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Toh JM, Yong J, Abrams ST, Wang L, Schofield J, Lane S, La Corte AC, Wang SS, Ariëns RAS, Philippou H, Xie J, Yu W, Wang G, Toh CH. Fibrinogen binding to histones in circulation protects against adverse cellular and clinical outcomes. J Thromb Haemost 2024; 22:2247-2260. [PMID: 38777257 DOI: 10.1016/j.jtha.2024.05.009] [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: 12/08/2023] [Revised: 04/17/2024] [Accepted: 05/08/2024] [Indexed: 05/25/2024]
Abstract
BACKGROUND Circulating histones are released by extensive tissue injury or cell death and play important pathogenic roles in critical illnesses. Their interaction with circulating plasma components and the potential roles in the clinical setting are not fully understood. OBJECTIVES We aimed to characterize the interaction of histones with fibrinogen and explore its roles in vitro, in vivo, and in patient samples. METHODS Histone-fibrinogen binding was assessed by electrophoresis and enzyme-linked immunosorbent assay-based affinity assay. Functional significance was explored using washed platelets and endothelial cells in vitro and histone-infusion mouse models in vivo. To determine clinical translatability, a retrospective single-center cohort study was conducted on patients requiring intensive care admission (n = 199) and validated in a cohort of hospitalized patients with COVID-19 (n = 69). RESULTS Fibrinogen binds histones through its D-domain with high affinity (calf thymus histones, KD = 18.0 ± 5.6 nM; histone 3, KD = 2.7 ± 0.8 nM; and histone 4, KD = 2.0 ± 0.7 nM) and significantly reduces histone-induced endothelial damage and platelet aggregation in vitro and in vivo in a histone-infusion mouse model. Physiologic concentrations of fibrinogen can neutralize low levels of circulating histones and increase the cytotoxicity threshold of histones to 50 μg/mL. In a cohort of patients requiring intensive care, a histone:fibrinogen ratio of ≥6 on admission was associated with moderate-severe thrombocytopenia and independently predicted mortality. This finding was validated in a cohort of hospitalized patients with COVID-19. CONCLUSION Fibrinogen buffers the cytotoxic properties of circulating histones. Detection and monitoring of circulating histones and histone:fibrinogen ratios will help identify critically ill patients at highest risk of adverse outcomes who might benefit from antihistone therapy.
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Affiliation(s)
- Julien M Toh
- Department of Clinical Infection, Microbiology and Immunology, University of Liverpool, Liverpool, UK; Department of Anaesthetics and Critical Care, St George's University Hospitals NHS Foundation Trust, London, UK
| | - Jun Yong
- Department of Clinical Infection, Microbiology and Immunology, University of Liverpool, Liverpool, UK; Roald Dahl Haemostasis & Thrombosis Centre, Liverpool University Hospitals NHS Foundation Trust, Liverpool, UK
| | - Simon T Abrams
- Department of Clinical Infection, Microbiology and Immunology, University of Liverpool, Liverpool, UK; Department of Haematology, Liverpool University Hospitals NHS Foundation Trust, Liverpool, UK
| | - Lijun Wang
- The Medical School, Southeast University, Nanjing, China
| | - Jeremy Schofield
- Department of Clinical Infection, Microbiology and Immunology, University of Liverpool, Liverpool, UK; Roald Dahl Haemostasis & Thrombosis Centre, Liverpool University Hospitals NHS Foundation Trust, Liverpool, UK
| | - Steven Lane
- Department of Medical Statistics, Institute of Translational Medicine, University of Liverpool, Liverpool, UK
| | - Amy Cilia La Corte
- Discovery and Translational Science Department, Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, UK
| | - Susan S Wang
- Department of Clinical Infection, Microbiology and Immunology, University of Liverpool, Liverpool, UK; William Harvey Research Institute, Barts & The London School of Medicine & Dentistry, Queen Mary University of London, Charterhouse Square, London, UK
| | - Robert A S Ariëns
- Leeds Institute of Cardiovascular & Metabolic Medicine, University of Leeds, Leeds, West Yorkshire, UK
| | - Helen Philippou
- Leeds Institute of Cardiovascular & Metabolic Medicine, University of Leeds, Leeds, West Yorkshire, UK
| | - Jianfeng Xie
- The Medical School, Southeast University, Nanjing, China
| | - Weiping Yu
- The Medical School, Southeast University, Nanjing, China
| | - Guozheng Wang
- Department of Clinical Infection, Microbiology and Immunology, University of Liverpool, Liverpool, UK; Department of Haematology, Liverpool University Hospitals NHS Foundation Trust, Liverpool, UK.
| | - Cheng-Hock Toh
- Department of Clinical Infection, Microbiology and Immunology, University of Liverpool, Liverpool, UK; Roald Dahl Haemostasis & Thrombosis Centre, Liverpool University Hospitals NHS Foundation Trust, Liverpool, UK.
