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Sikander B, Rosenberg J, Fonnes S. Individual biomarkers in the blood are not yet applicable in diagnosing complicated appendicitis: A scoping review. Am J Emerg Med 2023; 67:100-107. [PMID: 36842426 DOI: 10.1016/j.ajem.2023.02.016] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2022] [Revised: 02/09/2023] [Accepted: 02/12/2023] [Indexed: 02/21/2023] Open
Abstract
BACKGROUND Appendicitis is one of the most common surgical emergencies globally and it can both be difficult to diagnose but also to differentiate complicated from uncomplicated appendicitis preoperatively. The objective of this scoping review was to develop an overview of biomarkers in blood discriminating complicated from uncomplicated appendicitis and characterize their applicability in an acute setting including time, cost, and analysis technique required as well as their individual precision. METHOD This scoping review was reported in accordance with PRISMA-ScR. The included studies had to report on biomarkers measured in the blood for at least ten patients with suspected appendicitis. A systematic literature search was conducted on August 28, 2022, in PubMed and Embase but restricted to articles published in January 2000 and onwards. A protocol was uploaded to Open Science Framework prior to data extraction. RESULTS A total of 65 biomarkers were included from 52 studies, covering 14,312 patients. There was 60% routine- and 40% novel biomarkers based on the reported analysis technique. The most frequently investigated biomarkers within each group were white blood cell count and procalcitonin. The routine biomarkers were of low financial cost but poor diagnostic accuracy with sensitivity ranging between 15 and 100% and specificity between 27 and 100%. Novel markers were costly ranging from 275 to 800$, and their diagnostic accuracy was based on limited population sizes (median 34 patients) and reported for only 5% of the novel markers. CONCLUSION Routine biomarkers were applicable in an acute setting but had poor diagnostic accuracy. Novel biomarkers are being investigated for potential, but the concept is still premature due to lack of diagnostic accuracy studies reporting cost-benefit for individual markers and whether they can be applied in an acute setting.
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Affiliation(s)
- Binyamin Sikander
- Center for Perioperative Optimization, Department of Surgery, Herlev and Gentofte Hospital, University of Copenhagen, Borgmester Ib Juuls Vej 1, DK-2730 Herlev, Denmark.
| | - Jacob Rosenberg
- Center for Perioperative Optimization, Department of Surgery, Herlev and Gentofte Hospital, University of Copenhagen, Borgmester Ib Juuls Vej 1, DK-2730 Herlev, Denmark
| | - Siv Fonnes
- Center for Perioperative Optimization, Department of Surgery, Herlev and Gentofte Hospital, University of Copenhagen, Borgmester Ib Juuls Vej 1, DK-2730 Herlev, Denmark
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Wu Z, Zhao L, Liu Y, Qian S, Wu L, Liu X. Fibrinogen as a Marker of Overall and Complicated Acute Appendicitis: A Systematic Review and Meta-Analysis. J Surg Res 2022; 280:19-26. [PMID: 35944446 DOI: 10.1016/j.jss.2022.07.001] [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: 03/02/2022] [Revised: 06/14/2022] [Accepted: 07/04/2022] [Indexed: 11/17/2022]
Abstract
INTRODUCTION We performed a systematic review and meta-analysis to evaluate the diagnostic value of fibrinogen (FB) for acute appendicitis and whether it can distinguish between uncomplicated and complicated appendicitis. METHODS A search of electronic information sources was conducted to identify all studies reporting FB in patients with clinical suspicion or confirmed diagnosis of acute appendicitis. We considered two comparisons: (1) appendicitis versus no appendicitis and (2) uncomplicated appendicitis versus complicated appendicitis. To assess the diagnostic value of FB, sensitivity, specificity, diagnostic odds ratios, summary receiver operating characteristic curves, area under the curve, and 95% confidence intervals (95% CIs) were estimated. RESULTS Seven studies (917 confirmed appendicitis and 1026 controls) for overall appendicitis and eight studies (602 complicated appendicitis and 1386 uncomplicated appendicitis) for complicated appendicitis were identified. The pooled sensitivity and specificity of FB for the diagnosis of appendicitis were 0.62 (95% CI: 0.58-0.65) and 0.79 (95% CI: 0.77-0.82), respectively. FB was more accurate in diagnosing complicated appendicitis, with a pooled sensitivity of 0.74 (95% CI: 0.69-0.78), specificity of 0.76 (95% CI: 0.73-0.78), and the area under the curve was 0.84. CONCLUSIONS As per this meta-analysis, FB has a potential diagnostic value in overall appendicitis and that it has a higher diagnostic value in the diagnosis of complicated appendicitis. Future well-designed prospective studies are needed to corroborate the findings.
