine (M.K.), Haga Ziekenhuis, the Hague, the Departments of Critical Care (W.M.B.) and Hematology (A.B.U.M.), University Medical Center Groningen, University of Groningen, Groningen, the Departments of Hematology (A.M.P.D.) and Intensive Care Medicine (W.N.K.A.M.), Maastricht University Medical Center, Maastricht, the Department of Hematology, Erasmus Medical Center, University Medical Center Rotterdam, Rotterdam (A.J.G.J.), the Department of Internal Medicine, Albert Schweitzer Ziekenhuis, Dordrecht (P.E.W.), the Department of Intensive Care Medicine, Leiden University Medical Center, Leiden (S.M.A.), and the Department of Interventional Radiology, St. Antonius Ziekenhuis, Nieuwegein (K.P.L.) - all in the Netherlands
| | - Sesmu M Arbous
- From the Departments of Intensive Care Medicine (F.L.F.B., E.K.W., J.M.B., A.P.J.V.) and Hematology (B.J.B.) and the Laboratory of Experimental Intensive Care and Anesthesiology (F.L.F.B., E.K.W., A.P.J.V.), Amsterdam University Medical Centers location University of Amsterdam, the Department of Intensive Care Medicine, Amsterdam University Medical Centers location Vrije Universiteit Amsterdam (P.R.T.), and the Departments of Oncology (E.D.K.) and Intensive Care Medicine (R.M.D.), OLVG, Amsterdam, the Department of Hematology, Radboud University Medical Center, Nijmegen (W.J.F.M.V., R.A.R.), the Departments of Hematology (P.F.Y.) and Intensive Care Medicine (M.K.), Haga Ziekenhuis, the Hague, the Departments of Critical Care (W.M.B.) and Hematology (A.B.U.M.), University Medical Center Groningen, University of Groningen, Groningen, the Departments of Hematology (A.M.P.D.) and Intensive Care Medicine (W.N.K.A.M.), Maastricht University Medical Center, Maastricht, the Department of Hematology, Erasmus Medical Center, University Medical Center Rotterdam, Rotterdam (A.J.G.J.), the Department of Internal Medicine, Albert Schweitzer Ziekenhuis, Dordrecht (P.E.W.), the Department of Intensive Care Medicine, Leiden University Medical Center, Leiden (S.M.A.), and the Department of Interventional Radiology, St. Antonius Ziekenhuis, Nieuwegein (K.P.L.) - all in the Netherlands
| | - Rogier M Determann
- From the Departments of Intensive Care Medicine (F.L.F.B., E.K.W., J.M.B., A.P.J.V.) and Hematology (B.J.B.) and the Laboratory of Experimental Intensive Care and Anesthesiology (F.L.F.B., E.K.W., A.P.J.V.), Amsterdam University Medical Centers location University of Amsterdam, the Department of Intensive Care Medicine, Amsterdam University Medical Centers location Vrije Universiteit Amsterdam (P.R.T.), and the Departments of Oncology (E.D.K.) and Intensive Care Medicine (R.M.D.), OLVG, Amsterdam, the Department of Hematology, Radboud University Medical Center, Nijmegen (W.J.F.M.V., R.A.R.), the Departments of Hematology (P.F.Y.) and Intensive Care Medicine (M.K.), Haga Ziekenhuis, the Hague, the Departments of Critical Care (W.M.B.) and Hematology (A.B.U.M.), University Medical Center Groningen, University of Groningen, Groningen, the Departments of Hematology (A.M.P.D.) and Intensive Care Medicine (W.N.K.A.M.), Maastricht University Medical Center, Maastricht, the Department of Hematology, Erasmus Medical Center, University Medical Center Rotterdam, Rotterdam (A.J.G.J.), the Department of Internal Medicine, Albert Schweitzer Ziekenhuis, Dordrecht (P.E.W.), the Department of Intensive Care Medicine, Leiden University Medical Center, Leiden (S.M.A.), and the Department of Interventional Radiology, St. Antonius Ziekenhuis, Nieuwegein (K.P.L.) - all in the Netherlands
| | - Walther N K A van Mook
- From the Departments of Intensive Care Medicine (F.L.F.B., E.K.W., J.M.B., A.P.J.V.) and Hematology (B.J.B.) and the Laboratory of Experimental Intensive Care and Anesthesiology (F.L.F.B., E.K.W., A.P.J.V.), Amsterdam University Medical Centers location University of Amsterdam, the Department of Intensive Care Medicine, Amsterdam University Medical Centers location Vrije Universiteit Amsterdam (P.R.T.), and the Departments of Oncology (E.D.K.) and Intensive Care Medicine (R.M.D.), OLVG, Amsterdam, the Department of Hematology, Radboud University Medical Center, Nijmegen (W.J.F.M.V., R.A.R.), the Departments of Hematology (P.F.Y.) and Intensive Care Medicine (M.K.), Haga Ziekenhuis, the Hague, the Departments of Critical Care (W.M.B.) and Hematology (A.B.U.M.), University Medical Center Groningen, University of Groningen, Groningen, the Departments of Hematology (A.M.P.D.) and Intensive Care Medicine (W.N.K.A.M.), Maastricht University Medical Center, Maastricht, the Department of Hematology, Erasmus Medical Center, University Medical Center Rotterdam, Rotterdam (A.J.G.J.), the Department of Internal Medicine, Albert Schweitzer Ziekenhuis, Dordrecht (P.E.W.), the Department of Intensive Care Medicine, Leiden University Medical Center, Leiden (S.M.A.), and the Department of Interventional Radiology, St. Antonius Ziekenhuis, Nieuwegein (K.P.L.) - all in the Netherlands
| | - Mirelle Koeman
- From the Departments of Intensive Care Medicine (F.L.F.B., E.K.W., J.M.B., A.P.J.V.) and Hematology (B.J.B.) and the Laboratory of Experimental Intensive Care and Anesthesiology (F.L.F.B., E.K.W., A.P.J.V.), Amsterdam University Medical Centers location University of Amsterdam, the Department of Intensive Care Medicine, Amsterdam University Medical Centers location Vrije Universiteit Amsterdam (P.R.T.), and the Departments of Oncology (E.D.K.) and Intensive Care Medicine (R.M.D.), OLVG, Amsterdam, the Department of Hematology, Radboud University Medical Center, Nijmegen (W.J.F.M.V., R.A.R.), the Departments of Hematology (P.F.Y.) and Intensive Care Medicine (M.K.), Haga Ziekenhuis, the Hague, the Departments of Critical Care (W.M.B.) and Hematology (A.B.U.M.), University Medical Center Groningen, University of Groningen, Groningen, the Departments of Hematology (A.M.P.D.) and Intensive Care Medicine (W.N.K.A.M.), Maastricht University Medical Center, Maastricht, the Department of Hematology, Erasmus Medical Center, University Medical Center Rotterdam, Rotterdam (A.J.G.J.), the Department of Internal Medicine, Albert Schweitzer Ziekenhuis, Dordrecht (P.E.W.), the Department of Intensive Care Medicine, Leiden University Medical Center, Leiden (S.M.A.), and the Department of Interventional Radiology, St. Antonius Ziekenhuis, Nieuwegein (K.P.L.) - all in the Netherlands
| | - Anja B U Mäkelburg
- From the Departments of Intensive Care Medicine (F.L.F.B., E.K.W., J.M.B., A.P.J.V.) and Hematology (B.J.B.) and the Laboratory of Experimental Intensive Care and Anesthesiology (F.L.F.B., E.K.W., A.P.J.V.), Amsterdam University Medical Centers location University of Amsterdam, the Department of Intensive Care Medicine, Amsterdam University Medical Centers location Vrije Universiteit Amsterdam (P.R.T.), and the Departments of Oncology (E.D.K.) and Intensive Care Medicine (R.M.D.), OLVG, Amsterdam, the Department of Hematology, Radboud University Medical Center, Nijmegen (W.J.F.M.V., R.A.R.), the Departments of Hematology (P.F.Y.) and Intensive Care Medicine (M.K.), Haga Ziekenhuis, the Hague, the Departments of Critical Care (W.M.B.) and Hematology (A.B.U.M.), University Medical Center Groningen, University of Groningen, Groningen, the Departments of Hematology (A.M.P.D.) and Intensive Care Medicine (W.N.K.A.M.), Maastricht University Medical Center, Maastricht, the Department of Hematology, Erasmus Medical Center, University Medical Center Rotterdam, Rotterdam (A.J.G.J.), the Department of Internal Medicine, Albert Schweitzer Ziekenhuis, Dordrecht (P.E.W.), the Department of Intensive Care Medicine, Leiden University Medical Center, Leiden (S.M.A.), and the Department of Interventional Radiology, St. Antonius Ziekenhuis, Nieuwegein (K.P.L.) - all in the Netherlands
| | - Krijn P van Lienden
- From the Departments of Intensive Care Medicine (F.L.F.B., E.K.W., J.M.B., A.P.J.V.) and Hematology (B.J.B.) and the Laboratory of Experimental Intensive Care and Anesthesiology (F.L.F.B., E.K.W., A.P.J.V.), Amsterdam University Medical Centers location University of Amsterdam, the Department of Intensive Care Medicine, Amsterdam University Medical Centers location Vrije Universiteit Amsterdam (P.R.T.), and the Departments of Oncology (E.D.K.) and Intensive Care Medicine (R.M.D.), OLVG, Amsterdam, the Department of Hematology, Radboud University Medical Center, Nijmegen (W.J.F.M.V., R.A.R.), the Departments of Hematology (P.F.Y.) and Intensive Care Medicine (M.K.), Haga Ziekenhuis, the Hague, the Departments of Critical Care (W.M.B.) and Hematology (A.B.U.M.), University Medical Center Groningen, University of Groningen, Groningen, the Departments of Hematology (A.M.P.D.) and Intensive Care Medicine (W.N.K.A.M.), Maastricht University Medical Center, Maastricht, the Department of Hematology, Erasmus Medical Center, University Medical Center Rotterdam, Rotterdam (A.J.G.J.), the Department of Internal Medicine, Albert Schweitzer Ziekenhuis, Dordrecht (P.E.W.), the Department of Intensive Care Medicine, Leiden University Medical Center, Leiden (S.M.A.), and the Department of Interventional Radiology, St. Antonius Ziekenhuis, Nieuwegein (K.P.L.) - all in the Netherlands
| | - Jan M Binnekade
- From the Departments of Intensive Care Medicine (F.L.F.B., E.K.W., J.M.B., A.P.J.V.) and Hematology (B.J.B.) and the Laboratory of Experimental Intensive Care and Anesthesiology (F.L.F.B., E.K.W., A.P.J.V.), Amsterdam University Medical Centers location University of Amsterdam, the Department of Intensive Care Medicine, Amsterdam University Medical Centers location Vrije Universiteit Amsterdam (P.R.T.), and the Departments of Oncology (E.D.K.) and Intensive Care Medicine (R.M.D.), OLVG, Amsterdam, the Department of Hematology, Radboud University Medical Center, Nijmegen (W.J.F.M.V., R.A.R.), the Departments of Hematology (P.F.Y.) and Intensive Care Medicine (M.K.), Haga Ziekenhuis, the Hague, the Departments of Critical Care (W.M.B.) and Hematology (A.B.U.M.), University Medical Center Groningen, University of Groningen, Groningen, the Departments of Hematology (A.M.P.D.) and Intensive Care Medicine (W.N.K.A.M.), Maastricht University Medical Center, Maastricht, the Department of Hematology, Erasmus Medical Center, University Medical Center Rotterdam, Rotterdam (A.J.G.J.), the Department of Internal Medicine, Albert Schweitzer Ziekenhuis, Dordrecht (P.E.W.), the Department of Intensive Care Medicine, Leiden University Medical Center, Leiden (S.M.A.), and the Department of Interventional Radiology, St. Antonius Ziekenhuis, Nieuwegein (K.P.L.) - all in the Netherlands
| | - Bart J Biemond
- From the Departments of Intensive Care Medicine (F.L.F.B., E.K.W., J.M.B., A.P.J.V.) and Hematology (B.J.B.) and the Laboratory of Experimental Intensive Care and Anesthesiology (F.L.F.B., E.K.W., A.P.J.V.), Amsterdam University Medical Centers location University of Amsterdam, the Department of Intensive Care Medicine, Amsterdam University Medical Centers location Vrije Universiteit Amsterdam (P.R.T.), and the Departments of Oncology (E.D.K.) and Intensive Care Medicine (R.M.D.), OLVG, Amsterdam, the Department of Hematology, Radboud University Medical Center, Nijmegen (W.J.F.M.V., R.A.R.), the Departments of Hematology (P.F.Y.) and Intensive Care Medicine (M.K.), Haga Ziekenhuis, the Hague, the Departments of Critical Care (W.M.B.) and Hematology (A.B.U.M.), University Medical Center Groningen, University of Groningen, Groningen, the Departments of Hematology (A.M.P.D.) and Intensive Care Medicine (W.N.K.A.M.), Maastricht University Medical Center, Maastricht, the Department of Hematology, Erasmus Medical Center, University Medical Center Rotterdam, Rotterdam (A.J.G.J.), the Department of Internal Medicine, Albert Schweitzer Ziekenhuis, Dordrecht (P.E.W.), the Department of Intensive Care Medicine, Leiden University Medical Center, Leiden (S.M.A.), and the Department of Interventional Radiology, St. Antonius Ziekenhuis, Nieuwegein (K.P.L.) - all in the Netherlands
| | - Alexander P J Vlaar
- From the Departments of Intensive Care Medicine (F.L.F.B., E.K.W., J.M.B., A.P.J.V.) and Hematology (B.J.B.) and the Laboratory of Experimental Intensive Care and Anesthesiology (F.L.F.B., E.K.W., A.P.J.V.), Amsterdam University Medical Centers location University of Amsterdam, the Department of Intensive Care Medicine, Amsterdam University Medical Centers location Vrije Universiteit Amsterdam (P.R.T.), and the Departments of Oncology (E.D.K.) and Intensive Care Medicine (R.M.D.), OLVG, Amsterdam, the Department of Hematology, Radboud University Medical Center, Nijmegen (W.J.F.M.V., R.A.R.), the Departments of Hematology (P.F.Y.) and Intensive Care Medicine (M.K.), Haga Ziekenhuis, the Hague, the Departments of Critical Care (W.M.B.) and Hematology (A.B.U.M.), University Medical Center Groningen, University of Groningen, Groningen, the Departments of Hematology (A.M.P.D.) and Intensive Care Medicine (W.N.K.A.M.), Maastricht University Medical Center, Maastricht, the Department of Hematology, Erasmus Medical Center, University Medical Center Rotterdam, Rotterdam (A.J.G.J.), the Department of Internal Medicine, Albert Schweitzer Ziekenhuis, Dordrecht (P.E.W.), the Department of Intensive Care Medicine, Leiden University Medical Center, Leiden (S.M.A.), and the Department of Interventional Radiology, St. Antonius Ziekenhuis, Nieuwegein (K.P.L.) - all in the Netherlands