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Lu J, Wu Y, Xue J, Hao C. Risk stratification for infection during immunosuppressive therapy in patients with lupus nephritis: A nested case-control study. Lupus 2024; 33:828-839. [PMID: 38662532 DOI: 10.1177/09612033241248722] [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: 05/31/2024]
Abstract
BACKGROUND The current prediction models for the risk of infection during immunosuppressive treatment for lupus nephritis (LN) lack a prediction time window and have poor pertinence. This study aimed to develop a risk stratification to predict infection during immunosuppressive therapy in patients with LN. METHODS This retrospective nested case-control study collected patients with LN treated with immunosuppressive therapy between 2014 and 2022 in the Nephrology ward in Huashan Hospital affiliated to Fudan University and Huashan Hospital Baoshan Branch. Cases were defined as patients who experienced infection during the follow-up period; patients were eligible as controls if they did not have infection during the follow-up period. RESULTS There were 53 patients with infection by CTCAE V5.0 grade ≥2. According to the 1:3 nested matching, the 53 patients with infection were matched with 159 controls. In the multivariable logistic regression model, the change rate of fibrinogen (OR = 0.97, 95% CI: 0.94-0.99, p = 0.008), leukopenia (OR = 8.68, 95% CI: 1.16-301.72, p = 0.039), and reduced albumin (OR = 6.25, 95% CI: 1.38-28.24, p = 0.017) were independently associated with infection. The AUC of the ROC curve in the validation set of the multivariable logistic regression model in the internal random sampling was 0.864. The scores range from -2 to 10. The infection risk stratification ranges from 2.8% at score -2 to 97.5% at score 10. CONCLUSION A risk stratification was built to predict the risk of infection in patients with LN undergoing immunosuppressive therapy.
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Affiliation(s)
- Jianda Lu
- Department of Nephrology, Huashan Hospital Affiliated to Fudan University, Shanghai, China
| | - Yuanhao Wu
- Department of Nephrology, Huashan Hospital Affiliated to Fudan University, Shanghai, China
| | - Jun Xue
- Department of Nephrology, Huashan Hospital Affiliated to Fudan University, Shanghai, China
| | - Chuanming Hao
- Department of Nephrology, Huashan Hospital Affiliated to Fudan University, Shanghai, China
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Kao SY, Tsao CM, Ke HY, Chou MF, Wu CC, Shih CC. Loss of plasma fibrinogen contributes to platelet hyporeactivity in rats with septic shock. Thromb Res 2024; 241:109072. [PMID: 38945093 DOI: 10.1016/j.thromres.2024.109072] [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: 05/04/2024] [Revised: 06/03/2024] [Accepted: 06/24/2024] [Indexed: 07/02/2024]
Abstract
INTRODUCTION Dysregulated host response to infection causes life-threatening organ dysfunction. Excessive inflammation and abnormal blood coagulation can lead to disseminated intravascular coagulation (DIC) and multiple-organ failure in the late sepsis stages. Platelet function impairment in sepsis contributes to bleeding, secondary infection, and tissue injury. Platelet transfusion is considered in patients with sepsis with DIC and bleeding; however, its benefits are limited and of low quality. Fibrinogen plays a crucial role in platelet function, and establishing a fibrin network binds to activated integrin αIIbβ3 and promotes outside-in signaling that amplifies platelet functions. However, the role of fibrinogen in sepsis-induced platelet dysfunction remains unclear. MATERIALS AND METHODS We evaluated the effects of fibrinogen on platelet hyporeactivity during septic shock in adult male Wistar rats using lipopolysaccharide (LPS) injection and cecal ligation and puncture (CLP) surgery. Changes in the hemodynamic, biochemical, and coagulation parameters were examined. Platelet activation and aggregation were measured using whole-blood assay, 96-well plate-based aggregometry, and light-transmission aggregometry. Additionally, platelet adhesion, spreading, and fibrin clot retraction were evaluated. RESULTS Rats with LPS- and CLP-induced sepsis displayed considerable decreases in plasma fibrinogen levels and platelet aggregation, adhesion, spreading, and clot retraction. The aggregation of platelets obtained from rats with sepsis was markedly augmented by fibrinogen supplementation. Additionally, fibrinogen administration improved platelet adhesion, spreading, and clot retraction in rats with sepsis. CONCLUSIONS Fibrinogen supplementation could serve as a potential therapeutic intervention for alleviating platelet hyporeactivity in patients with sepsis and bleeding.