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Affiliation(s)
- Zhenfei Wu
- Department of Pediatric Surgery, Hangzhou Children's Hospital, Hangzhou, China
| | - Lingling Zhao
- Department of Pathology, Zhejiang Provincial Hospital of Chinese Medicine, The First Affiliated Hospital of Zhejiang Chinese Medical University, Hangzhou, China
| | - Yujun Liu
- Department of Pediatrics, The Fourth Clinical Medical College of Zhejiang Chinese Medical University, Hangzhou, China
| | - Shuyang Qian
- Department of Pediatrics, Zhejiang Chinese Medical University, Hangzhou, China
| | - Liuqing Wu
- Department of Pediatrics, Hangzhou Normal University, Hangzhou, China
| | - Xian Liu
- Department of Critical Care Medicine, Anji County People's Hospital, Huzhou, Zhejiang Province, China.
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Zhou Y, Rastegar V, Read TE, Al-Mansour MR. Safety of Laparoscopic Appendectomy in the Setting of Coagulopathy: An ACS-NSQIP Study. J Surg Res 2022; 275:103-108. [DOI: 10.1016/j.jss.2022.01.029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2021] [Revised: 12/31/2021] [Accepted: 01/29/2022] [Indexed: 10/18/2022]
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Zhou J, Xu W, Wang J, Fan Z. Related Markers for the Precision Diagnosis of Complex Appendicitis in Children. Front Pharmacol 2022; 13:865303. [PMID: 35431963 PMCID: PMC9010144 DOI: 10.3389/fphar.2022.865303] [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: 01/29/2022] [Accepted: 03/03/2022] [Indexed: 11/13/2022] Open
Abstract
Acute appendicitis is the most common surgical emergency in children. Despite the high incidence rate of appendicitis, it is sometimes misdiagnosed or missed. Complex appendicitis (CA) in children is characterized by a critical condition, several complications, and high mortality. Precision distinguishing between simple appendicitis and CA correctly is key to choosing appropriate treatment. A safe, cheap, rapid, extensive and accurate diagnostic marker of appendicitis will be of great significance for emergency general surgeons to treat suspected CA. Many studies have investigated possible diagnostic markers for the diagnosis of CA in children. In this study, studies related to CA in children in recent years are summarized, and the related markers and scoring system for the diagnosis of CA in children are summarized.
