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Castelli B, Scagnet M, Mussa F, Genitori L, Sardi I, Stagi S. Vascular complications in craniopharyngioma-resected paediatric patients: a single-center experience. Front Endocrinol (Lausanne) 2024; 15:1292025. [PMID: 38681768 PMCID: PMC11047119 DOI: 10.3389/fendo.2024.1292025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/10/2023] [Accepted: 03/12/2024] [Indexed: 05/01/2024] Open
Abstract
Background Craniopharyngioma (CP), although slow growing and histologically benign, has high morbidity, mostly related to hypothalamus-pituitary dysfunction and electrolyte imbalance. Increased risk of vascular complications has been described. However, data are still poor, especially in the paediatric population. The aim of our study was to evaluate the occurrence, timing, and predisposing factors of deep venous thrombosis (DVT) and other vascular alterations in neurosurgical paediatric CP patients. Materials and Methods In a single-centre, retrospective study, we investigated 19 CP patients (11 males, 8 females, mean age 10.5 ± 4.3 years), who underwent neurosurgery between December 2016 and August 2022, referred to Meyer Children's Hospital IRCCS in Florence. Results Five patients (26.3%) presented vascular events, which all occurred in connection with sodium imbalances. Three DVT (two with associated pulmonary embolism, in one case leading to death) developed in the post-operative period, most frequently at 7-10 days. Elevated D-dimers, a reduced partial activated thrombin time and a prolonged C-reactive protein increase were highly related to thrombotic vascular events. One case of posterior cerebral artery pseudoaneurysm was described soon after neurosurgery, requiring vascular stenting. Superficial vein thrombophlebitis was a late complication in one patient with other predisposing factors. Conclusion CP patients undergoing neurosurgery are at risk of developing DVT and vascular alterations, thus careful follow-up is mandatory. In our study, we found that the phase of transition from central diabetes insipidus to a syndrome of inappropriate antidiuretic hormone secretion may be a period of significant risk for DVT occurrence. Careful vascular follow-up is mandatory in CP-operated patients.
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Affiliation(s)
- Barbara Castelli
- Department of Health Sciences, University of Florence, Florence, Italy
- Neuro-oncology Department, Meyer Children’s Hospital IRCCS, Florence, Italy
| | - Mirko Scagnet
- Neurosurgery Department, Meyer Children’s Hospital IRCCS, Florence, Italy
| | - Federico Mussa
- Neurosurgery Department, Meyer Children’s Hospital IRCCS, Florence, Italy
| | - Lorenzo Genitori
- Neurosurgery Department, Meyer Children’s Hospital IRCCS, Florence, Italy
| | - Iacopo Sardi
- Neuro-oncology Department, Meyer Children’s Hospital IRCCS, Florence, Italy
| | - Stefano Stagi
- Department of Health Sciences, University of Florence, Florence, Italy
- Struttura Organizzativa Complessa (SOC) Diabetology and Endocrinology, Meyer Children’s Hospital IRCCS, Florence, Italy
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Helsloot D, Fitzgerald M, Lefering R, Verelst S, Missant C. Trauma-induced disturbances in ionized calcium levels correlate parabolically with coagulopathy, transfusion, and mortality: a multicentre cohort analysis from the TraumaRegister DGU ®. Crit Care 2023; 27:267. [PMID: 37415194 PMCID: PMC10324195 DOI: 10.1186/s13054-023-04541-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2023] [Accepted: 06/22/2023] [Indexed: 07/08/2023] Open
Abstract