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Affiliation(s)
- Shih-Yao Kao
- Graduate Institute of Life Sciences, National Defense Medical Center, Taipei, Taiwan, ROC
| | - Cheng-Ming Tsao
- Department of Anesthesiology, Taipei Veterans General Hospital and National Yang-Ming Chiao-Tung University, Taipei, Taiwan, ROC
| | - Hung-Yen Ke
- Division of Cardiovascular Surgery, Department of Surgery, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan, ROC
| | - Mei-Fang Chou
- Department of Pharmacy, Tri-Service General Hospital Penghu Branch, Penghu, Taiwan, ROC
| | - Chin-Chen Wu
- Department and Graduate Institute of Pharmacology, National Defense Medical Center, Taipei, Taiwan, ROC
| | - Chih-Chin Shih
- Graduate Institute of Life Sciences, National Defense Medical Center, Taipei, Taiwan, ROC; Department and Graduate Institute of Pharmacology, National Defense Medical Center, Taipei, Taiwan, ROC.
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Wada H, Kawasugi K, Honda G, Kawano N, Uchiyama T, Madoiwa S, Takezako N, Suzuki K, Seki Y, Ikezoe T, Iba T, Okamoto K. Sepsis-Associated DIC with Decreased Levels of Antithrombin and Fibrinogen is the Target for Combination Therapy with Thrombomodulin Alfa and Antithrombin. TH OPEN 2023; 7:e65-e75. [PMID: 36846833 PMCID: PMC9946787 DOI: 10.1055/a-2009-9073] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2022] [Accepted: 01/03/2023] [Indexed: 01/12/2023] Open
Abstract
Background Disseminated intravascular coagulation (DIC) is not a homogeneous condition, but rather includes heterogeneous conditions, and its pathophysiology and outcome vary considerably depending on the background. Although anticoagulant therapy is expected to be of benefit in the treatment of DIC, previous studies have suggested that the benefits are limited only to a specific subtype. Objects The purpose of this study was to identify the group that would benefit from combination therapy using thrombomodulin/antithrombin. Methods The data from 2,839 patients registered in the postmarketing surveillance of thrombomodulin were evaluated. The patients were divided into four groups depending on antithrombin and fibrinogen levels, and the additive effects of antithrombin on thrombomodulin were examined in the groups. Results The DIC score, Sequential Organ Failure Assessment score, and mortality were significantly higher in the DIC group with low-antithrombin/low-fibrinogen than in the DIC groups without either low antithrombin or low fibrinogen. The survival curve was significantly higher in DIC patients with combination therapy than in patients treated with thrombomodulin monotherapy, but this effect was seen only in patients with infection-based DIC. Conclusion DIC patients with low-antithrombin/low-fibrinogen risk poor outcomes, but they can be the target of combination therapy with antithrombin and thrombomodulin as long as the DIC is due to infection.