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Affiliation(s)
- Jialin Zhou
- Department of General Surgery, The Third People’s Hospital of Dalian, Dalian Medical University, Dalian, China
- Department of Central Laboratory, The Third People’s Hospital of Dalian, Dalian Medical University, Dalian, China
| | - Wenjing Xu
- Department of General Surgery, Zhongda Hospital, School of Medicine, Southeast University, Nanjing, China
| | - Jitao Wang
- Department of Hepatobiliary Surgery, Xingtai People’s Hospital, Xingtai, China
- *Correspondence: Jitao Wang, ; Zhe Fan,
| | - Zhe Fan
- Department of General Surgery, The Third People’s Hospital of Dalian, Dalian Medical University, Dalian, China
- Department of Central Laboratory, The Third People’s Hospital of Dalian, Dalian Medical University, Dalian, China
- *Correspondence: Jitao Wang, ; Zhe Fan,
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Bleeding risk of image-guided percutaneous catheter drainage of pyogenic liver abscess in patients with coagulopathy. Abdom Radiol (NY) 2021; 46:4460-4466. [PMID: 33861357 DOI: 10.1007/s00261-021-03075-y] [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] [Received: 01/13/2021] [Revised: 03/22/2021] [Accepted: 03/27/2021] [Indexed: 12/27/2022]
Abstract
OBJECTIVE Percutaneous catheter drainage (PCD) is the mainstream treatment for pyogenic liver abscess (PLA). However, in some patients with severe coagulopathy, there may increase the risk of bleeding complications related to PCD. Therefore, this study was aimed to evaluate the incidence of bleeding complications of PCD in PLA patients complicated with coagulopathy. METHODS Between January 2011 and September 2019, patients diagnosed with PLA who had undergone PCD were selected retrospectively. Based on the preoperative coagulation parameters, the patients were divided into the coagulopathy group (PLT ≤ 50 × 109/L or INR ≥ 1.5) and the normal coagulation group. The major and minor bleeding complications related to PCD were compared between the two groups. The ICU occupancy and mortality rates in the coagulopathy group were assessed and compared with patients of normal coagulation group. RESULTS A total of 583 PLA patients subjected to PCD were selected. 522 patients were finally included in this study: 64 cases (12.26%) in the coagulopathy group and 458 cases (87.74%) in the normal coagulation group. No major bleeding complications related to PCD was observed. Two patients (0.38%) of minor bleeding complications, one patient in each group, showed no statistically significant difference (0.2% vs.1.6%, P > 0.05). The ICU occupancy rate of coagulopathy group was significantly higher than normal coagulation group (6.2% vs. 0.7%, P < 0.05). No significant difference in mortality rate was noted between the two groups (4.7% vs.1.5%, P > 0.05). CONCLUSION The incidence of bleeding complications related to PCD in PLA patients is rare even if complicated with coagulopathy.
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Li H, Sun D, Sun D, Xiao Z, Zhuang J, Yuan C. The Diagnostic Value of Coagulation Indicators and Inflammatory Markers in Distinguishing Between Strangulated and Simple Intestinal Obstruction. Surg Laparosc Endosc Percutan Tech 2021; 31:750-755. [PMID: 34292211 PMCID: PMC8635269 DOI: 10.1097/sle.0000000000000982] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2020] [Accepted: 04/26/2021] [Indexed: 11/27/2022]
Abstract
BACKGROUND Intestinal obstruction with strangulation can be life-threating, and it is critical to make an accurate and timely diagnosis for emergency surgery. OBJECTIVE This was aimed to investigate the value of coagulation indicators and inflammatory markers in distinguishing between strangulated and simple intestinal obstruction. MATERIALS AND METHODS Fifty-four patients with intestinal obstruction were retrospectively studied. The correlation between coagulation indicators and inflammatory markers with intestinal obstruction was analyzed. Receiver operating characteristic curves were created to assess their ability in discriminative diagnosis. RESULTS Levels of fibrinogen (Fib), C-reactive protein (CRP), neutrophil ratio, and D-Dimer were significantly greater, while thrombin time was significantly shorter in strangulated intestinal obstruction compared with simple intestinal obstruction. Furthermore, Fib levels in the necrosis subgroup of strangulated intestinal obstruction were significantly higher than those in the ischemia subgroup and simple intestinal obstruction group. The areas under the receiver operating characteristic curve were 0.58 for white blood cells, 0.78 for CRP, and 0.80 for Fib. Using the optimal cutoff values of Fib (3.71 g/L) and CRP (14.54 mg/L), the sensitivity, specificity, positive predictive value, and negative predictive value in discriminating between strangulated intestinal obstruction and simple intestinal obstruction were 51.43%, 100%, 100%, and 52.78% for Fib, and 56.25%, 94.44%, 94.74%, and 54.84% for CRP, respectively. CONCLUSIONS Fib and CRP demonstrate good performance in predicting strangulation and are indicative of intestinal necrosis and ischemia. The combination of this coagulation indicator and inflammatory marker holds potential for better discrimination between strangulated and simple intestinal obstruction.