BACKGROUND To which extent trauma- induced disturbances in ionized calcium (iCa2+) levels have a linear relationship with adverse outcomes remains controversial. The goal of this study was to determine the association between the distribution and accompanying characteristics of transfusion-independent iCa2+ levels versus outcome in a large cohort of major trauma patients upon arrival at the emergency department. METHODS A retrospective observational analysis of the TraumaRegister DGU® (2015-2019) was performed. Adult major trauma patients with direct admission to a European trauma centre were selected as the study cohort. Mortality at 6 h and 24 h, in-hospital mortality, coagulopathy, and need for transfusion were considered as relevant outcome parameters. The distribution of iCa2+ levels upon arrival at the emergency department was calculated in relation to these outcome parameters. Multivariable logistic regression analysis was performed to determine independent associations. RESULTS In the TraumaRegister DGU® 30 183 adult major trauma patients were found eligible for inclusion. iCa2+ disturbances affected 16.4% of patients, with hypocalcemia (< 1.10 mmol/l) being more frequent (13.2%) compared to hypercalcemia (≥ 1.30 mmol/l, 3.2%). Patients with hypo- and hypercalcemia were both more likely (P < .001) to have severe injury, shock, acidosis, coagulopathy, transfusion requirement, and haemorrhage as cause of death. Moreover, both groups had significant lower survival rates. All these findings were most distinct in hypercalcemic patients. When adjusting for potential confounders, mortality at 6 h was independently associated with iCa2+ < 0.90 mmol/L (OR 2.69, 95% CI 1.67-4.34; P < .001), iCa2+ 1.30-1.39 mmol/L (OR 1.56, 95% CI 1.04-2.32, P = 0.030), and iCa2+ ≥ 1.40 mmol/L (OR 2.87, 95% CI 1.57-5.26; P < .001). Moreover, an independent relationship was determined for iCa2+ 1.00-1.09 mmol/L with mortality at 24 h (OR 1.25, 95% CI 1.05-1.48; P = .0011), and with in-hospital mortality (OR 1.29, 95% CI 1.13-1.47; P < .001). Both hypocalcemia < 1.10 mmol/L and hypercalcemia ≥ 1.30 mmol/L had an independent association with coagulopathy and transfusion. CONCLUSIONS Transfusion-independent iCa2+ levels in major trauma patients upon arrival at the emergency department have a parabolic relationship with coagulopathy, need for transfusion, and mortality. Further research is needed to confirm whether iCa2+ levels change dynamically and are more a reflection of severity of injury and accompanying physiological derangements, rather than an individual parameter that needs to be corrected as such.
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Affiliation(s)
- Dries Helsloot
- Department of Anaesthesia and Emergency Medicine, AZ Groeninge Hospital, President Kennedylaan 4, 8500, Kortrijk, Belgium.
- Department of Cardiovascular Sciences, KU Leuven University Campus Kulak, Etienne Sabbelaan 53, Box 7700, 8500, Kortrijk, Belgium.
- National Trauma Research Institute, Alfred Health and Monash University, Level 4, 89 Commercial Road, Melbourne, VIC, 3004, Australia.
| | - Mark Fitzgerald
- National Trauma Research Institute, Alfred Health and Monash University, Level 4, 89 Commercial Road, Melbourne, VIC, 3004, Australia
- Trauma Service, The Alfred Hospital, 55 Commercial Road, Melbourne, VIC, 3004, Australia
| | - Rolf Lefering
- Institute for Research in Operative Medicine (IFOM), Universität Witten/Herdecke, Ostmerheimer Str.200, Haus 38, 51109, Cologne, Germany
| | - Sandra Verelst
- Department of Emergency Medicine, UZ Leuven Hospital, Herestraat 49, 3000, Leuven, Belgium
- Department of Public Health and Primary Care, KU Leuven University, Herestraat 49, Box 7003, 3000, Leuven, Belgium
| | - Carlo Missant