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Affiliation(s)
- Hideo Wada
- Department of General Medicine, Mie Prefectural General Medical Center, Mie, Japan,Address for correspondence Hideo Wada, MD, PhD Department of General Medicine, Mie Prefectural General Medical CenterMieJapan
| | - Kazuo Kawasugi
- Faculty of Medical Technology, Teikyo University, Tokyo, Japan
| | - Goichi Honda
- Department of Medical Affairs, Asahi Kasei Pharma Corporation, Tokyo, Japan
| | - Noriaki Kawano
- Department of Internal Medicine, Miyazaki Prefectural Miyazaki Hospital, Miyazaki, Japan
| | - Toshimasa Uchiyama
- Department of Laboratory Medicine, National Hospital Organization Takasaki General Medical Center, Gunma, Japan
| | - Seiji Madoiwa
- Department of Clinical Laboratory Medicine, Tokyo Saiseikai Central Hospital, Tokyo, Japan
| | - Naoki Takezako
- Department of Hematology, Nerima Hikarigaoka Hospital, Tokyo, Japan
| | - Kei Suzuki
- Emergency and Critical Care Center, Mie University Hospital, Mie, Japan
| | - Yoshinobu Seki
- Department of Hematology, Uonuma Institute of Community Medicine, Niigata University Medical and Dental Hospital, Niigata, Japan
| | - Takayuki Ikezoe
- Department of Hematology, Fukushima Medical University, Fukushima, Japan
| | - Toshiaki Iba
- Department of Emergency and Disaster Medicine, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Kohji Okamoto
- Department of Surgery, Center for Gastroenterology and Liver Disease, Kitakyushu City Yahata Hospital, Fukuoka, Japan
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Lee JK, Yoon CS, Na YO, Park HK, Oh HJ, Kho BG, Park HY, Kim TO, Shin HJ, Kwon YS, Kim YI, Lim SC. Risk factors and clinical outcomes associated with acquired hypofibrinogenemia in patients administered hemocoagulase batroxobin for hemoptysis. J Thorac Dis 2023; 15:65-76. [PMID: 36794140 PMCID: PMC9922611 DOI: 10.21037/jtd-22-717] [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: 05/25/2022] [Accepted: 11/25/2022] [Indexed: 12/14/2022]
Abstract
Background Hemocoagulase batroxobin is used to prevent hemostasis or bleeding in surgical and trauma patients; however, the role of batroxobin in patients with hemoptysis is not well understood. We evaluated the risk factors and prognosis of acquired hypofibrinogenemia in hemoptysis patients treated systemically with batroxobin. Methods We retrospectively reviewed the medical charts of hospitalized patients who were administered batroxobin for hemoptysis. Acquired hypofibrinogenemia was defined as a plasma fibrinogen level >150 mg/dL at baseline, decreasing to <150 mg/dL after batroxobin administration. Results Overall, 183 patients were enrolled, of whom 75 had acquired hypofibrinogenemia after the administration of batroxobin. There was no statistical difference in the median age of the patients in the non-hypofibrinogenemia and hypofibrinogenemia groups (72.0 vs. 74.0 years, respectively). The patients in the hypofibrinogenemia group showed a higher rate of intensive care unit (ICU) admission (11.1% vs. 22.7%; P=0.041) and tended to have more massive hemoptysis than those in the non-hyperfibrinogenemia group (23.1% vs. 36.0%; P=0.068). The patients in the hypofibrinogenemia group further showed a higher requirement for transfusion (10.2% vs. 38.7%; P<0.000) than those in the non-hyperfibrinogenemia group. Low levels of baseline plasma fibrinogen and a prolonged and higher total dose of batroxobin were associated with the development of acquired hypofibrinogenemia. Acquired hypofibrinogenemia was associated with increased 30-day mortality [hazard ratio (HR), 4.164; 95% confidence interval (CI), 1.318-13.157]. Conclusions The plasma fibrinogen levels in patients who were administered batroxobin for hemoptysis should be monitored, and batroxobin should be discontinued if hypofibrinogenemia occurs.