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Chen YE, Ren FL, Gu X, Zhang HJ, Li WJ, Yang H, Shang FQ. Clinical Value of Platelets and Coagulation Parameters in Predicting the Severity of Delta Variant SARS-CoV-2. Pathobiology 2023; 90:241-250. [PMID: 36724757 PMCID: PMC9940264 DOI: 10.1159/000528318] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2022] [Accepted: 11/21/2022] [Indexed: 02/03/2023] Open
Abstract
INTRODUCTION The present study aimed to analyze the clinical features and laboratory markers of patients with Delta variant SARS-CoV-2 and explore the role of platelet in predicting the severity of Delta. METHODS This retrospective, observational study was conducted on 863 patients laboratory-confirmed Delta variant SARS-CoV-2. These cases were sub-classified based on disease severity into mild (n = 304), moderate (n = 537), and severe (n = 22). A series of laboratory findings and clinical data were collected and analyzed during hospitalization. RESULTS Of 863 hospitalized patients with Delta, the median age was 38 years (interquartile range, 30-51 years) and 471 (54.58%) were male. The most common clinical symptoms mainly included cough, fever, pharyngalgia, expectoration, dyspnea, fatigue, and headache, and the commonest comorbidities were hypertension and diabetes. Among the hematological variables, neutrophil count, red blood cell count, and hemoglobin, were found to be statistically significant with regard to subcategories based of disease severity (p < 0.05). Among coagulation parameters, there was a statistically significant difference in D-dimer, fibrinogen, international normalized ratio, and prothrombin time (p < 0.05). Statistically significant differences were observed in platelet markers including platelet count, large platelet count, and plateletcrit (p < 0.05). Additionally, there was strong correlation between platelet and other parameters with disease severity. Logistical regression analysis and ROC curves showed that D-dimer was a single best marker of disease severity (p = 0.005, p < 0.0001); however, platelet (p = 0.009, p = 0.002) and plateletcrit (p = 0.002, p = 0.001) could also predict severe disease. Platelet was identified as an independent risk factor for severe Delta. CONCLUSION Low platelet may be a marker of disease severity in Delta variant SARS-CoV-2 and may contribute to determine the severity of patients infected with Delta.
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Affiliation(s)
- Yue-e Chen
- Translational Medicine Center, Xi'an Chest Hospital, The Affiliated Chest Hospital of Xi'an Jiaotong University Medical School, Xi'an, China
| | - Fu-le Ren
- Department of Information, Xi'an Chest Hospital, The Affiliated Chest Hospital of Xi'an Jiaotong University Medical School, Xi'an, China
| | - Xing Gu
- Department of Respiratory and Critical Care Medicine, Xi'an Chest Hospital, The Affiliated Chest Hospital of Xi'an Jiaotong University Medical School, Xi'an, China
| | - Hong-jun Zhang
- Department of Respiratory and Critical Care Medicine, Xi'an Chest Hospital, The Affiliated Chest Hospital of Xi'an Jiaotong University Medical School, Xi'an, China
| | - Wen-jie Li
- Department of Respiratory and Critical Care Medicine, Xi'an Chest Hospital, The Affiliated Chest Hospital of Xi'an Jiaotong University Medical School, Xi'an, China
| | - Han Yang
- Translational Medicine Center, Xi'an Chest Hospital, The Affiliated Chest Hospital of Xi'an Jiaotong University Medical School, Xi'an, China
| | - Fen-qing Shang
- Translational Medicine Center, Xi'an Chest Hospital, The Affiliated Chest Hospital of Xi'an Jiaotong University Medical School, Xi'an, China
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15
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Cavallazzi R, Bradley J, Chandler T, Furmanek S, Ramirez JA. Severity of Illness Scores and Biomarkers for Prognosis of Patients with Coronavirus Disease 2019. Semin Respir Crit Care Med 2023; 44:75-90. [PMID: 36646087 DOI: 10.1055/s-0042-1759567] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
The spectrum of disease severity and the insidiousness of clinical presentation make it difficult to recognize patients with coronavirus disease 2019 (COVID-19) at higher risk of worse outcomes or death when they are seen in the early phases of the disease. There are now well-established risk factors for worse outcomes in patients with COVID-19. These should be factored in when assessing the prognosis of these patients. However, a more precise prognostic assessment in an individual patient may warrant the use of predictive tools. In this manuscript, we conduct a literature review on the severity of illness scores and biomarkers for the prognosis of patients with COVID-19. Several COVID-19-specific scores have been developed since the onset of the pandemic. Some of them are promising and can be integrated into the assessment of these patients. We also found that the well-known pneumonia severity index (PSI) and CURB-65 (confusion, uremia, respiratory rate, BP, age ≥ 65 years) are good predictors of mortality in hospitalized patients with COVID-19. While neither the PSI nor the CURB-65 should be used for the triage of outpatient versus inpatient treatment, they can be integrated by a clinician into the assessment of disease severity and can be used in epidemiological studies to determine the severity of illness in patient populations. Biomarkers also provide valuable prognostic information and, importantly, may depict the main physiological derangements in severe disease. We, however, do not advocate the isolated use of severity of illness scores or biomarkers for decision-making in an individual patient. Instead, we suggest the use of these tools on a case-by-case basis with the goal of enhancing clinician judgment.
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Affiliation(s)
- Rodrigo Cavallazzi
- Division of Pulmonary, Critical Care Medicine, and Sleep Disorders, University of Louisville, Norton Healthcare, Louisville, Kentucky
| | - James Bradley
- Division of Pulmonary, Critical Care Medicine, and Sleep Disorders, University of Louisville, Norton Healthcare, Louisville, Kentucky
| | - Thomas Chandler
- Norton Infectious Diseases Institute, Norton Healthcare, Louisville, Kentucky
| | - Stephen Furmanek
- Norton Infectious Diseases Institute, Norton Healthcare, Louisville, Kentucky
| | - Julio A Ramirez
- Norton Infectious Diseases Institute, Norton Healthcare, Louisville, Kentucky
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Is Thrombocytopenia an In-Hospital Mortality Risk Factor among Patients with Acute Ischemic Stroke? A Propensity Score-Matched Analysis from the MIMIC-IV Database. J Clin Med 2023; 12:jcm12020580. [PMID: 36675509 PMCID: PMC9861395 DOI: 10.3390/jcm12020580] [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: 12/08/2022] [Revised: 01/02/2023] [Accepted: 01/09/2023] [Indexed: 01/13/2023] Open
Abstract
(1) Background: We aimed to evaluate the aspect of thrombocytopenia in patients with acute ischemic stroke (AIS); (2) Methods: Patients with AIS were recruited in the Medical Information Mart for Intensive Care IV database from 2008 to 2019. The thrombocytopenia was defined as a platelet blood count of less than 150 K/µL. We compared the patient characteristics and clinical outcomes using propensity score matching (PSM); (3) Results: Thrombocytopenia affected 151 out of the 1236 patients (12.2%). Patients with thrombocytopenia were older (70.5 ± 12.8 vs. 68.4 ± 14.4; SMD = 0.154) and had a higher Charlson comorbidity index (7.3 ± 2.5 vs. 6.7 ± 2.7; SMD = 0.228) and acute physiology score III (44.8 ± 21.0 vs. 38.2 ± 19.1; SMD = 0.328) than those without thrombocytopenia. The risk of in-hospital mortality did not increase linearly or nonlinearly with a lower platelet count (overall p value = 0.794; nonlinear p value = 0.646). After PSM, 147 pairs remained. Thrombocytopenia was not linked with in-hospital mortality (HR: 1.06, 95% CIs: 0.60-1.88); (4) Conclusions: We described the clinical characteristics of patients admitted for thrombocytopenia and AIS who did not receive reperfusion therapy; additionally, we found that thrombocytopenia was not an independent short-term risk factor of in-hospital mortality.
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Jiang X, Zhang W, Pan Y, Cheng X. Identification of subphenotypes in critically ill thrombocytopenic patients with different responses to therapeutic interventions: a retrospective study. Front Med (Lausanne) 2023; 10:1166896. [PMID: 37181358 PMCID: PMC10174319 DOI: 10.3389/fmed.2023.1166896] [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: 02/15/2023] [Accepted: 04/10/2023] [Indexed: 05/16/2023] Open
Abstract
Introduction The causes of thrombocytopenia (TP) in critically ill patients are numerous and heterogeneous. Currently, subphenotype identification is a popular approach to address this problem. Therefore, this study aimed to identify subphenotypes that respond differently to therapeutic interventions in patients with TP using routine clinical data and to improve individualized management of TP. Methods This retrospective study included patients with TP admitted to the intensive care unit (ICU) of Dongyang People's Hospital during 2010-2020. Subphenotypes were identified using latent profile analysis of 15 clinical variables. The Kaplan-Meier method was used to assess the risk of 30-day mortality for different subphenotypes. Multifactorial Cox regression analysis was used to analyze the relationship between therapeutic interventions and in-hospital mortality for different subphenotypes. Results This study included a total of 1,666 participants. Four subphenotypes were identified by latent profile analysis, with subphenotype 1 being the most abundant and having a low mortality rate. Subphenotype 2 was characterized by respiratory dysfunction, subphenotype 3 by renal insufficiency, and subphenotype 4 by shock-like features. Kaplan-Meier analysis revealed that the four subphenotypes had different in-30-day mortality rates. The multivariate Cox regression analysis indicated a significant interaction between platelet transfusion and subphenotype, with more platelet transfusion associated with a decreased risk of in-hospital mortality in subphenotype 3 [hazard ratio (HR): 0.66, 95% confidence interval (CI): 0.46-0.94]. In addition, there was a significant interaction between fluid intake and subphenotype, with a higher fluid intake being associated with a decreased risk of in-hospital mortality for subphenotype 3 (HR: 0.94, 95% CI: 0.89-0.99 per 1 l increase in fluid intake) and an increased risk of in-hospital mortality for high fluid intake in subphenotypes 1 (HR: 1.10, 95% CI: 1.03-1.18 per 1 l increase in fluid intake) and 2 (HR: 1.19, 95% CI: 1.08-1.32 per 1 l increase in fluid intake). Conclusion Four subphenotypes of TP in critically ill patients with different clinical characteristics and outcomes and differential responses to therapeutic interventions were identified using routine clinical data. These findings can help improve the identification of different subphenotypes in patients with TP for better individualized treatment of patients in the ICU.
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Kometani S, Kawai M, Teraoka N, Miyazaki R, Ikezaki H. Evaluation of Platelet Function Using Thromboelastography for a Patient With Pseudothrombocytopenia Requiring Cardiac Reoperation. Cureus 2022; 14:e28366. [PMID: 36171853 PMCID: PMC9508524 DOI: 10.7759/cureus.28366] [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] [Accepted: 08/24/2022] [Indexed: 11/21/2022] Open
Abstract
Pseudothrombocytopenia (PTCP) is a phenomenon in which platelet aggregation occurs in vitro when an anticoagulant such as ethylenediaminetetraacetic acid (EDTA) is used in a blood sample, causing automated cell counters (ACC) to calculate a lower platelet count than the actual count. While a peripheral blood smear is required to assess platelet count in PTCP accurately, such a time-consuming test is not accessible during the perioperative period. In this study, we evaluated platelet function using thromboelastography (TEG) for a patient with PTCP requiring cardiac reoperation. The preoperative TEG value of the patient was within the normal range, suggesting that TEG for PTCP reflects platelet function more accurately than ACC. Since there is an insufficient number of case reports on the use of TEG for PTCP, it is necessary to consider its usefulness not only during the perioperative period but also for other critical care.