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Affiliation(s)
| | | | | | | | | | - Chunlei Yuan
- Clinical Laboratory, Boai Hospital of Zhongshan Affiliated to Southern Medical University, Zhongshan, Guangdong, China
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Kumar MSV, Tiwari MK, Singh J, Malik A. Plasma Fibrinogen: An Independent Predictor of Pediatric Appendicitis. J Indian Assoc Pediatr Surg 2021; 26:240-245. [PMID: 34385767 PMCID: PMC8323581 DOI: 10.4103/jiaps.jiaps_123_20] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2020] [Revised: 08/04/2020] [Accepted: 10/28/2020] [Indexed: 11/04/2022] Open
Abstract
Aims Appendicitis, in spite of all the diagnostic advances, achieving an accurate and timely diagnosis of this common condition in children remains a challenge. Plasma fibrinogen (FB) is an acute inflammatory mediator and has been proposed and evaluated as an adjunct laboratory marker for improving diagnostic accuracy. The study evaluates the plasma values of Se FB along with other serum markers in pediatric appendicitis patients, to determine their diagnostic accuracy. Methods Prospective observational study on 120 patients between the age group of 5 and 12 years. All eligible enrolled cases underwent total leukocyte count (TLC), plasma FB, C reactive protein (CRP), neutrophil-lymphocyte ratio (NLR), absolute neutrophil count (ANC), and erythrocyte sedimentation rate on admission along with pediatric appendicitis score. Final confirmation of diagnosis and allotment of cohort was made by intra operative findings and histopathological confirmation. Two groups were defined: (1) Histopathologically confirmed acute appendicitis-Cases (2) Nonspecific abdominal pain-Controls. Laboratory results were statistically analyzed between the case and the control groups for diagnostic accuracy. Results Study reflected strong statistical significance in terms of leukocyte count, ANC, NLR, CRP, and FB levels. However, plasma FB (value above 4.02 g/L) had the highest diagnostic accuracy rate of 82.50% compared to other laboratory values (TLC-70.83%, CRP-70.00%). Conclusion Plasma FB has emerged as an accurate diagnostic tool and its diagnostic accuracy is superior to all other laboratory parameter studied (TLC, CRP, NLR, and ANC). Plasma FB values above 4.02 g/L is an independent predictor of appendicitis and can help in reducing negative laparotomy in pediatric age group.
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Affiliation(s)
- M S Vinod Kumar
- Department of Surgery, Command Hospital (EC), Kolkata, West Bengal, India
| | - Mannu Kumar Tiwari
- Department of Surgery, Command Hospital (EC), Kolkata, West Bengal, India
| | - Jasdeep Singh
- Department of Pathology, Command Hospital (EC), Kolkata, West Bengal, India
| | - Anil Malik
- Department of Surgery, Command Hospital (EC), Kolkata, West Bengal, India
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Morandi A, Cipriani E, Parolini F, Consonni D, Calderini E, Franzini S, Leva E. The coagulation profile as a marker for acute appendicitis in the paediatric population: Retrospective study. Afr J Paediatr Surg 2020; 17:59-63. [PMID: 33342835 PMCID: PMC8051619 DOI: 10.4103/ajps.ajps_52_20] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
INTRODUCTION Appendicitis is the commonest and most frequently misdiagnosed acute abdominal surgical illness in the paediatric population worldwide. The aim of this study is to evaluate the role of coagulation profile in acute appendicitis (AA) in children. MATERIALS AND METHODS we retrospectively collected data of patients submitted to appendectomy from 2011 to 2017. According to histopathology, patients were divided into three groups: not histologically confirmed AA (NAA), simple AA (SAA) and complicated AA (CAA). White blood cell (WBC) count, relative neutrophilia (Neutr%), C-reactive protein (CRP), prothrombin time ratio (PTratio), activated partial thromboplastin time ratio (APTTratio) and fibrinogen (Fib) were compared among groups. RESULTS Three hundred and seven patients were included: 57 NAA, 184 SAA and 66 CAA. WBC was significantly different among groups: CAA (mean 16.67 × 103/ml), SAA (14.73 × 103/ml, P= 0.01) and NAA (10.85 × 103/ml, P< 0.0001). Significant differences were found for Neutr% (mean CAA 81.14 vs. SAA 77.03 P= 0.006, vs. NAA 63.86 P< 0.0001) and CRP (mean NAA 2.56, SAA 3.26, CAA 11.58, P< 0.0001). PTratio and Fib increased with the severity of AA receiver operator characteristic curves were similar for CRP (0.739), Fib (0.726), WBC (0.746) and Neutr% (0.754), while for PTratio and aPTTratio were 0.634 and 0.441, respectively. CONCLUSIONS extrinsic coagulation pathway is altered in AA, especially in CAA. Coagulation can be useful in the diagnostic and perioperative anaesthetic management of AA in children. Fib seems to have the highest accuracy.