- Department of Anaesthesia and Emergency Medicine, AZ Groeninge Hospital, President Kennedylaan 4, 8500, Kortrijk, Belgium
- Department of Cardiovascular Sciences, KU Leuven University Campus Kulak, Etienne Sabbelaan 53, Box 7700, 8500, Kortrijk, Belgium
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Zhang J, Ali A, Liu Y, Peng L, Pu J, Yi Q, Zhou H. Additive prognostic value of serum calcium to the ESC risk stratification in patients with acute pulmonary embolism. Thromb J 2023; 21:20. [PMID: 36793097 PMCID: PMC9930215 DOI: 10.1186/s12959-023-00461-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2022] [Accepted: 01/30/2023] [Indexed: 02/17/2023] Open
Abstract
BACKGROUND Hypocalcemia has been shown to be involved in the adverse outcomes of acute pulmonary embolism (APE). We aimed to determine the incremental value of adding hypocalcemia, defined as serum calcium level ≤ 2.12 mmol/L, on top of the European Society of Cardiology (ESC) prognostic algorithm, for the prediction of in-hospital mortality in APE patients, which in turn could lead to the optimization of APE management. METHODS This study was conducted at West China Hospital of Sichuan University from January 2016 to December 2019. Patients with APE were retrospectively analyzed and divided into 2 groups based on serum calcium levels. Associations between hypocalcemia and adverse outcomes were assessed by Cox analysis. The accuracy of risk stratification for in-hospital mortality was assessed with the addition of serum calcium to the current ESC prognostic algorithm. RESULTS Among 803 patients diagnosed with APE, 338 (42.1%) patients had serum calcium levels ≤ 2.12 mmol/L. Hypocalcemia was significantly associated with higher in-hospital and 2-year all-cause mortality compared to the control group. The addition of serum calcium to ESC risk stratification enhanced net reclassification improvement. Low-risk group with serum calcium level > 2.12 mmol/L had a 0% mortality rate, improving the negative predictive value up to 100%, while high-risk group with serum calcium level ≤ 2.12 mmol/L indicated a higher mortality of 25%. CONCLUSION Our study identified serum calcium as a novel predictor of mortality in patients with APE. In the future, serum calcium may be added to the commonly used ESC prognostic algorithm for better risk stratification of patients suffering from APE.
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Affiliation(s)
- Jiarui Zhang
- grid.412901.f0000 0004 1770 1022Department of Respiratory and Critical Care Medicine, West China Hospital of Sichuan University, Chengdu, Sichuan China
| | - Adila Ali
- grid.412901.f0000 0004 1770 1022Department of Respiratory and Critical Care Medicine, West China Hospital of Sichuan University, Chengdu, Sichuan China
| | - Yu Liu
- grid.412901.f0000 0004 1770 1022Department of Respiratory and Critical Care Medicine, West China Hospital of Sichuan University, Chengdu, Sichuan China
| | - Lige Peng
- grid.412901.f0000 0004 1770 1022Department of Respiratory and Critical Care Medicine, West China Hospital of Sichuan University, Chengdu, Sichuan China
| | - Jiaqi Pu
- grid.412901.f0000 0004 1770 1022Department of Respiratory and Critical Care Medicine, West China Hospital of Sichuan University, Chengdu, Sichuan China
| | - Qun Yi
- Department of Respiratory and Critical Care Medicine, West China Hospital of Sichuan University, Chengdu, Sichuan, China. .,Cancer Hospital Affiliate to School of Medicine, Sichuan Cancer Hospital and Institution, Sichuan Cancer Center, UESTC, Sichuan Province, Chengdu, China.
| | - Haixia Zhou
- Department of Respiratory and Critical Care Medicine, West China Hospital of Sichuan University, Chengdu, Sichuan, China.