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Santoshi RK, Patel R, Patel NS, Bansro V, Chhabra G. A Comprehensive Review of Thrombocytopenia With a Spotlight on Intensive Care Patients. Cureus 2022; 14:e27718. [PMID: 35949449 PMCID: PMC9356658 DOI: 10.7759/cureus.27718] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/05/2022] [Indexed: 01/31/2023] Open
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Xu W, Fu Y, Yao Y, Zhou J, Zhou H. Nosocomial Infections in Nonsurgical Patients Undergoing Extracorporeal Membrane Oxygenation: A Retrospective Analysis in a Chinese Hospital. Infect Drug Resist 2022; 15:4117-4126. [PMID: 35937786 PMCID: PMC9347224 DOI: 10.2147/idr.s372913] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2022] [Accepted: 07/26/2022] [Indexed: 11/24/2022] Open
Abstract
Background The effect of nosocomial infections (NIs) in adult patients undergoing ECMO has been rarely reported in China. Moreover, the effect of NIs on ECMO patients’ mortality is still unclear and inconclusive according to literature data. In this study, we examined the prevalence, risk factors, causative organisms, and effects on outcomes of NIs in ECMO patients. Methods A total of 79 nonsurgical patients (mean age 53.3±15.2 year (yr); 66% male) who underwent ECMO between January 2011 and September 2020 were enrolled in this retrospective study. Patients’ demographic and clinical data and ECMO parameters were collected from all patients. Results Among 79 patients who underwent ECMO for a total of 1253 ECMO days (mean time 15.9±14.1 d), 42 developed NIs. We observed 30 ventilator-associated pneumonia (VAP), 19 bloodstream infections (BSIs), and 4 urinary tract infections, corresponding to 23.9/1000 ECMO days, 15.2/1000 ECMO days, and 3.2/1000 ECMO days, respectively. ECMO duration (22.0±16.5 VS 8.9±5.3 d, P < 0.001), invasive mechanical ventilation (IMV) duration (27.4±20.5 VS 11.4±10.1 d, P < 0001), and ICU length of stay (35.9±22.9 VS 15.7±9.2 d, P < 0.001) were longer in patients with NIs. The independent risk factors for NIs were ECMO duration (Odds Ratio [OR], 1.414; 95% Confidence Interval [CI], (1.051–1.238); P = 0.002) and viral pneumonia (OR, 5.788; 95% CI, (1.551–21.596); P = 0.009). Gram-negative bacteria were the most common causative organisms of NIs; Acinetobacter baumannii (A. baumannii), Klebsiella pneumoniae (K. pneumoniae), and Pseudomonas aeruginosa (P. aeruginosa) were the most common bacteria. BSI (OR, 8.106; 95% CI, (1.384–47.474); P = 0.02) was an independent predictor for mortality. Conclusion NIs are common complications in patients during ECMO treatment, especially VAP, followed by BSI. Also, BSI can negatively affect the survival rate.
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Affiliation(s)
- Wenzeng Xu
- Department of Respiratory and Critical Care Medicine, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, 310003, People’s Republic of China
| | - Yiqi Fu
- Department of Respiratory and Critical Care Medicine, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, 310003, People’s Republic of China
| | - Yake Yao
- Department of Respiratory and Critical Care Medicine, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, 310003, People’s Republic of China
| | - Jianying Zhou
- Department of Respiratory and Critical Care Medicine, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, 310003, People’s Republic of China
| | - Hua Zhou
- Department of Respiratory and Critical Care Medicine, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, 310003, People’s Republic of China
- Correspondence: Hua Zhou; Jianying Zhou, Email ;
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21
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Hsu YC, Chen SY, Hung YJ, Huang YW. Renal replacement therapy and concurrent fluconazole therapy increase linezolid-related thrombocytopenia among adult patients. Sci Rep 2022; 12:9894. [PMID: 35701469 PMCID: PMC9198091 DOI: 10.1038/s41598-022-13874-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2021] [Accepted: 05/30/2022] [Indexed: 11/26/2022] Open
Abstract
Linezolid has been reported to be associated with thrombocytopenia. However, limited information is available on susceptibility to thrombocytopenia after linezolid usage. We aimed to investigate the risk factors for linezolid-associated thrombocytopenia (LAT). We conducted a retrospective cohort study of patients aged ≥ 18 years who received linezolid for ≥ 5 d during hospitalization in 2019. Information was extracted from electronic medical records. Thrombocytopenia was defined as a platelet count of < 100 × 109/L or a reduction from baseline ≥ 25%. Binary logistic regression and survival analyses were used to evaluate the risk factors for LAT. A total of 98 patients were enrolled. Thrombocytopenia occurred in 53.1% patients, with a median of 9 d after initiation of linezolid. There was no significant difference in the mortality or proportion of platelet transfusions between patients with and without thrombocytopenia. A higher risk of LAT was found in patients who received renal replacement therapy (RRT) (OR 4.8 [1.4–16.4]), or concurrent fluconazole (OR 3.5 [1.2–9.8]). Patients who received RRT (8 vs. 15 d) or concurrent fluconazole (11 vs. 15 d) had a shorter median time to develop thrombocytopenia. Those who simultaneously received RRT and fluconazole had the shortest median of time (6.5 d) and the highest risk of developing thrombocytopenia (87.5%).
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Affiliation(s)
- Yueh-Chun Hsu
- Department of Pharmacy, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, 833, Taiwan
| | - Szu-Ying Chen
- Department of Nursing, Fooyin University, Kaohsiung, 831, Taiwan.,Division of Occupational Medicine, E-Da Hospital, I-Shou University, Kaohsiung, 824, Taiwan.,Division of Surgical Intensive Care, Department of Critical Care Medicine, E-Da Hospital, I-Shou University, Kaohsiung, 824, Taiwan
| | - Yung-Jun Hung
- Department of Pharmacy, E-Da hospital, Kaohsiung, 824, Taiwan
| | - Yu-Wei Huang
- Department of Anesthesiology, Emergency and Critical Care Center, E-Da hospital, I-Shou University, Kaohsiung, 824, Taiwan. .,Department of Nursing, Fooyin University, Kaohsiung, 831, Taiwan.
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22
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Gonzalez DA, Kumar R, Asif S, Bali A, Dang AK. Sepsis and Thrombocytopenia: A Nowadays Problem. Cureus 2022; 14:e25421. [PMID: 35774677 PMCID: PMC9236694 DOI: 10.7759/cureus.25421] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/27/2022] [Indexed: 12/11/2022] Open
Abstract
Sepsis is a life-threatening organ failure produced by a dysregulated host response to infection that involves 15.6% of hospital mortality. The most common signs and symptoms of sepsis are hypotension, tachypnea, fever, and leukocytosis, whether suspected or confirmed. Including a major one, thrombocytopenia is a sign that is an independent predictor of poor outcomes in patients with sepsis, increasing their mortality rate and their length of stay in the intensive care unit (ICU). So far, the ongoing treatment for this problem is securing the airway, treating hypoxemia, and providing vascular access for hydration, antibiotic delivery, and vasopressors, if needed. This article has reviewed the different possible mechanisms found for sepsis-associated thrombocytopenia, going from the most acknowledged one as decreased platelet production to the potential aftermath of sepsis itself as disseminated intravascular coagulation (DIC). This article has also discussed the future treatment for patients suffering from thrombocytopenia and sepsis, going from phase I and II trials as GI antagonists to the well-known drug aspirin as a possible treatment for this problem.
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Farrar JE, Naik K, Van Matre ET, Martin KG, Magnotti LJ, Wood GC, Swanson JM. Characterization of platelet concentrations and evaluation of risk factors for thrombocytopenia following traumatic injury. TRAUMA-ENGLAND 2022. [DOI: 10.1177/14604086221076280] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Introduction Thrombocytopenia is common in critically ill trauma patients and can lead to potentially broad differentials, including major bleeding, hemodilution, extracorporeal circuit losses, heparin-induced thrombocytopenia, and more. Understanding the normal time course of platelet decline and recovery may delineate thrombocytopenia(HIT) secondary to traumatic injury versus other inciting factors. Methods This retrospective study included trauma patients admitted over a 1-year period. The primary aim was characterizing the effect of trauma on platelet concentration and thrombocytopenia incidence in the first 30 days following injury. Thrombocytopenia was defined as platelet concentration <150 × 109/L. A secondary aim was evaluating significant factors contributing to thrombocytopenia. Results A total of 225 patients were included. Thrombocytopenia occurred in 67.3% of patients, and a platelet decline of 50% or greater occurred in 44%. Decrease in platelet concentration was significant from day 1 to day 4 (mean ± SD, 232 ± 86 vs 142 ± 76 × 109/L; p = .001). Platelets recovered to baseline on day 8 and peaked on day 16. Packed red blood cell or platelet transfusion, continuous renal replacement therapy, and acute liver injury independently predicted a ≥50% platelet decrease. HIT was not diagnosed in any patients. Conclusion Platelet nadir likely occurs approximately 4 days after injury and recovers relatively quickly thereafter. More studies are needed to evaluate the magnitude of effect on thrombocytopenia by factors beyond trauma.
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Affiliation(s)
- Julie E Farrar
- Department of Pharmacy Practice, Auburn University Harrison School of Pharmacy, Mobile, AL, USA
| | - Kushal Naik
- Department of Pharmacy, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Edward T Van Matre
- Department of Clinical Pharmacy and Translational Sciences, University of Tennessee Health Science Center College of Pharmacy, Memphis, TN, USA
- Department of Pharmacy, Regional One Health, Memphis, TN, USA
| | | | - Louis J Magnotti
- Department of Surgery, University of Tennessee Health Science Center College of Medicine, Memphis, TN, USA
- Trauma Surgery Services, Regional One Health, Memphis, TN, USA
| | - G Christopher Wood
- Department of Clinical Pharmacy and Translational Sciences, University of Tennessee Health Science Center College of Pharmacy, Memphis, TN, USA
- Department of Pharmacy, Regional One Health, Memphis, TN, USA
| | - Joseph M Swanson
- Department of Clinical Pharmacy and Translational Sciences, University of Tennessee Health Science Center College of Pharmacy, Memphis, TN, USA
- Department of Pharmacy, Regional One Health, Memphis, TN, USA
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Chang JC. Pathogenesis of Two Faces of DVT: New Identity of Venous Thromboembolism as Combined Micro-Macrothrombosis via Unifying Mechanism Based on "Two-Path Unifying Theory" of Hemostasis and "Two-Activation Theory of the Endothelium". Life (Basel) 2022; 12:220. [PMID: 35207507 PMCID: PMC8874373 DOI: 10.3390/life12020220] [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: 12/20/2021] [Revised: 01/17/2022] [Accepted: 01/21/2022] [Indexed: 11/16/2022] Open
Abstract
Venous thrombosis includes deep venous thrombosis (DVT), venous thromboembolism (VTE), venous microthrombosis and others. Still, the pathogenesis of each venous thrombosis is not clearly established. Currently, isolated distal DVT and multiple proximal/central DVT are considered to be the same macrothrombotic disease affecting the venous system but with varying degree of clinical expression related to its localization and severity. The genesis of two phenotypes of DVT differing in clinical features and prognostic outcome can be identified by their unique hemostatic mechanisms. Two recently proposed hemostatic theories in vivo have clearly defined the character between "microthrombi" and "macrothrombus" in the vascular system. Phenotypic expression of thrombosis depends upon two major variables: (1) depth of vascular wall damage and (2) extent of the injury affecting the vascular tree system. Vascular wall injury limited to endothelial cells (ECs) in sepsis produces "disseminated" microthrombi, but intravascular injury due to trauma extending from ECs to subendothelial tissue (SET) produces "local" macrothrombus. Pathogen-induced sepsis activates the complement system leading to generalized endotheliopathy, which releases ultra large von Willebrand factor (ULVWF) multimers from ECs and promotes ULVWF path of hemostasis. In the venous system, the activated ULVWF path initiates microthrombogenesis to form platelet-ULVWF complexes, which become "microthrombi strings" that produce venous endotheliopathy-associated vascular microthrombotic disease (vEA-VMTD) and immune thrombocytopenic purpura (ITP)-like syndrome. In the arterial system, endotheliopathy produces arterial EA-VMTD (aEA-VMTD) with "life-threatening" thrombotic thrombocytopenic purpura (TTP)-like syndrome. Typically, vEA-VMTD is "silent" unless complicated by additional local venous vascular injury. A local venous vessel trauma without sepsis produces localized macrothrombosis due to activated ULVWF and tissue factor (TF) paths from damaged ECs and SET, which causes distal DVT with good prognosis. However, if a septic patient with "silent" vEA-VMTD is complicated by additional vascular injury from in-hospital vascular accesses, "venous combined micro-macrothrombosis" may develop as VTE via the unifying mechanism of the "two-path unifying theory" of hemostasis. This paradigm shifting pathogenetic difference between distal DVT and proximal/central DVT calls for a reassessment of current therapeutic approaches.