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Affiliation(s)
- Jae-Kyeong Lee
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Chonnam National University Hospital, Gwangju, Republic of Korea;,Chonnam National University Medical School, Gwangju, Republic of Korea
| | - Chang-Seok Yoon
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Chonnam National University Hospital, Gwangju, Republic of Korea
| | - Young-Ok Na
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Chonnam National University Hospital, Gwangju, Republic of Korea
| | - Hwa Kyung Park
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Chonnam National University Hospital, Gwangju, Republic of Korea;,Chonnam National University Medical School, Gwangju, Republic of Korea
| | - Hyung-Joo Oh
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Chonnam National University Hospital, Gwangju, Republic of Korea;,Chonnam National University Medical School, Gwangju, Republic of Korea
| | - Bo-Gun Kho
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Chonnam National University Hospital, Gwangju, Republic of Korea
| | - Ha-Young Park
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Chonnam National University Hospital, Gwangju, Republic of Korea
| | - Tae-Ok Kim
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Chonnam National University Hospital, Gwangju, Republic of Korea;,Chonnam National University Medical School, Gwangju, Republic of Korea
| | - Hong-Joon Shin
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Chonnam National University Hospital, Gwangju, Republic of Korea;,Chonnam National University Medical School, Gwangju, Republic of Korea
| | - Yong-Soo Kwon
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Chonnam National University Hospital, Gwangju, Republic of Korea;,Chonnam National University Medical School, Gwangju, Republic of Korea
| | - Yu-Il Kim
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Chonnam National University Hospital, Gwangju, Republic of Korea;,Chonnam National University Medical School, Gwangju, Republic of Korea
| | - Sung-Chul Lim
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Chonnam National University Hospital, Gwangju, Republic of Korea;,Chonnam National University Medical School, Gwangju, Republic of Korea
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Ikeda N, Wada H, Ichikawa Y, Ezaki M, Tanaka M, Hiromori S, Shiraki K, Moritani I, Yamamoto A, Shimpo H, Shimaoka M. D-dimer kit with a High FDP/D-Dimer Ratio is Useful for Diagnosing Thrombotic Diseases. Clin Appl Thromb Hemost 2022; 28:10760296211070584. [PMID: 34994210 PMCID: PMC8753237 DOI: 10.1177/10760296211070584] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
Introduction Although D-dimer is a useful biomarker of thrombosis, there are many D-dimer kits, with high and low fibrinogen and fibrin degradation products (FDP)/ D-dimer ratios. Methods Plasma D-dimer levels were measured using three different kits in critically ill patients to examine the usefulness of such measurements for detecting the thrombotic diseases and determining the correlation with the FDP and FDP/D-dimer ratio. Results Although three D-dimer kits showed marked utility for diagnosing disseminated intravascular coagulation (DIC) and peripheral arterial and venous thromboembolism (PAVTE), the D-dimer levels determined using the three kits varied among diseases. Indeed, one D-dimer kit showed a high FDP/D-dimer ratio, and another kit showed a low FDP/D-dimer ratio. D-dimer kit with low FDP/D-dimer ratio tended to have high cut-off values and low specificity for diagnosing DIC and PAVTE. In D-dimer kit with high FDP/D-dimer ratio, FDP/D-dimer ratios in patients with thrombosis was significantly higher than that in patients without thrombosis. Conclusion All three D-dimer kits show utility for detecting thrombotic diseases. However, the D-dimer levels determined using the kits varied due to differences in the FDP/D-dimer ratio. In combination with the FDP level, a D-dimer kit with a high FDP/D-dimer ratio may be useful.
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Affiliation(s)
- Nozomi Ikeda
- 36941Mie Prefectural General Medical Center, Yokkaichi, Japan
| | - Hideo Wada
- 36941Mie Prefectural General Medical Center, Yokkaichi, Japan
| | - Yuhuko Ichikawa
- 36941Mie Prefectural General Medical Center, Yokkaichi, Japan
| | - Minoru Ezaki
- 36941Mie Prefectural General Medical Center, Yokkaichi, Japan
| | - Motoko Tanaka
- 36941Mie Prefectural General Medical Center, Yokkaichi, Japan
| | - Shinya Hiromori
- 36941Mie Prefectural General Medical Center, Yokkaichi, Japan
| | - Katsuya Shiraki
- 36941Mie Prefectural General Medical Center, Yokkaichi, Japan
| | - Isao Moritani
- 36941Mie Prefectural General Medical Center, Yokkaichi, Japan
| | | | - Hideto Shimpo
- 36941Mie Prefectural General Medical Center, Yokkaichi, Japan
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Mori K, Tsujita Y, Yamane T, Eguchi Y. Decreasing Plasma Fibrinogen Levels in the Intensive Care Unit Are Associated with High Mortality Rates In Patients With Sepsis-Induced Coagulopathy. Clin Appl Thromb Hemost 2022; 28:10760296221101386. [PMID: 35549920 PMCID: PMC9112680 DOI: 10.1177/10760296221101386] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Plasma fibrinogen levels increase in response to infection, but they could also decrease due to degradation as in severe coagulopathy. We evaluated 60 septic patients with their CRP levels over 5.00 mg/dL. The patients were classified into three groups based on the ratio of the maximum or minimum fibrinogen concentration within day 3 to the initial concentration on day 0: down-, flat, and uptrend groups (n = 15, 30, and 15, respectively). Both down- and flat trend groups showed reduced inflammatory markers on day 3, and the degree of platelet loss (103/μL) and the mortality rate (%) were more remarkable in the downtrend group ( - 108 vs - 42 [p = 0.026] and 46.7 vs 10.0 [p = 0.027]). On day 0, in total 12 and 9 patients were diagnosed with non-overt DIC in the down- and uptrend groups, of which 5 (41.7%) and 1 (11.1%) died within 28 days after admission. In conclusion, decreasing fibrinogen levels in the ICU are associated with high mortality in patients with sepsis followed by decreasing platelet counts, even when they are diagnosed with non-overt DIC.