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Chunilal SD, Bennett A. A new clinical prediction rule for pulmonary embolism: What's new? Respirology 2022; 27:571-572. [PMID: 35734781 DOI: 10.1111/resp.14314] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2022] [Accepted: 06/09/2022] [Indexed: 11/27/2022]
Affiliation(s)
- Sanjeev Daya Chunilal
- Department of Haematology, Monash Medical Center, Clayton, Victoria, Australia.,School of Clinical Sciences at Monash Health, Monash University, Clayton, Victoria, Australia
| | - Ashwini Bennett
- Department of Haematology, Monash Medical Center, Clayton, Victoria, Australia.,School of Clinical Sciences at Monash Health, Monash University, Clayton, Victoria, Australia
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Yang YQ, Wang X, Zhang YJ, Chen YF, Wang L, Hu XW, Niu L, Pu HM, Zhang X, Zhang Z, Wang L, Chen FW, Shi J, Ji YQ. Prognosis assessment model based on low serum calcium in patients with acute pulmonary thromboembolism. Respirology 2022; 27:645-652. [PMID: 35297140 PMCID: PMC9540334 DOI: 10.1111/resp.14243] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2021] [Revised: 02/10/2022] [Accepted: 02/28/2022] [Indexed: 12/19/2022]
Abstract
Background and objective The pulmonary embolism severity index (PESI) and simplified PESI (sPESI) are recommended to recognize patients with acute pulmonary thromboembolism (PTE) with low prognosis risk, which is of great significance for treatment. This study aims to verify the influence of hypocalcaemia on the prognosis of patients with PTE and to establish a new prognosis assessment model. Methods This is an observational, multicentre study enrolling patients with PTE from February 2010 to June 2020 across 12 Chinese hospitals. Variables in PESI, serum calcium levels and patient survival status as of 5 July 2020 were collected. The area under the curve of the receiver operating characteristic curve, sensitivity, specificity and Youden index were used to evaluate model performance. Results In the cohort of 4196 patients with PTE, independent associations existed between hypocalcaemia and mid‐ and long‐term mortalities (p <0.05). By including hypocalcaemia, the new 30‐day death risk prediction rule, Peking Union Medical College Hospital rule (PUMCH rule), showed significantly higher specificity (0.622 [0.582, 0.661]; p <0.001) than the PESI (0.514 [0.473, 0.554]) and sPESI (0.484 [0.444, 0.525]) and similar sensitivity (0.963 [0.810, 0.999]; p = 0.161) with PESI (0.889 [0.708, 0.976]) and sPESI (0.963 [0.810, 0.999]) in the internal validation cohort. Well‐performing predictive validity was also verified on a constructed external validation cohort. Conclusion Hypocalcaemia is independently associated with mid‐ and long‐term PTE mortalities. The PUMCH rule showed significantly higher specificity than the PESI and sPESI and similar sensitivity, which may be used as a prognostic assessment tool for patients with acute PTE. Currently, pulmonary embolism severity index (PESI) and simplified PESI (sPESI) are recommended to recognize pulmonary thromboembolism (PTE) patients with low prognosis risk. In this multicentre research, a new prognosis assessment model including hypocalcaemia, which is confirmed to be independently associated with mid‐ and long‐term PTE mortalities, showed significantly higher specificity with PESI and sPESI and similar sensitivity. See relatedEditorial
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Affiliation(s)
- Yu-Qing Yang
- State Key Laboratory of Networking and Switching Technology, Beijing University of Posts and Telecommunications, Beijing, China
| | - Xin Wang
- Department of Ultrasound, Peking Union Medical College Hospital, Beijing, China.,Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, China
| | - Yun-Jian Zhang
- Department of Respiration, Beijing Jishuitan Hospital, Beijing, China
| | - Yan-Fan Chen
- Department of Respiration, the First Affiliated Hospital of Wenzhou Medical College, Zhejiang, China
| | - Ling Wang
- Department of Respiration, Traditional Chinese Medicine Hospital of Xinjiang Uygur Autonomous Region, Xinjiang Uygur Autonomous Region, Uygur, China
| | - Xiao-Wen Hu
- Department of Respiration, Anhui Provincial Hospital, Hefei, China
| | - Ling Niu
- Department of Respiration, People's Hospital of Xinjiang Uygur Autonomous Region, Xinjiang Uygur Autonomous Region, Uygur, China
| | - Hong-Mei Pu
- Department of Respiration, Yanbian University Affiliated Hospital Organization, Yanji, China
| | - Xin Zhang
- Department of Respiration, Hebei Chest Hospital, Hebei, China
| | - Zhen Zhang
- Department of Respiration, BaoDing No. 1 Hospital, Hebei, China
| | - Lan Wang
- Department of Respiration, Shanghai Pulmonary Hospital, Shanghai, China
| | - Fang-Wei Chen
- Department of Respiration, Zhuzhou People's Hospital of Hunan Province, Hunan, China
| | - Juhong Shi
- Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, China.,Department of Pulmonary and Critical Care Medicine, Peking Union Medical College Hospital, Beijing, China
| | - Ying-Qun Ji
- Department of Pulmonary and Critical Care Medicine, East Hospital, Shanghai, China
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