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Affiliation(s)
- Jae C Chang
- Department of Medicine, Irvine School of Medicine, University of California, Irvine, CA 92868, USA
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25
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Red Cell Distribution Width to Platelet Ratio Is Associated with Increasing In-Hospital Mortality in Critically Ill Patients with Acute Kidney Injury. DISEASE MARKERS 2022; 2022:4802702. [PMID: 35082929 PMCID: PMC8786548 DOI: 10.1155/2022/4802702] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/15/2021] [Revised: 12/13/2021] [Accepted: 01/05/2022] [Indexed: 12/11/2022]
Abstract
Background. Inflammation plays a key role in the pathophysiology and progression of acute kidney injury (AKI). Red cell distribution width (RDW) to platelet ratio (RPR) is a novel inflammatory index, and its prognostic effect on critically ill patients with AKI is rarely investigated. This work is aimed at investigating the association between RPR and in-hospital mortality in these patients. Methods. Data were extracted from the Medical Information Mart for Intensive Care III database. All-cause death during hospitalization was selected as the primary outcome. Receiver operating characteristic (ROC) curve was used to determine the optimal cut-off value, and the area under the curve (AUC) was applied to compare predictive ability among different indices. Cox proportional hazard models were utilized to assess the association between RPR and in-hospital mortality. Restricted cubic spline analysis for multivariate Cox model was performed to explore the shape of the relationship between RPR and mortality. Results. A total of 24,166 critically ill patients with AKI were included. The relationship of RPR and in-hospital mortality was nonlinear with a trend to rise rapidly and then gradually. For mortality prediction, RPR had the optimal cut-off value of 0.093, of which the AUC was 0.791 (95% confidence interval (CI): 0.773–0.810), which was higher than those of RDW, platelet, sequential organ failure assessment score, simplified acute physiology score II, neutrophil to lymphocyte ratio, and platelet to lymphocytes ratio. After adjustments for various confounders, high RPR showed a significant association with increased mortality with hazard ratios of 1.46 (95% CI: 1.40–1.55) for categorical variable and 1.88 (95% CI: 1.80–1.97) for continuous variables in the fully adjusted model. Conclusions. Elevated RPR on admission is substantially associated with high risk of in-hospital mortality in critically ill patients with AKI and thus may serve as a novel predictor of prognosis for these patients.
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Asai Y, Yamamoto T, Abe Y. Evaluation of the Expression Profile of Antibiotic-Induced Thrombocytopenia Using the Japanese Adverse Drug Event Report Database. Int J Toxicol 2021; 40:542-550. [PMID: 34658275 DOI: 10.1177/10915818211048151] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Drug-induced thrombocytopenia (DITP) can be triggered by antibiotics; however, the details remain unclear. Here, we evaluated the expression profiles of DITP using the Japanese Adverse Drug Event Report (JADER) database. We analyzed reports of DITP between April 2004 and January 2021 from the JADER database. The reporting odds ratio (ROR) and 95% confidence interval (CI) were used to detect DITP signals. Factors thought to affect DITP, such as male sex and an age of at least 60 years, were added as covariates. We evaluated the time-to-onset profile and hazard type using the Weibull shape parameter. The JADER database contained 1,048,576 reports. Twelve of 60 antibiotics showed signals for DITP; the RORs (95% CIs) for ampicillin/sulbactam, ceftazidime, cefozopran, ciprofloxacin, fluconazole, fos-fluconazole, linezolid, pazufloxacin, piperacillin/tazobactam, teicoplanin, trimethoprim/sulfamethoxazole, and voriconazole were 1.75 (1.41-2.16), 1.77 (1.42-2.18), 1.35 (1.06-1.72), 2.56 (2.19-2.98), 1.93 (1.67-2.23), 2.08 (1.76-2.46), 5.29 (2.73-9.60), 1.92 (1.51-2.41), 1.54 (1.05-2.19), 1.47 (1.16-1.84), 1.92 (1.73-2.14), and 2.32 (1.59-3.30), respectively. In multiple logistic regression analysis, 7 and 6 antibiotics were detected for the factors age and male sex, respectively. The median times-to-onset of DITP for ciprofloxacin (oral treatment), fluconazole, linezolid, piperacillin/tazobactam, and trimethoprim/sulfamethoxazole were 91, 91, 11.5, 10, and 9 days, respectively. Furthermore, the 95% CI of the Weibull shape parameter β for these antibiotics was above and excluded 1, indicating that the antibiotics were the wear out failure type. We revealed the expression profiles of DITP following treatment with 12 antibiotics.
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Affiliation(s)
- Yuki Asai
- Pharmacy, National Hospital Organization Mie Chuo Medical Center, Tsu, Japan
| | - Takanori Yamamoto
- Pharmacy, National Hospital Organization Mie Chuo Medical Center, Tsu, Japan
| | - Yasuharu Abe
- Pharmacy, National Hospital Organization Mie Chuo Medical Center, Tsu, Japan
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Estimated glomerular filtration rate may be an independent predictor for clinical outcomes regardless of acute kidney injury complication in the emergency department. PLoS One 2021; 16:e0258665. [PMID: 34648576 PMCID: PMC8516290 DOI: 10.1371/journal.pone.0258665] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2021] [Accepted: 10/04/2021] [Indexed: 11/20/2022] Open
Abstract
Study objective Acute kidney injury (AKI), chronic kidney disease (CKD), and decreased estimated glomerular filtration rate (eGFR) are all associated with poor clinical outcomes among emergency department (ED) patients. This study aimed to evaluate the effect of different types of renal dysfunction and the degree of eGFR reduction on the clinical outcomes in a real-world ED setting. Methods Adult patients with an eGFR lower than 60 mL/min/1.73m2 in our ED, from October 1, 2016, to December 31, 2016, were enrolled in this retrospective observational study. Besides AKI and CKD, patients with unknown baseline renal function before an ED visit were categorized in the undetermined renal dysfunction (URD) category. Results Among 1495 patients who had eGFR evaluation at ED, this study finally enrolled 441 patients; 22 patients (5.0%) had AKI only, 32 (7.3%) had AKI on CKD, 196 (44.4%) had CKD only, 27 (6.1%) had subclinical kidney injury (those who met neither criteria for AKI nor CKD), and 164 (37.2%) had URD. There was a significant association between eGFR and critical illness defined as the composite outcome of death or intensive care unit (ICU) need, hospitalization, ICU need, death, and renal replacement therapy need (odds ratio [95% confidence interval]: 1.72 [1.45–2.05], 1.36 [1.16–1.59], 1.66 [1.39–2.00], 1.73 [1.32–2.28], and 2.71 [1.73–4.24] for every 10 mL/min/1.73m2 of reduction, respectively). Multivariate logistic regression analysis showed eGFR was an independent predictor of critical illness composite outcome (death or ICU need), hospitalization, and ICU need even after adjustment with AKI or URD. Conclusions Estimated GFR may be a sufficient predictor of clinical outcomes of ED patients regardless of AKI complication. Considerable ED patients were determined as URD, which might have a significant impact on the ED statistics regarding renal dysfunction.
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Li J, Yu D, Song Y, Cheang I, Wang X. Association Between Postoperative Thrombocytopenia and Outcomes After Coronary Artery Bypass Grafting Surgery. Front Surg 2021; 8:747986. [PMID: 34604298 PMCID: PMC8484630 DOI: 10.3389/fsurg.2021.747986] [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: 07/27/2021] [Accepted: 08/25/2021] [Indexed: 11/13/2022] Open
Abstract
Objectives: The effect of postoperative thrombocytopenia on adverse events among coronary artery bypass graft (CABG) patients remains unclear. This study aims to investigate the association between postoperative thrombocytopenia and perioperative outcomes of CABG. Methods: This is a retrospective study with MIMIC-III (Medical Information Mart for Intensive Care III) database. Adult patients who underwent CABG were included to analyze the impact of thrombocytopenia in patients' outcomes. Postoperative thrombocytopenia was defined as a platelet count <100 × 109/L on the first day after CABG surgery. A multivariable logistic regression analysis was utilized to adjust the effect of thrombocytopenia on outcomes for baseline and covariates, and to determine the association with outcomes. Results: A total of 4,915 patients were included, and postoperative thrombocytopenia occurred in 696 (14.2%) patients. Postoperative thrombocytopenia was not associated with increased 28-day mortality (OR 0.75; 95% CI 0.33-1.72; P = 0.496) or in-hospital mortality (OR 0.75; 95% CI 0.34-1.63; P = 0.463) after adjusting for confounders. Regarding the secondary outcomes, it was associated with a higher risk of a prolonged stay in the intensive care unit (OR 1.53; 95% CI 1.18-1.97; P = 0.001), prolonged hospital stays (OR 1.58; 95% CI 1.21-2.06; P = 0.001), prolonged mechanical ventilation time (OR 1.67; 95% CI 1.14-2.44; P = 0.009), and a trend toward increased occurrence of massive bleeding (OR 1.41; 95% CI 1.00-2.01; P = 0.054). There was no significant association between an increased risk of prolonged vasopressor use and the continuous renal replacement therapy rate. Conclusions: Postoperative thrombocytopenia was associated with prolonged ICU and hospital stays but not with increased perioperative mortality among CABG patients.
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Affiliation(s)
- Jinghang Li
- Department of Cardiovascular Surgery, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Dongmin Yu
- Department of Cardiovascular Surgery, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Yuanyuan Song
- Department of Cardiovascular Surgery, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Iokfai Cheang
- Department of Cardiology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Xiaowei Wang
- Department of Cardiovascular Surgery, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
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Cheng Y, Chen C, Yang J, Yang H, Fu M, Zhong X, Wang B, He M, Hu Z, Zhang Z, Jin X, Kang Y, Wu Q. Using Machine Learning Algorithms to Predict Hospital Acquired Thrombocytopenia after Operation in the Intensive Care Unit: A Retrospective Cohort Study. Diagnostics (Basel) 2021; 11:diagnostics11091614. [PMID: 34573956 PMCID: PMC8466367 DOI: 10.3390/diagnostics11091614] [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: 07/06/2021] [Revised: 08/25/2021] [Accepted: 09/01/2021] [Indexed: 02/05/2023] Open
Abstract
Hospital acquired thrombocytopenia (HAT) is a common hematological complication after surgery. This research aimed to develop and compare the performance of seven machine learning (ML) algorithms for predicting patients that are at risk of HAT after surgery. We conducted a retrospective cohort study which enrolled adult patients transferred to the intensive care unit (ICU) after surgery in West China Hospital of Sichuan University from January 2016 to December 2018. All subjects were randomly divided into a derivation set (70%) and test set (30%). ten-fold cross-validation was used to estimate the hyperparameters of ML algorithms during the training process in the derivation set. After ML models were developed, the sensitivity, specificity, area under the curve (AUC), and net benefit (decision analysis curve, DCA) were calculated to evaluate the performances of ML models in the test set. A total of 10,369 patients were included and in 1354 (13.1%) HAT occurred. The AUC of all seven ML models exceeded 0.7, the two highest were Gradient Boosting (GB) (0.834, 0.814-0.853, p < 0.001) and Random Forest (RF) (0.828, 0.807-0.848, p < 0.001). There was no difference between GB and RF (0.834 vs. 0.828, p = 0.293); however, these two were better than the remaining five models (p < 0.001). The DCA revealed that all ML models had high net benefits with a threshold probability approximately less than 0.6. In conclusion, we found that ML models constructed by multiple preoperative variables can predict HAT in patients transferred to ICU after surgery, which can improve risk stratification and guide management in clinical practice.
