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Shock (Augusta, Ga.) Apr 2022Platelet distribution width (PDW) and PDW-to-platelet ratio (PPR) have been proven to be good prognostic indicators for many diseases. However, their prognostic values...
BACKGROUND
Platelet distribution width (PDW) and PDW-to-platelet ratio (PPR) have been proven to be good prognostic indicators for many diseases. However, their prognostic values in severe burns have not been reported.
OBJECTIVE
To investigate the early time course of PDW and PPR in severe burn patients and investigate their prognostic values.
METHODS
This is a 16-year, single-center retrospective study of 590 severe burn patients. The complete blood count parameters on day 1, day 3, and day 7 postburn, including PDW and PPR, were collected. Receiver operating characteristic curves (ROC) analysis, multiple logistic regression analysis and Kaplan-Meier survival analysis were performed to evaluate the prognostic values of PDW and PPR in severe burn patients.
RESULTS
According to 120-day follow-up records, 96 patients were nonsurvivors and 494 patients were survivors. ROC and area under the curve (AUC) analysis showed that, for predicting 120-day prognosis, the AUC of PDW (0.782) and PPR (0.816) on day 3 was the highest, followed by the AUC of PDW (0.764) and PPR (0.750) on day 7. The ROC-AUC of PPR (0.816) on day 3 was very close to that of the ABSI score (0.818). Multiple logistic regression analysis showed that the PDW (P = 0.033 and P = 0.009) and PPR (P = 0.052 and P = 0.046) on day 3 and day 7 were all significantly independently positively associated with 120-day mortality. Kaplan-Meier survival analysis showed that high PDW and PPR were both significantly associated with a high 120-day mortality rate on day 3 and day 7.
CONCLUSION
PDW and PPR on day 3 and day 7 were independent risk factors for 120-day mortality in severe burn patients. These objective and readily available prognostic indicators may be more clinically favored.
Topics: Blood Platelets; Burns; Humans; Platelet Count; Prognosis; ROC Curve; Retrospective Studies
PubMed: 34812187
DOI: 10.1097/SHK.0000000000001890 -
Jornal Brasileiro de Nefrologia 2021Inflammation promotes the progression of chronic renal failure, and the start of dialysis worsens inflammation. The enlargement of the spleen is associated with...
INTRODUCTION
Inflammation promotes the progression of chronic renal failure, and the start of dialysis worsens inflammation. The enlargement of the spleen is associated with inflammation, and patients on hemodialysis may show a large spleen. The aim of the present study was to compare the spleen size of patients undergoing hemodialysis versus controls to update this thread.
METHODS
Controls and patients were eligible to participate in the study provided they were negative for serological markers of hepatitis B and C viruses and HIV, if they had no lymphoproliferative disorder, and if they were at least 18 years of age. Age, sex, and the duration of dialysis were recorded. Laboratory variables (hemoglobin, hematological cell count, serum creatinine) and the underlying cause of end-stage renal disease were analyzed. The spleen sizes of the patients were divided into tertiles.
RESULTS
The 75 controls and 168 patients selected were sex-matched. The patients were older, had larger spleens and lower platelet counts than controls. The relationship between spleen size and age in the controls and patients was quite similar. The patients in the first tertile of spleen size compared with those in the third were older and had a higher platelet counts. The underlying disease and dialysis vintage had no effect on spleen size.
DISCUSSION
The patients had larger spleens and a greater range of spleen sizes than the controls. In patients, the association between larger and smaller spleen with lower and higher platelet counts, respectively, sparked the speculation of occurrence of hypersplenism and hyposplenism.
Topics: Creatinine; Humans; Kidney Failure, Chronic; Platelet Count; Renal Dialysis; Spleen
PubMed: 33079128
DOI: 10.1590/2175-8239-JBN-2020-0116 -
BMC Neurology Aug 2022Platelets play an important role in homeostasis however, they have also been associated with increased mortality after myocardial infarction. In the present study, we...