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Affiliation(s)
- Anna Morandi
- Department of Pediatric Surgery, Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, Milan, Italy
| | | | - Filippo Parolini
- Department of Pediatric Surgery, Spedali Civili Children's Hospital, Brescia, Italy
| | - Dario Consonni
- Department of Epidemiology, Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, Milan, Italy
| | - Edoardo Calderini
- Department of Anesthesia and Pediatric Intensive Care, Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, Milan, Italy
| | - Stefania Franzini
- Department of Anesthesia and Pediatric Intensive Care, Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, Milan, Italy; Department of Pediatric Anaestesia and Intensive Care, Hôpital Universitaire Necker Enfants Malades, Paris, France
| | - Ernesto Leva
- Department of Pediatric Surgery, Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, Milan; Università Degli Studi of Milan, Italy
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9
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Otsuka H, Izumi M, Ota E, Mochizuki N. Incidence of postsurgical pulmonary embolism and deep venous thrombosis: a single-center retrospective observational study. JA Clin Rep 2020; 6:22. [PMID: 32180028 PMCID: PMC7076101 DOI: 10.1186/s40981-020-00328-5] [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: 01/14/2020] [Accepted: 03/09/2020] [Indexed: 11/11/2022] Open
Abstract
Background Cancer is a risk factor for perioperative deep venous thrombosis and pulmonary embolism (DVT/PE). However, there is a paucity of data on non-malignant digestive diseases. In this study, we aimed to investigate the incidence of DVT/PE among patients, following surgery for acute appendicitis and other digestive diseases. Methods We retrospectively reviewed the records of patients who underwent surgical procedures involving the digestive system between April 2018 and March 2019 attended by anesthesiologists (n = 536). Results DVT/PE developed in seven patients (7/77, 9.1%, 95% confidence interval [CI] 3.7–17.8%) after surgery for acute appendicitis, and in six patients (6/83, 7.2%, 95%CI 2.7–15.1%) after elective surgery for colorectal cancer. Among the acute appendicitis group, six patients (6/30 20.0%) with complicated appendicitis (gangrenous or perforated appendicitis), and one patient (1/47 2.1%) with simple appendicitis showed postoperative DVT/PE. Patients with complicated appendicitis had a higher risk of DVT/PE than those with simple appendicitis with an odds ratio of 11.5 (95%CI 1.3–101.1). Conclusions Although patients with acute appendicitis lack three of the risk factors for DVT/PE (cancer, long operative time, and older age), their 95% CI for the incidence of DVT/PE was comparable to that of patients undergoing elective surgery for colorectal cancer. Therefore, caution must be exercised during the perioperative period for preventing DVT/PE.