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Affiliation(s)
- Yisong Cheng
- Department of Critical Care Medicine, West China Hospital, Sichuan University, Chengdu 610041, China; (Y.C.); (J.Y.); (H.Y.); (M.F.); (X.Z.); (B.W.); (M.H.); (Z.H.); (Z.Z.); (X.J.); (Y.K.)
| | - Chaoyue Chen
- Department of Neurosurgery, West China Hospital, Sichuan University, Chengdu 610041, China;
| | - Jie Yang
- Department of Critical Care Medicine, West China Hospital, Sichuan University, Chengdu 610041, China; (Y.C.); (J.Y.); (H.Y.); (M.F.); (X.Z.); (B.W.); (M.H.); (Z.H.); (Z.Z.); (X.J.); (Y.K.)
| | - Hao Yang
- Department of Critical Care Medicine, West China Hospital, Sichuan University, Chengdu 610041, China; (Y.C.); (J.Y.); (H.Y.); (M.F.); (X.Z.); (B.W.); (M.H.); (Z.H.); (Z.Z.); (X.J.); (Y.K.)
| | - Min Fu
- Department of Critical Care Medicine, West China Hospital, Sichuan University, Chengdu 610041, China; (Y.C.); (J.Y.); (H.Y.); (M.F.); (X.Z.); (B.W.); (M.H.); (Z.H.); (Z.Z.); (X.J.); (Y.K.)
| | - Xi Zhong
- Department of Critical Care Medicine, West China Hospital, Sichuan University, Chengdu 610041, China; (Y.C.); (J.Y.); (H.Y.); (M.F.); (X.Z.); (B.W.); (M.H.); (Z.H.); (Z.Z.); (X.J.); (Y.K.)
| | - Bo Wang
- Department of Critical Care Medicine, West China Hospital, Sichuan University, Chengdu 610041, China; (Y.C.); (J.Y.); (H.Y.); (M.F.); (X.Z.); (B.W.); (M.H.); (Z.H.); (Z.Z.); (X.J.); (Y.K.)
| | - Min He
- Department of Critical Care Medicine, West China Hospital, Sichuan University, Chengdu 610041, China; (Y.C.); (J.Y.); (H.Y.); (M.F.); (X.Z.); (B.W.); (M.H.); (Z.H.); (Z.Z.); (X.J.); (Y.K.)
| | - Zhi Hu
- Department of Critical Care Medicine, West China Hospital, Sichuan University, Chengdu 610041, China; (Y.C.); (J.Y.); (H.Y.); (M.F.); (X.Z.); (B.W.); (M.H.); (Z.H.); (Z.Z.); (X.J.); (Y.K.)
| | - Zhongwei Zhang
- Department of Critical Care Medicine, West China Hospital, Sichuan University, Chengdu 610041, China; (Y.C.); (J.Y.); (H.Y.); (M.F.); (X.Z.); (B.W.); (M.H.); (Z.H.); (Z.Z.); (X.J.); (Y.K.)
| | - Xiaodong Jin
- Department of Critical Care Medicine, West China Hospital, Sichuan University, Chengdu 610041, China; (Y.C.); (J.Y.); (H.Y.); (M.F.); (X.Z.); (B.W.); (M.H.); (Z.H.); (Z.Z.); (X.J.); (Y.K.)
| | - Yan Kang
- Department of Critical Care Medicine, West China Hospital, Sichuan University, Chengdu 610041, China; (Y.C.); (J.Y.); (H.Y.); (M.F.); (X.Z.); (B.W.); (M.H.); (Z.H.); (Z.Z.); (X.J.); (Y.K.)
| | - Qin Wu
- Department of Critical Care Medicine, West China Hospital, Sichuan University, Chengdu 610041, China; (Y.C.); (J.Y.); (H.Y.); (M.F.); (X.Z.); (B.W.); (M.H.); (Z.H.); (Z.Z.); (X.J.); (Y.K.)
- Correspondence: ; Tel.: +86-028-8542-2506
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Kohs TCL, Liu P, Raghunathan V, Amirsoltani R, Oakes M, McCarty OJT, Olson SR, Masha L, Zonies D, Shatzel JJ. Severe thrombocytopenia in adults undergoing extracorporeal membrane oxygenation is predictive of thrombosis. Platelets 2021; 33:570-576. [PMID: 34355646 PMCID: PMC9089832 DOI: 10.1080/09537104.2021.1961707] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Extracorporeal membrane oxygenation (ECMO) provides lifesaving circulatory support and gas exchange, although hematologic complications are frequent. The relationship between ECMO and severe thrombocytopenia (platelet count <50 × 109/L) remains ill-defined. We performed a cohort study of 67 patients who received ECMO between 2016 and 2019, of which 65.7% received veno-arterial (VA) ECMO and 34.3% received veno-venous (VV) ECMO. All patients received heparin and 25.4% received antiplatelet therapy. In total, 23.9% of patients had a thrombotic event and 67.2% had a hemorrhagic event. 38.8% of patients developed severe thrombocytopenia. Severe thrombocytopenia was more common in patients with lower baseline platelet counts and increased the likelihood of thrombosis by 365% (OR 3.65, 95% CI 1.13-11.8, P = .031), while the type of ECMO (VA or VV) was not predictive of severe thrombocytopenia (P = .764). Multivariate logistic regression controlling for additional clinical variables found that severe thrombocytopenia predicted thrombosis (OR 3.65, CI 1.13-11.78, P = .031). Over a quarter of patients requiring ECMO developed severe thrombocytopenia in our cohort, which was associated with an increased risk of thrombosis and in-hospital mortality. Additional prospective observation is required to clarify the clinical implications of severe thrombocytopenia in the ECMO patient population.
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Affiliation(s)
- Tia C L Kohs
- Department of Biomedical Engineering, Oregon Health & Science University, Portland, USA
| | - Patricia Liu
- Department of Medicine, Oregon Health & Science University, Portland, USA
| | - Vikram Raghunathan
- Division of Hematology and Oncology, Oregon Health & Science University, Portland, USA
| | - Ramin Amirsoltani
- Department of Surgery, Oregon Health & Science University, Portland, USA
| | - Michael Oakes
- Department of Medicine, Oregon Health & Science University, Portland, USA
| | - Owen J T McCarty
- Department of Biomedical Engineering, Oregon Health & Science University, Portland, USA
| | - Sven R Olson
- Department of Biomedical Engineering, Oregon Health & Science University, Portland, USA.,Division of Hematology and Oncology, Oregon Health & Science University, Portland, USA
| | - Luke Masha
- Department of Cardiology, Oregon Health & Science University, Portland, USA
| | - David Zonies
- Department of Cardiology, Oregon Health & Science University, Portland, USA
| | - Joseph J Shatzel
- Department of Biomedical Engineering, Oregon Health & Science University, Portland, USA.,Division of Hematology and Oncology, Oregon Health & Science University, Portland, USA
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Rosso F, Parra-Lara LG, Agudelo-Rojas OL, Martinez-Ruiz DM. Differentiating Dengue from COVID-19: Comparison of Cases in Colombia. Am J Trop Med Hyg 2021; 105:745-750. [PMID: 34242180 PMCID: PMC8592361 DOI: 10.4269/ajtmh.20-0912] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2020] [Accepted: 06/04/2021] [Indexed: 11/07/2022] Open
Abstract
The differentiation between dengue and COVID-19 diagnoses is a challenge in tropical regions because of the similarity of symptoms and limited access to specific diagnostic tests for each disease. The objective of this study was to describe the initial symptoms and laboratory test values of patients who presented to the emergency department with dengue or COVID-19. A cross-sectional study was performed in a single center in Cali, Colombia. The inclusion criteria were patients with a diagnosis of dengue or COVID-19 who were older than 14 years of age. All patients experienced fever or other symptoms for fewer than 10 days. Linear regression was performed to evaluate the differences in the neutrophil-lymphocyte ratio (NLR) between patients diagnosed with COVID-19 and dengue, and was adjusted for sex and age group (≤ 31 and > 31 years). The sample size was calculated to test the hypothesis that the median NLR in COVID-19 patients is higher than that in dengue patients. A P value < 0.05 was considered statistically significant for all analyses. A total of 93 patients were included: 70 with dengue and 23 with COVID-19. Dengue patients were younger than COVID-19 patients. There were significant differences between dengue and COVID-19 patients regarding platelet count (P < 0.01), neutrophil count (P < 0.01), NLR (P < 0.01), and abnormal alanine transaminase (ALT) (P = 0.03). The NLR was significantly higher in COVID-19 patients than in dengue patients (P < 0.01). In conclusion, during the first week of symptoms, absolute neutrophil count, NLR, and platelet count could help guide the initial differential approach between dengue and COVID-19. These findings could be useful in geographical areas with a lack of resources.
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Affiliation(s)
- Fernando Rosso
- Fundación Valle del Lili, Cali, Colombia
- Universidad Icesi, Cali, Colombia
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ENNAB RM, MOMANI WM, JAIUOSSI AM, ALJABALI AA, TAMBWALA MM. Risks of emergency vascular surgery in COVID-19 patients. ITALIAN JOURNAL OF VASCULAR AND ENDOVASCULAR SURGERY 2021. [DOI: 10.23736/s1824-4777.21.01467-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
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Al Saleh K, AlQahtani RM. Platelet count patterns and patient outcomes in sepsis at a tertiary care center: Beyond the APACHE score. Medicine (Baltimore) 2021; 100:e25013. [PMID: 33950914 PMCID: PMC8104228 DOI: 10.1097/md.0000000000025013] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/18/2020] [Accepted: 02/12/2021] [Indexed: 01/04/2023] Open
Abstract
Acute physiology and chronic health evaluation II (APACHE-II) scoring system is used to classify disease severity of patients in the intensive care unit. However, several limitations render the scoring system inadequate in identifying risk factors associated with outcomes. Little is known about the association of platelet count patterns, and the timing of platelet count and other hematologic parameters in predicting mortality in patients with sepsis.This retrospective observational study included 205 septic shock patients, with an overall mortality of 47.8%, enrolled at a tertiary care hospital in Riyadh, Kingdom of Saudi Arabia between 2018 and 2020. Bivariate and multivariate regression analyses were used to identify hematologic risk factors associated with mortality. We used the bivariate Pearson Correlation test to determine correlations between the tested variables and APACHE-II score.Two platelet count patterns emerged: patients with a decline in platelet count after admission (group A pattern, 93.7%) and those with their lowest platelet count at admission (group B pattern, 6.3%). The lowest mean platelet count was significantly lower in nonsurvivors (105.62 ± 10.67 × 103/μL) than in survivors (185.52 ± 10.81 × 103/μL), P < .001. Bivariate Pearson correlation revealed that the lowest platelet count and platelet count decline were significantly correlated with APACHE-II score (r = -0.250, P < .01), (r = 0.326, P < .001), respectively. In multiple logistic regression analysis, the independent mortality risk factors were degree of platelet count decline in group A (odds ratio, 1.028 [95% confidence interval: 1.012-1.045], P = .001) and platelet pattern in group B (odds ratio, 6.901 [95% confidence interval: 1.446-32.932], P = .015). The patterns, values, subsets, and ratios of white blood cell count were not significantly associated with mortality.Nadir platelet count and timing, and degree of platelet count decline are useful markers to predict mortality in early septic shock. Therefore, platelet count patterns might enhance the performance of severity scoring systems in the intensive care unit.
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Affiliation(s)
| | - Rakan M. AlQahtani
- Department of Critical Care, King Saud University Medical City, King Saud University, Riyadh, Kingdom of Saudi Arabia
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Khalirakhmanov AF, Idrisova KF, Gaifullina RF, Zinchenko SV, Litvinov RI, Sharafeev AZ, Kiyasov AP, Rizvanov AA. Pathogenesis, Diagnosis, and Treatment of Hemostatic Disorders in COVID-19 Patients. Acta Naturae 2021; 13:79-84. [PMID: 34377558 PMCID: PMC8327143 DOI: 10.32607/actanaturae.11182] [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: 08/31/2020] [Accepted: 11/12/2020] [Indexed: 01/08/2023] Open
Abstract
The novel coronavirus infection named COVID-19 was first detected in Wuhan, China, in December 2019, and it has been responsible for significant morbidity and mortality in scores of countries. At the time this article was being written, the number of infected and deceased patients continued to grow worldwide. Most patients with severe forms of the disease suffer from pneumonia and pulmonary insufficiency; in many cases, the disease is generalized and causes multiple organ failures and a dysfunction of physiological systems. One of the most serious and prognostically ominous complications from COVID-19 is coagulopathy, in particular, decompensated hypercoagulability with the risk of developing disseminated intravascular coagulation. In most cases, local and diffuse macro- and microthromboses are present, a condition which causes multiple-organ failure and thromboembolic complications. The causes and pathogenic mechanisms of coagulopathy in COVID-19 remain largely unclear, but they are associated with systemic inflammation, including the so-called cytokine storm. Despite the relatively short period of the ongoing pandemic, laboratory signs of serious hemostatic disorders have been identified and measures for specific prevention and correction of thrombosis have been developed. This review discusses the causes of COVID-19 coagulopathies and the associated complications, as well as possible approaches to their early diagnosis, prevention, and treatment.
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Affiliation(s)
- A. F. Khalirakhmanov
- University Hospital “Kazan Federal University”, Kazan, 420043 Russia
- Kazan Federal University, Kazan, 420012 Russia
| | | | - R. F. Gaifullina
- University Hospital “Kazan Federal University”, Kazan, 420043 Russia
- Kazan Federal University, Kazan, 420012 Russia
| | | | - R. I. Litvinov
- Kazan Federal University, Kazan, 420012 Russia
- University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, 19104-6058 USA
| | - A. Z. Sharafeev
- Republican Clinical Hospital named after Sh.Sh. Ependiev, Grozniy, 364030 Russia
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Asan A, Üstündağ Y, Koca N, Şimşek A, Sayan HE, Parildar H, Dalyan Cilo B, Huysal K. Do initial hematologic indices predict the severity of COVID-19 patients? Turk J Med Sci 2021; 51:39-44. [PMID: 33003692 PMCID: PMC7991886 DOI: 10.3906/sag-2007-97] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2020] [Accepted: 10/01/2020] [Indexed: 01/08/2023] Open
Abstract
Background/aim In this study, we aimed to evaluate the initial hematological findings analyzed on admission in confirmed COVID-19 patients who were transferred to the intensive care unit (ICU), to predict possible hematological indices. Materials and methods Initial neutrophil to lymphocyte ratio (NLR), platelet to lymphocyte ratio (PLR), monocyte to lymphocyte ratio (MLR), red cell distribution width to platelet ratio (RPR), mean platelet volume to platelet ratio, and lymphocyte multiplied by platelet count (LYM × PLT), of 695 patients with laboratory-confirmed COVID-19 were investigated and comparisons were made between the mild/moderate and severe groups. Results The proportion of COVID-19 cases admitted to the ICU was 3.9%. The median age of patients admitted to the ICU was significantly higher than those who were not; [68.5 (interquartile range (IQR); 21.5] years vs. 41.0 (IQR; 15.7) years; P < 0.001.Severe cases had higher NLR (6.6 vs. 2.4; P < 0.001), and MLR (0.40 vs. 0.28; P = 0.004) and lower PLR (180.0 vs. 129.0; P < 0.001) compared to that of mild or moderate patients. Among all of the parameters, the ROC curve of NLR gave us the best ability to distinguish serious patients at an early stage (AUC = 0. 819, 95% confidence interval 0.729–0.910; P < 0.001). Conclusion These data showed that age, initial NLR, PLR, and LYM × PLT were associated with the severity of COVID-19 disease and patients’ need for the ICU. Therefore, initial hemogram parameters may be essential to predict the prognosis of COVID-19 patients.