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Affiliation(s)
- Keisuke Mori
- School of Medicine, 13051Shiga University of Medical Science, Otsu, Shiga, Japan
| | - Yasuyuki Tsujita
- Emergency and Intensive Care Unit, 469340Shiga University of Medical Science Hospital, Otsu, Shiga, Japan
| | - Tetsunobu Yamane
- Emergency and Intensive Care Unit, 469340Shiga University of Medical Science Hospital, Otsu, Shiga, Japan
| | - Yutaka Eguchi
- Department of Critical and Intensive Care Medicine, 13051Shiga University of Medical Science, Otsu, Shiga, Japan
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Dubova OA, Feshchenko DV, Bakhur TI, Dubovyi AA, Zghozinska OA, Chala IV. Splenomegaly development and disseminated intravascular coagulation syndrome in acute canine babesiosis. REGULATORY MECHANISMS IN BIOSYSTEMS 2021. [DOI: 10.15421/022192] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Disseminated intravascular coagulation (DIC) syndrome is the main defining process in the pathogenetic axis of complications in canine babesiosis. The involvement of the spleen with further irreversible changes in the organ largely determines the severity of the animal’s condition after spontaneous babesiosis. The work presented here aimed to determine the role of the DIC syndrome as a triggering factor for lesions of the spleen. Clinical and laboratory studies (haematological, biochemical, hemodynamic) have been carried out. Pathological studies of the removed spleen were carried out by histological methods using universal and specific staining. After suffering acute spontaneous babesiosis, the development of hypersplenism and splenomegaly was found in dogs. The diagnosis was confirmed haematologically by the detected cytopenia, normochromic type anaemia. An additional parameter was a significantly increased erythrocyte sedimentation rate. The biochemical profile indicated the development of bilirubinaemia due to the conjugated fraction, hyperfermentation of transaminases, hypoalbuminemia, which reflected the development of hepatitis and liver failure. Markers of DIC syndrome in laboratory studies are represented by reliable hypofibrinogenemia, increased level of fibrinogen/fibrin degradation products, including D-dimer, and soluble fibrin monomer complexes. The multidirectional indices of coagulation tests (activated partial thromboplastin and prothrombin time) made it possible to classify the stage of “consumption coagulopathy” of the DIC syndrome. The haemodynamic parameters of the sick dogs were characterized by a significant deficit in the circulating blood volume. Together with the indicators of the “consumption coagulopathy” stage of the DIC syndrome, the hemodynamic indexes indicate a moderate degree of shock stage II – the stable reversibility, but the magnitude of the circulating blood volume deficit determines the tendency towards shock irreversibility. Histological studies have established a significant proliferation of the stromal elements of the organ, the formation of specific complexes of vessels with sinuses, clogging with blood clots, and the organ's parenchyma dystrophy. Such changes characterize complete splenomegaly, which is based on the organo-pathology of the DIC syndrome. The deposition of “old” fibrin in the connective tissue structures of the spleen indicates that DIC syndrome continues throughout the entire period of hyperplastic changes in the organ. The presence of hyalinosis in blood vessel walls of the spleen parenchyma determines irreversible changes in them. Thus, DIC syndrome is the basis for splenomegaly development in dogs after acute spontaneous babesiosis. It is confirmed by laboratory blood tests and histologically by the presence of fibrin thrombi in the structures of the organ, which determine the organopathology of the syndrome. The information obtained serves to expand the concepts of the pathogenesis of blood protozoal disease, define the high risk of complications that can become fatal for the health and life of animals.