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Affiliation(s)
- Hitomi Otsuka
- Department of Anesthesiology, Shinshu Ueda Medical Center, 1-27-21, Midorigaoka, Ueda City, Nagano, 386-8610, Japan.
| | - Makoto Izumi
- Department of Anesthesiology, Shinshu Ueda Medical Center, 1-27-21, Midorigaoka, Ueda City, Nagano, 386-8610, Japan
| | - Eriko Ota
- Department of Anesthesiology, Shinshu Ueda Medical Center, 1-27-21, Midorigaoka, Ueda City, Nagano, 386-8610, Japan
| | - Noriaki Mochizuki
- Department of Anesthesiology, Shinshu Ueda Medical Center, 1-27-21, Midorigaoka, Ueda City, Nagano, 386-8610, Japan
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Lukas P, Durila M, Jonas J, Vymazal T. Evaluation of Thromboelastometry in Sepsis in Correlation With Bleeding During Invasive Procedures. Clin Appl Thromb Hemost 2017; 24:993-997. [PMID: 28950719 PMCID: PMC6714732 DOI: 10.1177/1076029617731624] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
Prolongation of prothrombin time (PT) is often encountered in patients with sepsis. On the other hand, thromboelastometry as a global coagulation test might yield normal results. The aim of our study was to evaluate whether prolonged PT in the presence of normal thromboelastometry parameters is associated with severe bleeding in patients with sepsis undergoing invasive procedures. In patients with sepsis undergoing low-risk bleeding invasive procedures (central venous catheter placement, dialysis catheter insertion, drain insertion, and so on) or high-risk bleeding invasive procedures (surgical tracheostomy, surgical laparotomy, thoracotomy, and so on), coagulation was assessed by thromboelastometry using EXTEM test (test for evaluation of the extrinsic pathway of coagulation, contains activator of extrinsic pathway) and with PT. For period of years 2013 to 2016, we assessed occurrence of severe bleeding during those procedures and 24 hours later in patients with prolonged PT and normal thromboelastometry results. This retrospective study was performed at Department of Anaesthesiology and Intensive Care Medicine of Motol University Hospital in Prague. Data from 76 patients with sepsis were analyzed. Median value of international normalized ratio (INR) was 1.59 (min—1.3 and max—2.56), and median value of prothrombin ratio (PR) was 1.5 (min—1.23 and max—2.55) with normal thromboelastometry finding. Despite prolonged INR/PR, no severe bleeding was observed during invasive procedures. Our data show that sepsis may be accompanied by normal thromboelastometry results, despite prolonged values of PT, and invasive procedures were performed without severe bleeding. This approach to coagulation assessment in sepsis may reduce administration of fresh frozen plasma to the patients. The study was registered at Clinical Trials.gov with assigned number NCT02971111.
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Affiliation(s)
- Pavel Lukas
- 1 Second Faculty of Medicine, Department of Anaesthesiology and Intensive Care Medicine, Charles University, Motol University Hospital, Prague, Czech Republic, Europe
| | - Miroslav Durila
- 1 Second Faculty of Medicine, Department of Anaesthesiology and Intensive Care Medicine, Charles University, Motol University Hospital, Prague, Czech Republic, Europe
| | - Jakub Jonas
- 1 Second Faculty of Medicine, Department of Anaesthesiology and Intensive Care Medicine, Charles University, Motol University Hospital, Prague, Czech Republic, Europe
| | - Tomas Vymazal
- 1 Second Faculty of Medicine, Department of Anaesthesiology and Intensive Care Medicine, Charles University, Motol University Hospital, Prague, Czech Republic, Europe
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Prada-Arias M, Vázquez JL, Salgado-Barreira Á, Gómez-Veiras J, Montero-Sánchez M, Fernández-Lorenzo JR. Diagnostic accuracy of fibrinogen to differentiate appendicitis from nonspecific abdominal pain in children. Am J Emerg Med 2017; 35:66-70. [PMID: 27760719 DOI: 10.1016/j.ajem.2016.10.003] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2016] [Revised: 09/07/2016] [Accepted: 10/03/2016] [Indexed: 12/29/2022] Open