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Affiliation(s)
- Ali Asan
- Department of Infectious Diseases and Clinical Microbiology, University of Health Sciences, Bursa Yüksek İhtisas Training and Research Hospital, Bursa, Turkey
| | - Yasemin Üstündağ
- Department of Clinical Biochemistry, University of Health Sciences, Bursa Yüksek İhtisas Training and Research Hospital, Bursa, Turkey
| | - Nizameddin Koca
- Department of Internal Medicine, University of Health Sciences, Bursa Yüksek İhtisas Training and Research Hospital, Bursa, Turkey
| | - Abdullah Şimşek
- Department of Pulmonary Diseases, University of Health Sciences, Bursa Yüksek İhtisas Training and Research Hospital, Bursa, Turkey
| | - Halil Erkan Sayan
- Department of Anesthesiology and Reanimation, University of Health Sciences, Bursa Yüksek İhtisas Training and Research Hospital, 6 Bursa, Turkey
| | - Hülya Parildar
- Department of Family Medicine, University of Health Sciences, Tepecik Trainingand Research Hospital , İzmir, Turkey
| | - Burcu Dalyan Cilo
- Department of Microbiology, University of Health Sciences, Bursa Yüksek İhtisas Training and Research Hospital, Bursa, Turkey
| | - Kağan Huysal
- Department of Clinical Biochemistry, University of Health Sciences, Bursa Yüksek İhtisas Training and Research Hospital, Bursa, Turkey
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Pollack MM, Chamberlain JM, Patel AK, Heneghan JA, Rivera EAT, Kim D, Bost JE. The Association of Laboratory Test Abnormalities With Mortality Risk in Pediatric Intensive Care. Pediatr Crit Care Med 2021; 22:147-160. [PMID: 33258574 PMCID: PMC7855885 DOI: 10.1097/pcc.0000000000002610] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
OBJECTIVES To determine the bivariable associations between abnormalities of 28 common laboratory tests and hospital mortality and determine how mortality risks changes when the ranges are evaluated in the context of commonly used laboratory test panels. DESIGN A 2009-2016 cohort from the Health Facts (Cerner Corporation, Kansas City, MO) database. SETTING Hospitals caring for children in ICUs. PATIENTS Children cared for in ICUs with laboratory data. INTERVENTIONS None. MEASUREMENTS AND MAIN RESULTS There were 2,987,515 laboratory measurements in 71,563 children. The distribution of laboratory test values in 10 groups defined by population percentiles demonstrated the midrange of tests was within the normal range except for those measured predominantly when significant abnormalities are suspected. Logistic regression analysis at the patient level combined the population-based groups into ranges with nonoverlapping mortality odds ratios. The most deviant test ranges associated with increased mortality risk (mortality odds ratios > 5.0) included variables associated with acidosis, coagulation abnormalities and blood loss, immune function, liver function, nutritional status, and the basic metabolic profile. The test ranges most associated with survival included normal values for chloride, pH, and bicarbonate/total Co2. When the significant test ranges from bivariable analyses were combined in commonly used test panels, they generally remained significant but were reduced as risk was distributed among the tests. CONCLUSIONS The relative importance of laboratory test ranges vary widely, with some ranges strongly associated with mortality and others strongly associated with survival. When evaluated in the context of test panels rather than isolated tests, the mortality odds ratios for the test ranges decreased but generally remained significant as risk was distributed among the components of the test panels. These data are useful to develop critical values for children in ICUs, to identify risk factors previously underappreciated, for education and training, and for future risk score development.
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Affiliation(s)
- Murray M Pollack
- Department of Pediatrics, Division of Critical Care Medicine, Children's National Hospital and George Washington University School of Medicine and Health Sciences, Washington, DC
| | - James M Chamberlain
- Department of Pediatrics, Division of Emergency Medicine Children's National Hospital and George Washington University School of Medicine and Health Sciences, Washington, DC
| | - Anita K Patel
- Department of Pediatrics, Division of Critical Care Medicine, Children's National Hospital and George Washington University School of Medicine and Health Sciences, Washington, DC
| | - Julia A Heneghan
- Department of Pediatrics, Division of Critical Care Medicine, Children's National Hospital and George Washington University School of Medicine and Health Sciences, Washington, DC
| | - Eduardo A Trujillo Rivera
- Biomedical Informatics Center, George Washington University School of Medicine and Health Sciences, Washington, DC
| | - Dongkyu Kim
- Children's National Hospital and George Washington University School of Medicine and Health Sciences, Washington, DC
| | - James E Bost
- Children's National Hospital and George Washington University School of Medicine and Health Sciences, Washington, DC
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Thrombocytopenia and its effect on mortality and morbidity in the intensive care unit. JOURNAL OF SURGERY AND MEDICINE 2021. [DOI: 10.28982/josam.842587] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Lee YT, Wang WY, Kuo CH, Lee MY, Lu YC, Hsiao CY, Hsu YH, Hung PH. Older Age and High Serum Ferritin Levels Associated With the Risk of Chronic Cytopenia in Hemodialysis Patients. Front Med (Lausanne) 2020; 7:568350. [PMID: 33195315 PMCID: PMC7662880 DOI: 10.3389/fmed.2020.568350] [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: 06/01/2020] [Accepted: 09/22/2020] [Indexed: 12/18/2022] Open
Abstract
Leukopenia or thrombocytopenia is sometimes observed in end-stage renal disease (ESRD) patients, but the association between chronic leukopenia or thrombocytopenia and hemodialysis (HD) is still unclear. We aimed to investigate the incidence of chronic leukopenia or thrombocytopenia in patients with ESRD who received HD and to determine the risk factors of this complication. We retrospectively analyzed ESRD patients treated with HD at Ditmanson Medical Foundation Chia-Yi Christian Hospital in 2018. The risk factors for the occurrence of chronic leukopenia and thrombocytopenia were analyzed by Cox regression models. Of the 473 patients in our study cohort, 46 (9.7%) patients had a hematologic abnormality, including 18 patients with chronic leukopenia, 18 with chronic thrombocytopenia, and 10 with pancytopenia. Multivariate analysis revealed that patient age ≥60 years at the initiation of dialysis was a significant predictor for both chronic leukopenia [adjusted hazard ratio (aHR), 2.71; 95% confidence interval (CI), 1.06-6.89] and chronic thrombocytopenia (aHR, 2.83; 95% CI, 1.08-7.35). Chronic liver disease (aHR, 3.31; 95% CI, 1.27-8.61) and serum ferritin levels >800 mg/dl (aHR, 3.29; 95% CI, 1.29-8.39) were risk factors for chronic thrombocytopenia. A trend showed that vitamin D from intravenous supplementation (aHR, 0.13; 95% CI, 0.01-1.16, P = 0.066) and serum phosphorous level (aHR, 0.73; 95% CI, 0.53-1.02, P = 0.068) may be associated with chronic thrombocytopenia. Our study demonstrated that hematological abnormality was a long-term complication of HD. These results reveal that older patients with HD and high serum ferritin levels are at an elevated risk for chronic cytopenia. Healthcare professionals should be aware of this risk when treating HD patients in order to improve their prognosis.
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Affiliation(s)
- Yu-Ting Lee
- Division of Hematology and Oncology, Department of Medicine, Ditmanson Medical Foundation Chia-Yi Christian Hospital, Chiayi, Taiwan
| | - Wei-Yu Wang
- Division of Hematology and Oncology, Department of Medicine, Ditmanson Medical Foundation Chia-Yi Christian Hospital, Chiayi, Taiwan
| | - Chin-Ho Kuo
- Division of Hematology and Oncology, Department of Medicine, Ditmanson Medical Foundation Chia-Yi Christian Hospital, Chiayi, Taiwan
- Min-Hwei Junior College of Health Care Management, Tainan, Taiwan
| | - Ming-Yang Lee
- Division of Hematology and Oncology, Department of Medicine, Ditmanson Medical Foundation Chia-Yi Christian Hospital, Chiayi, Taiwan
- Min-Hwei Junior College of Health Care Management, Tainan, Taiwan
| | - Yin-Che Lu
- Division of Hematology and Oncology, Department of Medicine, Ditmanson Medical Foundation Chia-Yi Christian Hospital, Chiayi, Taiwan
- Min-Hwei Junior College of Health Care Management, Tainan, Taiwan
| | - Chih-Yen Hsiao
- Division of Nephrology, Department of Medicine, Ditmanson Medical Foundation Chia-Yi Christian Hospital, Chiayi, Taiwan
- Department of Hospital and Health Care Administration, Chia Nan University of Pharmacy and Science, Tainan, Taiwan
| | - Yueh-Han Hsu
- Min-Hwei Junior College of Health Care Management, Tainan, Taiwan
- Division of Nephrology, Department of Medicine, Ditmanson Medical Foundation Chia-Yi Christian Hospital, Chiayi, Taiwan
| | - Peir-Haur Hung
- Division of Nephrology, Department of Medicine, Ditmanson Medical Foundation Chia-Yi Christian Hospital, Chiayi, Taiwan
- Department of Applied Life Science and Health, Chia Nan University of Pharmacy and Science, Tainan, Taiwan
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Lee HH, Hong SJ, Ahn CM, Yang JH, Gwon HC, Kim JS, Kim BK, Ko YG, Choi D, Hong MK, Jang Y. Clinical Implications of Thrombocytopenia at Cardiogenic Shock Presentation: Data from a Multicenter Registry. Yonsei Med J 2020; 61:851-859. [PMID: 32975059 PMCID: PMC7515787 DOI: 10.3349/ymj.2020.61.10.851] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/05/2020] [Revised: 08/10/2020] [Accepted: 08/17/2020] [Indexed: 12/25/2022] Open
Abstract
PURPOSE Thrombocytopenia (platelet count <150×10³/μL) is associated with poor outcomes in various critical illness settings. However, the prognostic value of platelet count in patients with cardiogenic shock (CS) remains unclear. MATERIALS AND METHODS We enrolled 1202 patients between January 2014 and December 2018 from a multicenter retrospective-prospective cohort registry of CS. Clinical characteristics and treatment outcomes were compared between the patients with and without thrombocytopenia. RESULTS At presentation with CS, 244 (20.3%) patients had thrombocytopenia. The patients with thrombocytopenia had lower blood pressure, hemoglobin level, and worse liver and renal functions compared to the patients without. During hospitalization, the patients with thrombocytopenia had more frequent gastrointestinal bleeding (10.5% vs. 3.8%, p=0.009), sepsis (8.3% vs. 2.6%, p=0.013), requirement of renal replacement therapy (36.5% vs. 18.9%, p<0.001), requirement of mechanical ventilation (65.2% vs. 54.4%, p=0.003), longer intensive care unit stay (8 days vs. 4 days, p<0.001), and thirty-day mortality (40.2% vs. 28.5%, p<0.001) compared to those without. In addition, the platelet count was an independent predictor of 30-day mortality (per 103/μL decrease; adjusted hazard ratio: 1.002, 95% confidence interval: 1.000-1.003, p=0.021). CONCLUSION Thrombocytopenia at CS presentation was associated with worse clinical findings, higher frequencies of complications, and longer stay at the intensive care unit. Also, thrombocytopenia was independently associated with increased 30-day mortality. (Clinical trial registration No. NCT02985008).