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Nishigaki A, Ichikawa Y, Ezaki M, Yamamoto A, Suzuki K, Tachibana K, Kamon T, Horie S, Masuda J, Makino K, Shiraki K, Shimpo H, Shimaoka M, Suzuki-Inoue K, Wada H. Soluble C-Type Lectin-Like Receptor 2 Elevation in Patients with Acute Cerebral Infarction. J Clin Med 2021; 10:jcm10153408. [PMID: 34362190 PMCID: PMC8348423 DOI: 10.3390/jcm10153408] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2021] [Revised: 07/28/2021] [Accepted: 07/28/2021] [Indexed: 01/01/2023] Open
Abstract
Background: Acute cerebral infarction (ACI) includes cardiogenic ACI treated with anticoagulants and atherosclerotic ACI treated with antiplatelet agents. The differential diagnosis between cardiogenic and atherosclerotic ACI is still difficult. Materials and Methods: The plasma sCLEC-2 and D-dimer levels were measured using the STACIA system. Results: The plasma sCLEC-2 level was significantly high in patients with ACI, especially those in patients with atherosclerotic or lacunar ACI, and plasma D-dimer levels were significantly high in patients with cardioembolic ACI. The plasma levels of sCLEC-2 and the sCLEC-2/D-dimer ratios in patients with atherosclerotic or lacunar ACI were significantly higher than those in patients with cardioembolic ACI. The plasma D-dimer levels in patients with atherosclerotic or lacunar ACI were significantly lower than those in patients with cardioembolic ACI. The plasma levels of sCLEC-2 and the sCLEC-2/D-dimer ratios were significantly higher in patients with atherosclerotic or lacunar ACI or acute myocardial infarction in comparison to patients with cardioembolic ACI or those with deep vein thrombosis. Conclusion: Using both the plasma sCLEC-2 and D-dimer levels may be useful for the diagnosis of ACI, and differentiating between atherosclerotic and cardioembolic ACI.
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Affiliation(s)
- Akisato Nishigaki
- Department of Neurology, Mie Prefectural General Medical Center, Yokkaichi 510-8561, Japan; (A.N.); (K.S.); (K.T.); (T.K.); (S.H.)
| | - Yuhuko Ichikawa
- Department of Central Laboratory, Mie Prefectural General Medical Center, Yokkaichi 510-8561, Japan; (Y.I.); (M.E.)
| | - Minoru Ezaki
- Department of Central Laboratory, Mie Prefectural General Medical Center, Yokkaichi 510-8561, Japan; (Y.I.); (M.E.)
| | - Akitaka Yamamoto
- Department of Emergency and Critical Care Center, Mie Prefectural General Medical Center, Yokkaichi 510-8561, Japan;
| | - Kenji Suzuki
- Department of Neurology, Mie Prefectural General Medical Center, Yokkaichi 510-8561, Japan; (A.N.); (K.S.); (K.T.); (T.K.); (S.H.)
| | - Kei Tachibana
- Department of Neurology, Mie Prefectural General Medical Center, Yokkaichi 510-8561, Japan; (A.N.); (K.S.); (K.T.); (T.K.); (S.H.)
| | - Toshitaka Kamon
- Department of Neurology, Mie Prefectural General Medical Center, Yokkaichi 510-8561, Japan; (A.N.); (K.S.); (K.T.); (T.K.); (S.H.)
| | - Shotaro Horie
- Department of Neurology, Mie Prefectural General Medical Center, Yokkaichi 510-8561, Japan; (A.N.); (K.S.); (K.T.); (T.K.); (S.H.)
| | - Jun Masuda
- Department of Cardiovascular Medicine, Mie Prefectural General Medical Center, Yokkaichi 510-8561, Japan; (J.M.); (K.M.)
| | - Katsutoshi Makino
- Department of Cardiovascular Medicine, Mie Prefectural General Medical Center, Yokkaichi 510-8561, Japan; (J.M.); (K.M.)
| | - Katsuya Shiraki
- Department of Laboratory and General Medicine, Mie Prefectural General Medical Center, Yokkaichi 510-8561, Japan;
| | - Hideto Shimpo
- Mie Prefectural General Medical Center, Yokkaichi 510-8561, Japan;
| | - Motomu Shimaoka
- Department of Molecular Pathobiology and Cell Adhesion Biology, Mie University Graduate School of Medicine, Tsu 514-8507, Japan;
| | - Katsue Suzuki-Inoue
- Department of Clinical and Laboratory Medicine, University of Yamanashi, Yamanashi 409-3898, Japan;
| | - Hideo Wada
- Department of Laboratory and General Medicine, Mie Prefectural General Medical Center, Yokkaichi 510-8561, Japan;
- Correspondence: ; Tel.: +81-59-345-2321
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