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Alvarez-Alvarez F, Maciel-Gutierrez V, Rocha-Muñoz A, Lujan J, Ploneda-Valencia C. Diagnostic value of serum fibrinogen as a predictive factor for complicated appendicitis (perforated). A cross-sectional study. Int J Surg 2016; 25:109-13. [PMID: 26644291 DOI: 10.1016/j.ijsu.2015.11.046] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2015] [Revised: 11/09/2015] [Accepted: 11/22/2015] [Indexed: 12/26/2022]
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13
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Zhao L, Feng S, Huang S, Tong Y, Chen Z, Wu P, Lai XH, Chen X. Diagnostic value of hyperfibrinogenemia as a predictive factor for appendiceal perforation in acute appendicitis. ANZ J Surg 2015; 87:372-375. [PMID: 26362339 DOI: 10.1111/ans.13316] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/11/2015] [Indexed: 11/27/2022]
Affiliation(s)
- Lingling Zhao
- Department of Pathology; The First Affiliated Hospital of Wenzhou Medical University; Wenzhou China
| | - Shaoguang Feng
- Department of Pediatric Surgery; The First Affiliated Hospital of Wenzhou Medical University; Wenzhou China
- Department of Pediatric Surgery; Hangzhou Children's Hospital; Hangzhou China
| | - Songsong Huang
- Department of Pediatric Surgery; The First Affiliated Hospital of Wenzhou Medical University; Wenzhou China
| | - Yulong Tong
- Department of Pediatric Surgery; The First Affiliated Hospital of Wenzhou Medical University; Wenzhou China
| | - Zhongliang Chen
- Department of Pediatric Surgery; The First Affiliated Hospital of Wenzhou Medical University; Wenzhou China
| | - Peng Wu
- Department of Pediatric Surgery; The First Affiliated Hospital of Wenzhou Medical University; Wenzhou China
- Department of Pediatric Surgery; Northwest Women and Children's Hospital; Xi'an China
| | - Xin-He Lai
- Institute of Inflammation and Diseases; The First Affiliated Hospital of Wenzhou Medical University; Wenzhou China
- Institute of Translational Medicine; The First Affiliated Hospital of Wenzhou Medical University; Wenzhou China
| | - Xiaoming Chen
- Department of Pediatric Surgery; The First Affiliated Hospital of Wenzhou Medical University; Wenzhou China
- Institute of Inflammation and Diseases; The First Affiliated Hospital of Wenzhou Medical University; Wenzhou China
- Institute of Translational Medicine; The First Affiliated Hospital of Wenzhou Medical University; Wenzhou China
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Farach SM, Danielson PD, Chandler NM. Preprocedural Coagulation Studies in Pediatric Patients Undergoing Percutaneous Intervention for Appendiceal Abscesses. Am Surg 2015. [DOI: 10.1177/000313481508100917] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
The literature reports poor correlation between coagulation screening and prediction of bleeding risk in children. Our aim is to determine whether there is a role for coagulation studies in children undergoing percutaneous intervention for appendiceal abscesses. A retrospective review of 1805 patients presenting with a diagnosis of appendicitis from September 2008 to September 2013 was performed. Patients presenting with appendiceal abscess who underwent percutaneous intervention were selected for further review (n = 131). A total of 76 patients (58%) had normal coagulation studies, whereas 55 (42%) had elevated values. An international normalized ratio ≥ 1.3 was found in 26 patients. Patients with normal coagulation values had an incidence of bleeding of 1.3 per cent. In the abnormal coagulation group, 8 patients received fresh frozen plasma before intervention, whereas 47 did not. There was one hematoma noted in each group with an incidence of bleeding of 3.6 per cent. The overall incidence of hematoma was 2.3 per cent with no significant difference in bleeding risk between the normal and abnormal coagulation groups. In conclusion, although many patients are found to have elevated coagulation studies, most do not have bleeding complications after intervention. There is poor correlation between coagulation screening and postprocedural outcomes evidenced by the low risk of bleeding.