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Affiliation(s)
- Hyeok Hee Lee
- Department of Preventive Medicine, Yonsei University College of Medicine, Seoul, Korea
- Division of Cardiology, Department of Internal Medicine, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Seoul, Korea
- Graduate School, Yonsei University College of Medicine, Seoul, Korea
| | - Sung Jin Hong
- Division of Cardiology, Department of Internal Medicine, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Chul Min Ahn
- Division of Cardiology, Department of Internal Medicine, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Seoul, Korea.
| | - Jeong Hoon Yang
- Division of Cardiology, Department of Internal Medicine, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Hyeon Cheol Gwon
- Division of Cardiology, Department of Internal Medicine, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Jung Sun Kim
- Division of Cardiology, Department of Internal Medicine, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Byeong Keuk Kim
- Division of Cardiology, Department of Internal Medicine, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Young Guk Ko
- Division of Cardiology, Department of Internal Medicine, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Donghoon Choi
- Division of Cardiology, Department of Internal Medicine, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Myeong Ki Hong
- Division of Cardiology, Department of Internal Medicine, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Yangsoo Jang
- Division of Cardiology, Department of Internal Medicine, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Seoul, Korea
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Ou M, Zhu J, Ji P, Li H, Zhong Z, Li B, Pang J, Zhang J, Zheng X. Risk factors of severe cases with COVID-19: a meta-analysis. Epidemiol Infect 2020; 148:e175. [PMID: 32782035 PMCID: PMC7438625 DOI: 10.1017/s095026882000179x] [Citation(s) in RCA: 65] [Impact Index Per Article: 16.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2020] [Revised: 07/23/2020] [Accepted: 08/04/2020] [Indexed: 01/08/2023] Open
Abstract
Our study aimed to systematically analyse the risk factors of coronavirus disease 2019 (COVID-19) patients with severe disease. An electronic search in eight databases to identify studies describing severe or critically ill COVID-19 patients from 1 January 2020 to 3 April 2020. In the end, we meta-analysed 40 studies involving 5872 COVID-19 patients. The average age was higher in severe COVID-19 patients (weighted mean difference; WMD = 10.69, 95%CI 7.83-13.54). Patients with severe disease showed significantly lower platelet count (WMD = -18.63, 95%CI -30.86 to -6.40) and lymphocyte count (WMD = -0.35, 95%CI -0.41 to -0.30) but higher C-reactive protein (CRP; WMD = 42.7, 95%CI 31.12-54.28), lactate dehydrogenase (LDH; WMD = 137.4, 95%CI 105.5-169.3), white blood cell count(WBC), procalcitonin(PCT), D-dimer, alanine aminotransferase (ALT), aspartate aminotransferase (AST) and creatinine(Cr). Similarly, patients who died showed significantly higher WBC, D-dimer, ALT, AST and Cr but similar platelet count and LDH as patients who survived. These results indicate that older age, low platelet count, lymphopenia, elevated levels of LDH, ALT, AST, PCT, Cr and D-dimer are associated with severity of COVID-19 and thus could be used as early identification or even prediction of disease progression.
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Affiliation(s)
- Mingchun Ou
- Department of Pharmacy, People's Hospital of Baise, Baise533000, People's Republic China
| | - Jieyun Zhu
- Department of Emergency, The Second Affiliated Hospital of Guangxi Medical University, Nanning530007, People's Republic China
| | - Pan Ji
- Department of Emergency, The Second Affiliated Hospital of Guangxi Medical University, Nanning530007, People's Republic China
| | - Hongyuan Li
- Department of Emergency, The Second Affiliated Hospital of Guangxi Medical University, Nanning530007, People's Republic China
| | - Zhimei Zhong
- Department of Emergency, The Second Affiliated Hospital of Guangxi Medical University, Nanning530007, People's Republic China
| | - Bocheng Li
- Department of Emergency, The Second Affiliated Hospital of Guangxi Medical University, Nanning530007, People's Republic China
| | - Jielong Pang
- Department of Emergency, The Second Affiliated Hospital of Guangxi Medical University, Nanning530007, People's Republic China
| | - Jianfeng Zhang
- Department of Emergency, The Second Affiliated Hospital of Guangxi Medical University, Nanning530007, People's Republic China
| | - Xiaowen Zheng
- Department of Emergency, The Second Affiliated Hospital of Guangxi Medical University, Nanning530007, People's Republic China
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Lefler DS, Cuker A, Linkins LA, Warkentin TE, Pishko AM. Maximum 24-hour platelet count fall: Metric for improving the diagnosis of heparin-induced thrombocytopenia among patients with intermediate probability 4Ts scores. J Thromb Haemost 2020; 18:2018-2024. [PMID: 32430965 DOI: 10.1111/jth.14897] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2020] [Revised: 04/20/2020] [Accepted: 05/06/2020] [Indexed: 12/15/2022]
Abstract
BACKGROUND Most patients with suspected heparin-induced thrombocytopenia (HIT) and an intermediate probability 4Ts score do not have HIT. We aimed to develop a metric based on the rate of platelet count fall to aid in discriminating HIT status among patients with an intermediate 4Ts score. METHODS We derived a measure of the maximum 24-hour percentage decrease in platelet count (Fallmax ) in a cohort of patients with suspected HIT and an intermediate 4Ts score at the University of Pennsylvania. We validated this metric in a prospectively collected cohort of patients with suspected HIT and an intermediate 4Ts score from four hospitals in Hamilton, Ontario. RESULTS One hundred fifty-eight and 139 patients were included in the analysis from the derivation and validation cohorts, respectively. Fallmax was significantly higher in HIT-positive patients in the derivation cohort (49.6% versus 38.6%, P = .009) and validation cohort (43.5% versus 29.3%, P = .027). The area under the receiver operating characteristic curve was 0.68 (95% confidence interval [CI] 0.57-0.78) and 0.71 (0.59-0.83) in the two cohorts, respectively. At Fallmax ≥ 30%, sensitivity and specificity were 95.5% and 29.4% in the derivation cohort and 80.0% and 52.7% in the validation cohort. CONCLUSIONS Among patients with suspected HIT and an intermediate 4Ts score, Fallmax aided in discriminating HIT-negative from HIT-positive patients. Using a measure that accounts for the rate of platelet count fall may help to avoid unnecessary suspension of heparin and treatment with an alternative anticoagulant in HIT-negative patients with an intermediate probability 4Ts score, though further evaluation is warranted.
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Affiliation(s)
- Daniel S Lefler
- Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Adam Cuker
- Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
- Department of Pathology and Laboratory Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Lori-Ann Linkins
- Department of Medicine, Michael G. DeGroote School of Medicine, McMaster University, Hamilton, ON, Canada
| | - Theodore E Warkentin
- Department of Medicine, Michael G. DeGroote School of Medicine, McMaster University, Hamilton, ON, Canada
- Department of Pathology and Molecular Medicine, Michael G. DeGroote School of Medicine, McMaster University, Hamilton, ON, Canada
| | - Allyson M Pishko
- Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
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Di Minno MND, Calcaterra I, Lupoli R, Storino A, Spedicato GA, Maniscalco M, Di Minno A, Ambrosino P. Hemostatic Changes in Patients with COVID-19: A Meta-Analysis with Meta-Regressions. J Clin Med 2020; 9:E2244. [PMID: 32679766 PMCID: PMC7408674 DOI: 10.3390/jcm9072244] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2020] [Revised: 06/30/2020] [Accepted: 07/10/2020] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND Complications of coronavirus disease 2019 (COVID-19) include coagulopathy. We performed a meta-analysis on the association of COVID-19 severity with changes in hemostatic parameters. METHODS Data on prothrombin time (PT), activated partial thromboplastin time (aPTT), D-Dimer, platelets (PLT), or fibrinogen in severe versus mild COVID-19 patients, and/or in non-survivors to COVID-19 versus survivors were systematically searched. The standardized mean difference (SMD) was calculated. RESULTS Sixty studies comparing 5487 subjects with severe and 9670 subjects with mild COVID-19 documented higher PT (SMD: 0.41; 95%CI: 0.21, 0.60), D-Dimer (SMD: 0.67; 95%CI: 0.52, 0.82), and fibrinogen values (SMD: 1.84; 95%CI: 1.21, 2.47), with lower PLT count (SMD: -0.74; 95%CI: -1.01, -0.47) among severe patients. Twenty-five studies on 1511 COVID-19 non-survivors and 6287 survivors showed higher PT (SMD: 0.67; 95%CI: 0.39, 0.96) and D-Dimer values (SMD: 3.88; 95%CI: 2.70, 5.07), with lower PLT count (SMD: -0.60, 95%CI: -0.82, -0.38) among non-survivors. Regression models showed that C-reactive protein values were directly correlated with the difference in PT and fibrinogen. CONCLUSIONS Significant hemostatic changes are associated with COVID-19 severity. Considering the risk of fatal complications with residual chronic disability and poor long-term outcomes, further studies should investigate the prognostic role of hemostatic parameters in COVID-19 patients.
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Affiliation(s)
| | - Ilenia Calcaterra
- Department of Clinical Medicine and Surgery, Federico II University, 80131 Naples, Italy;
| | - Roberta Lupoli
- Department of Molecular Medicine and Medical Biotechnologies, Federico II University, 80131 Naples, Italy;
| | - Antonio Storino
- Istituti Clinici Scientifici Maugeri IRCCS, 27100 Pavia, Italy; (A.S.); (M.M.); (P.A.)
| | | | - Mauro Maniscalco
- Istituti Clinici Scientifici Maugeri IRCCS, 27100 Pavia, Italy; (A.S.); (M.M.); (P.A.)
| | | | - Pasquale Ambrosino
- Istituti Clinici Scientifici Maugeri IRCCS, 27100 Pavia, Italy; (A.S.); (M.M.); (P.A.)
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43
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Lippi G, Plebani M, Henry BM. Thrombocytopenia is associated with severe coronavirus disease 2019 (COVID-19) infections: A meta-analysis. CLINICA CHIMICA ACTA; INTERNATIONAL JOURNAL OF CLINICAL CHEMISTRY 2020. [PMID: 32178975 DOI: 10.1016/j.cca.2020.03.022)] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
BACKGROUND Coronavirus disease 2019 (COVID-19) is a novel infectious disease with lack of established laboratory markers available to evaluate illness severity. In this study, we investigate whether platelet count could differentiate between COVID-19 patients with or without severe disease. Additionally, we evaluate if thrombocytopenia is associated with severe COVID-19. METHODS An electronic search in Medline, Scopus and Web of Science was performed to identify studies reporting data on platelet count in COVID-19 patients. A meta-analysis was performed, with calculation of weighted mean difference (WMD) of platelet number in COVID-19 patients with or without severe disease and odds ratio (OR) of thrombocytopenia for severe form of COVID-19. RESULTS Nine studies with 1779 COVID-19 patients, 399 (22.4%) with severe disease, were included in the meta-analysis. The pooled analysis revealed that platelet count was significantly lower in patients with more severe COVID-19 (WMD -31 × 109/L; 95% CI, from -35 to -29 × 109/L). A subgroup analysis comparing patients by survival, found an even lower platelet count was observed with mortality (WMD, -48 × 109/L; 95% CI, -57 to -39 × 109/L. In the four studies (n = 1427) which reported data on rate of thrombocytopenia, a low platelet count was associated with over fivefold enhanced risk of severe COVID-19 (OR, 5.1; 95% CI, 1.8-14.6). CONCLUSIONS Low platelet count is associated with increased risk of severe disease and mortality in patients with COVID-19, and thus should serve as clinical indicator of worsening illness during hospitalization.
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Affiliation(s)
- Giuseppe Lippi
- Section of Clinical Biochemistry, Department of Neuroscience, Biomedicine and Movement, University of Verona, Verona, Italy
| | - Mario Plebani
- Department of Laboratory Medicine, University Hospital of Padova, Padova, Italy
| | - Brandon Michael Henry
- Cardiac Intensive Care Unit, The Heart Institute, Cincinnati Children's Hospital Medical Center, OH, USA.
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44
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Song JC, Liu SY, Zhu F, Wen AQ, Ma LH, Li WQ, Wu J. Expert consensus on the diagnosis and treatment of thrombocytopenia in adult critical care patients in China. Mil Med Res 2020; 7:15. [PMID: 32241296 PMCID: PMC7118900 DOI: 10.1186/s40779-020-00244-w] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/12/2020] [Accepted: 03/20/2020] [Indexed: 01/14/2023] Open
Abstract
Thrombocytopenia is a common complication of critical care patients. The rates of bleeding events and mortality are also significantly increased in critical care patients with thrombocytopenia. Therefore, the Critical Care Medicine Committee of Chinese People's Liberation Army (PLA) worked with Chinese Society of Laboratory Medicine, Chinese Medical Association to develop this consensus to provide guidance for clinical practice. The consensus includes five sections and 27 items: the definition of thrombocytopenia, etiology and pathophysiology, diagnosis and differential diagnosis, treatment and prevention.
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Affiliation(s)
- Jing-Chun Song
- Department of Critical Care Medicine, the 908th Hospital of Joint Logistics Support Forces of Chinese PLA, Nanchang, 360104, China.
| | - Shu-Yuan Liu
- Emergency Department, the Sixth Medical Center, Chinese PLA General Hospital, Beijing, 100048, China
| | - Feng Zhu
- Burns and Trauma ICU, Changhai Hospital, Naval Medical University, Shanghai, 200003, China
| | - Ai-Qing Wen
- Department of Blood Transfusion, Daping Hospital of Army Medical University, Chongqing, 400042, China
| | - Lin-Hao Ma
- Department of Emergency and Critical Care Medicine, Changzheng Hospital, Naval Medical University, Shanghai, 200003, China
| | - Wei-Qin Li
- Surgery Intensive Care Unit, Jinling Hospital, Medical School of Nanjing University, Nanjing, 210002, China.
| | - Jun Wu
- Department of Clinical Laboratory, Peking University Fourth School of Clinical Medicine, Beijing Jishuitan Hospital, Beijing, 100035, China.