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Affiliation(s)
- Sandra M. Farach
- Division of Pediatric Surgery, All Children's Hospital Johns Hopkins Medicine, Saint Petersburg, Florida
| | - Paul D. Danielson
- Division of Pediatric Surgery, All Children's Hospital Johns Hopkins Medicine, Saint Petersburg, Florida
| | - Nicole M. Chandler
- Division of Pediatric Surgery, All Children's Hospital Johns Hopkins Medicine, Saint Petersburg, Florida
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Hyperfibrinogenemia in appendicitis: a new predictor of perforation in children. Pediatr Surg Int 2014; 30:1143-7. [PMID: 25117821 DOI: 10.1007/s00383-014-3585-8] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/05/2014] [Indexed: 10/24/2022]
Abstract
PURPOSE Acute appendicitis is the most common emergency abdominal inflammation requiring operation in children. As an acute-phase protein, plasma fibrinogen always increases with inflammation or tissue necrosis. This had brought about the assumption that hyperfibrinogenemia in patients with appendicitis may have a predictive ability for the preoperative diagnosis of appendiceal. Aim of this retrospective study was to assess the diagnostic value of hyperfibrinogenemia as a preoperative laboratory marker for appendiceal perforation in children with acute appendicitis. METHODS We screened 466 children (168 girls, 298 boys, mean age, 7.6 years) with histologically confirmed acute appendicitis who received laparoscopic or open appendectomy between January 2012 and April 2014 in a pediatric surgery department of an academic teaching hospital. A retrospective review of the medical records including appendiceal perforation rate and laboratory results was conducted. RESULTS Mean plasma fibrinogen level of all patients was 4.89 g/L (SD 1.74 g/L, range 1.94-15 g/L, median 4.61 mg/dL). Children with appendiceal perforation had a mean fibrinogen level of 6.18 g/L (SD 1.83 g/L, range 3.02-15 g/L, median 5.79 g/L), which was significantly higher than those with non-perforated children (P = 0.0001). The specificity of hyperfibrinogenemia for appendiceal perforation was 0.82 in comparison with 0.25 for white blood count (WBC) and 0.34 for C-reactive protein (CRP). Sensitivity was 0.74 compared with 0.76 for WBC and 0.94 for CRP. CONCLUSION Children with hyperfibrinogenemia and clinical symptoms of appendicitis may be regarded as a higher risk of appendiceal perforation than whose fibrinogen level is normal.
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Koch A, Meesters MI, Scheller B, Boer C, Zacharowski K. Systemic endotoxin activity correlates with clot formation: an observational study in patients with early systemic inflammation and sepsis. CRITICAL CARE : THE OFFICIAL JOURNAL OF THE CRITICAL CARE FORUM 2013; 17:R198. [PMID: 24025340 PMCID: PMC4057518 DOI: 10.1186/cc12892] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/12/2013] [Accepted: 09/11/2013] [Indexed: 01/08/2023]
Abstract
Introduction Inflammation and coagulation are closely linked, and both can be triggered by endotoxin. Thrombelastometry and impedance aggregometry are of diagnostic and predictive value in critically ill patients. In this observational study we investigated the correlation of endotoxin activity with thrombelasometric and aggregometric variables in patients with systemic inflammation. Methods Based on a daily screening on a tertiary academic surgical ICU, patients, as soon as they fulfilled two or more criteria for systemic inflammatory response syndrome (SIRS), were included. In whole blood we performed endotoxin activity (EA) assay, thrombelastometry (ROTEM®) and impendance aggregometry (Multiplate®). Results In total, 49 patients were included with a broad spread of EA levels of (median (minimum to maximum)) 0.27 (0.01 to 0.72), allowing expedient correlative analysis. Clot formation time (CFT) (263 s (60 to 1,438 s)) and clotting time (CT) (1,008 s (53 to 1,481 s)) showed a significant negative correlation with EA level (r = -0.38 (P < 0.005) and r = -0.29 (P < 0.05)). Positive correlations were found for alpha-angle (50° (17 to 78°), r = 0.40 (P < 0.005)) and maximum clot firmness (MCF) (55 mm (5/76), r = 0.27 (P < 0.05)). No significant correlations were found between Lysis Index at 60 minutes (LI60) and EA levels. There was no correlation between EA level and aggregometric values, or classical coagulation parameters. Conclusions In patients with systemic inflammation, increasing endotoxin concentrations correlate with increased clot formation.
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