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45
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Sykes DB, Zhang EW, Karp Leaf RS, Nardi V, Turbett SE. Case 10-2020: An 83-Year-Old Man with Pancytopenia and Acute Renal Failure. N Engl J Med 2020; 382:1258-1266. [PMID: 32212524 DOI: 10.1056/nejmcpc1916250] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Affiliation(s)
- David B Sykes
- From the Departments of Medicine (D.B.S., R.S.K.L., S.E.T.), Radiology (E.W.Z.), and Pathology (V.N., S.E.T.), Massachusetts General Hospital, and the Departments of Medicine (D.B.S., R.S.K.L., S.E.T.), Radiology (E.W.Z.), and Pathology (V.N., S.E.T.), Harvard Medical School - both in Boston
| | - Eric W Zhang
- From the Departments of Medicine (D.B.S., R.S.K.L., S.E.T.), Radiology (E.W.Z.), and Pathology (V.N., S.E.T.), Massachusetts General Hospital, and the Departments of Medicine (D.B.S., R.S.K.L., S.E.T.), Radiology (E.W.Z.), and Pathology (V.N., S.E.T.), Harvard Medical School - both in Boston
| | - Rebecca S Karp Leaf
- From the Departments of Medicine (D.B.S., R.S.K.L., S.E.T.), Radiology (E.W.Z.), and Pathology (V.N., S.E.T.), Massachusetts General Hospital, and the Departments of Medicine (D.B.S., R.S.K.L., S.E.T.), Radiology (E.W.Z.), and Pathology (V.N., S.E.T.), Harvard Medical School - both in Boston
| | - Valentina Nardi
- From the Departments of Medicine (D.B.S., R.S.K.L., S.E.T.), Radiology (E.W.Z.), and Pathology (V.N., S.E.T.), Massachusetts General Hospital, and the Departments of Medicine (D.B.S., R.S.K.L., S.E.T.), Radiology (E.W.Z.), and Pathology (V.N., S.E.T.), Harvard Medical School - both in Boston
| | - Sarah E Turbett
- From the Departments of Medicine (D.B.S., R.S.K.L., S.E.T.), Radiology (E.W.Z.), and Pathology (V.N., S.E.T.), Massachusetts General Hospital, and the Departments of Medicine (D.B.S., R.S.K.L., S.E.T.), Radiology (E.W.Z.), and Pathology (V.N., S.E.T.), Harvard Medical School - both in Boston
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Thrombocytopenia is associated with severe coronavirus disease 2019 (COVID-19) infections: A meta-analysis. Clin Chim Acta 2020; 506:145-148. [PMID: 32178975 PMCID: PMC7102663 DOI: 10.1016/j.cca.2020.03.022] [Citation(s) in RCA: 1082] [Impact Index Per Article: 270.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2020] [Revised: 03/11/2020] [Accepted: 03/12/2020] [Indexed: 01/08/2023]
Abstract
Platelet count can discriminate between severe and non-severe COVID-19 infections. Patients who did not survive have a significantly lower platelet count than survivors. Thrombocytopenia is associated with increased risk of severe disease. A substantial decrease in platelet count may be an indicator of worsening illness.
Background Coronavirus disease 2019 (COVID-19) is a novel infectious disease with lack of established laboratory markers available to evaluate illness severity. In this study, we investigate whether platelet count could differentiate between COVID-19 patients with or without severe disease. Additionally, we evaluate if thrombocytopenia is associated with severe COVID-19. Methods An electronic search in Medline, Scopus and Web of Science was performed to identify studies reporting data on platelet count in COVID-19 patients. A meta-analysis was performed, with calculation of weighted mean difference (WMD) of platelet number in COVID-19 patients with or without severe disease and odds ratio (OR) of thrombocytopenia for severe form of COVID-19. Results Nine studies with 1779 COVID-19 patients, 399 (22.4%) with severe disease, were included in the meta-analysis. The pooled analysis revealed that platelet count was significantly lower in patients with more severe COVID-19 (WMD −31 × 109/L; 95% CI, from −35 to −29 × 109/L). A subgroup analysis comparing patients by survival, found an even lower platelet count was observed with mortality (WMD, −48 × 109/L; 95% CI, −57 to −39 × 109/L. In the four studies (n = 1427) which reported data on rate of thrombocytopenia, a low platelet count was associated with over fivefold enhanced risk of severe COVID-19 (OR, 5.1; 95% CI, 1.8–14.6). Conclusions Low platelet count is associated with increased risk of severe disease and mortality in patients with COVID-19, and thus should serve as clinical indicator of worsening illness during hospitalization.
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47
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Kim DW, Kim W, Lee CH, Chun YI. Thrombocytopenia during intravenous valproic acid therapy in the neurological intensive care unit. J Clin Pharm Ther 2020; 45:1014-1020. [PMID: 32040242 DOI: 10.1111/jcpt.13125] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2019] [Revised: 12/17/2019] [Accepted: 01/07/2020] [Indexed: 11/30/2022]
Abstract
WHAT IS KNOWN AND OBJECTIVE Thrombocytopenia is a common laboratory abnormality among critically ill patients under neurological intensive care unit (NCU) care. Valproic acid (VPA), a widely used antiepileptic drug, is one of the common causes of drug-induced thrombocytopenia. The purpose of this study was to estimate the incidence and risk factors of thrombocytopenia after intravenous VPA therapy among the patients admitted to NCU. METHODS We retrospectively reviewed the medical records of patients who were treated with intravenous VPA during their NCU stay between January 2014 and December 2018. We studied the frequency of thrombocytopenia and further evaluated the risk of thrombocytopenia in these patients. RESULTS Among the 283 patients (181 male [64.0%], mean age: [61.0 ± 14.9] years) who were treated with intravenous VPA, thrombocytopenia was observed in 104 patients (36.7%). Thrombocytopenia was associated with several risk factors, including lower baseline platelet counts (<200 × 109 /L); aetiologies other than intracranial or subarachnoid haemorrhage; longer use of VPA (more than 3 days); higher daily dose of VPA (more than 1000 mg/d); concurrent use of VPA with other antiepileptic drugs; infection; and the use of mechanical ventilation. Multivariate analysis found several independent risk factors of thrombocytopenia with intravenous VPA therapy, including lower baseline platelet counts, aetiologies other than intracranial or subarachnoid haemorrhage, use of VPA for more than 3 days and infection. WHAT IS NEW AND CONCLUSION Thrombocytopenia is common in NCU patients. Because several clinical and laboratory factors are associated with thrombocytopenia, careful use of VPA should be considered in patients with these risk factors.
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Affiliation(s)
- Dong Wook Kim
- Department of Neurology, Konkuk University School of Medicine, Seoul, South Korea
| | - Wonshik Kim
- Department of Neurology, Konkuk University School of Medicine, Seoul, South Korea
| | - Chang-Hoon Lee
- Department of Internal Medicine, Seoul National University Hospital, Seoul, South Korea
| | - Young Il Chun
- Department of Neurosurgery, Konkuk University School of Medicine, Seoul, South Korea
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Abstract
In sepsis, coagulation is activated and there is an increased risk of developing a consumptive coagulopathy with attendant increase in mortality. The processes that regulate hemostasis evolved as a component of the inflammatory response to infection. Many points of interaction occur on the endothelial cell surface linking the 2 cell types in the initiation and regulation of hemostasis and inflammation. Consequently, inflammation stimulates both platelets and endothelial cells in ways that affect both hemostasis and the immune response. Platelets are also prime drivers of the inflammatory response. This article discusses the pathways wherein inflammation regulates platelet and endothelial cell function.
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Affiliation(s)
- Tom van der Poll
- Amsterdam University Medical Centers, Location Academic Medical Center, University of Amsterdam, Center of Experimental and Molecular Medicine & Division of Infectious Diseases, Meibergdreef 9, Room G2-130, Amsterdam 1105AZ, the Netherlands
| | - Robert I Parker
- Department of Pediatrics, Pediatric Hematology/Oncology, Renaissance School of Medicine, Stony Brook University, Stony Brook, NY 11794-8111, USA.
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49
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Eslamijouybari M, Heydari K, Maleki I, Moosazadeh M, Hedayatizadeh-Omran A, Vahedi L, Ghasemian R, Sharifpour A, Alizadeh-Navaei R. Neutrophil-to-Lymphocyte and Platelet-to-Lymphocyte Ratios in COVID-19 Patients and Control Group and Relationship with Disease Prognosis. CASPIAN JOURNAL OF INTERNAL MEDICINE 2020; 11:531-535. [PMID: 33425271 PMCID: PMC7780872 DOI: 10.22088/cjim.11.0.531] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/09/2020] [Revised: 08/25/2020] [Accepted: 09/07/2020] [Indexed: 02/05/2023]
Abstract
BACKGROUND The present study aimed to compare the complete blood count (CBC) indices between COVID-19 patients and the control group, and assess the relationship of these indices with COVID-19 prognosis. METHODS COVID-19 patients (confirmed by PCR or CT-Scan) who visited Imam Hospital in Sari were selected in this case-control study. The control group was selected from Tabari cohort population matched with the case group in terms of gender and age. CBC, neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), and outcome of the disease (in the case group) were assessed in this study. RESULTS The number of participants were 527 in both case and control groups, of which, 232 (44%) were females in each arms. Platelet count, lymphocyte count, and hemoglobin concentration were also higher in the control group (P=0.000). NLR and PLR were significantly higher in COVID-19 patients compared to the control group (P=0.000). NLR had a significant relationship with the severity of the disease. NLR was two times higher in the patients who died of COVID-19 than those who recovered (P=0.000). ROC curve analysis for diagnostic values of NLR and PLR showed that the areas under the ROC curves for NLR and PLR were 0.703 (95% CI: 0.64-0.76) and 0.535 (95% CI: 0.46-06), respectively. CONCLUSION NLR can be used as a prognostic marker for COVID-19 given the significant difference of NLR between those who died and recovered from COVID-19.
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Affiliation(s)
- Mohammad Eslamijouybari
- Gastrointestinal Cancer Research Center, Non-Communicable Diseases Institute, Mazandaran University of Medical Sciences, Sari, Iran
| | - Keyvan Heydari
- Student Research Committee, School of Medicine, Mazandaran University of Medical Sciences, Sari, Iran
| | - Iradj Maleki
- Gut and Liver Research Center, Non-Communicable Diseases Institute, Mazandaran University of Medical Sciences, Sari, Iran
| | - Mahmood Moosazadeh
- Health Sciences Research Center, Addiction Institute, Mazandaran University of Medical Sciences, Sari, Iran
| | - Akbar Hedayatizadeh-Omran
- Gastrointestinal Cancer Research Center, Non-Communicable Diseases Institute, Mazandaran University of Medical Sciences, Sari, Iran
| | - Lale Vahedi
- Department of Pathology, Faculty of Medicine, Mazandaran University of Medical Sciences, Sari, Iran
| | - Roya Ghasemian
- Antimicrobial Resistance Research Center, Communicable Diseases Institute, Mazandaran University of Medical Sciences, Sari, Iran
| | - Ali Sharifpour
- Department of Pulmonary and Critical Care, Mazandaran University of Medical Sciences, Sari, Iran
| | - Reza Alizadeh-Navaei
- Gastrointestinal Cancer Research Center, Non-Communicable Diseases Institute, Mazandaran University of Medical Sciences, Sari, Iran
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McDonald B, Dunbar M. Platelets and Intravascular Immunity: Guardians of the Vascular Space During Bloodstream Infections and Sepsis. Front Immunol 2019; 10:2400. [PMID: 31681291 PMCID: PMC6797619 DOI: 10.3389/fimmu.2019.02400] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2019] [Accepted: 09/25/2019] [Indexed: 12/12/2022] Open
Abstract
Despite their humble origins as anuclear fragments of megakaryocytes, platelets have emerged as versatile mediators of thrombosis and immunity. The diverse spectrum of platelet functions are on full display during the host response to severe infection and sepsis, with platelets taking center-stage in the intravascular immune response to blood-borne pathogens. Platelets are endowed with a comprehensive armamentarium of pathogen detection systems that enable them to function as sentinels in the bloodstream for rapid identification of microbial invasion. Through both autonomous anti-microbial effector functions and collaborations with other innate immune cells, platelets orchestrate a complex intravascular immune defense system that protects against bacterial dissemination. As with any powerful immune defense system, dysregulation of platelet-mediated intravascular immunity can lead to profound collateral damage to host cells and tissues, resulting in sepsis-associated organ dysfunction. In this article, the cellular and molecular contributions of platelets to intravascular immune defenses in sepsis will be reviewed, including the roles of platelets in surveillance of the microcirculation and elicitation of protective anti-bacterial responses. Mechanisms of platelet-mediated thromboinflammatory organ dysfunction will be explored, with linkages to clinical biomarkers of platelet homeostasis that aid in the diagnosis and prognostication of human sepsis. Lastly, we discuss novel therapeutic opportunities that take advantage of our evolving understanding of platelets and intravascular immunity in severe infection.
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Affiliation(s)
- Braedon McDonald
- Department of Critical Care Medicine, Snyder Institute for Chronic Diseases, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Mary Dunbar
- Department of Pediatrics, Alberta Children's Hospital Research Institute, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
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