BACKGROUND AND AIMS
Platelets play an important role in homeostasis however, they have also been associated with increased mortality after myocardial infarction. In the present study, we investigated whether platelet count is associated with differences in the short-term prognosis at the time of hospital discharge and early neurological deterioration in ischemic stroke patients.
METHODS
Patients with ischemic stroke were enrolled from among 661 cerebrovascular disease patients admitted between January 2018 and December 2020. Patients who received hyperacute treatment, had a pre-onset modified Rankin scale (mRS) ≥ 3, transient ischemic attack, or active malignant disease were excluded. The platelet count was divided into quartiles (Q1-4) according to the number of patients, and the relationship between platelet count and prognosis was assessed using multivariable analysis.
RESULTS
In total, 385 patients were included in the study. Regarding the functional outcome by platelet count, there was a significant increase in mRS ≥ 3 at discharge in the Q4 (range: 243-1327 × 10/L, p = 0.013, ORs: 1.674, 95%CI: 1.253-6.681) group compared to the Q3 (range: 205-242 × 10/L) group even after adjusting for factors with P < 0.2 in univariate analysis. Furthermore, the frequency of neurological deterioration (NIHSS ≥ 4) within 1 week was significantly lower in the Q3 group than in the Q1 (range; 19-173 × 10/L) and Q4 groups even after adjustment (Q1; p = 0.020 ORs: 6.634, 95%CI: 1.352-32.557, Q4; p = 0.007 ORs: 8.765, 95%CI: 1.827-42.035).
CONCLUSION
Platelet count at onset may affect the prognosis of cerebral infarction and early neurological deterioration. This study may help clarify the pathogenesis of cerebral infarction to improve prognosis.
Topics: Brain Ischemia; Cerebral Infarction; Humans; Ischemic Stroke; Platelet Count; Prognosis; Retrospective Studies; Stroke
PubMed: 36008789
DOI: 10.1186/s12883-022-02845-5 -
Journal of Hepatology Feb 2023In individuals with compensated advanced chronic liver disease (cACLD), the severity of portal hypertension (PH) determines the risk of decompensation. Invasive...
BACKGROUND & AIMS
In individuals with compensated advanced chronic liver disease (cACLD), the severity of portal hypertension (PH) determines the risk of decompensation. Invasive measurement of the hepatic venous pressure gradient (HVPG) is the diagnostic gold standard for PH. We evaluated the utility of machine learning models (MLMs) based on standard laboratory parameters to predict the severity of PH in individuals with cACLD.
METHODS
A detailed laboratory workup of individuals with cACLD recruited from the Vienna cohort (NCT03267615) was utilised to predict clinically significant portal hypertension (CSPH, i.e., HVPG ≥10 mmHg) and severe PH (i.e., HVPG ≥16 mmHg). The MLMs were then evaluated in individual external datasets and optimised in the merged cohort.
RESULTS
Among 1,232 participants with cACLD, the prevalence of CSPH/severe PH was similar in the Vienna (n = 163, 67.4%/35.0%) and validation (n = 1,069, 70.3%/34.7%) cohorts. The MLMs were based on 3 (3P: platelet count, bilirubin, international normalised ratio) or 5 (5P: +cholinesterase, +gamma-glutamyl transferase, +activated partial thromboplastin time replacing international normalised ratio) laboratory parameters. The MLMs performed robustly in the Vienna cohort. 5P-MLM had the best AUCs for CSPH (0.813) and severe PH (0.887) and compared favourably to liver stiffness measurement (AUC: 0.808). Their performance in external validation datasets was heterogeneous (AUCs: 0.589-0.887). Training on the merged cohort optimised model performance for CSPH (AUCs for 3P and 5P: 0.775 and 0.789, respectively) and severe PH (0.737 and 0.828, respectively).
CONCLUSIONS
Internally trained MLMs reliably predicted PH severity in the Vienna cACLD cohort but exhibited heterogeneous results on external validation. The proposed 3P/5P online tool can reliably identify individuals with CSPH or severe PH, who are thus at risk of hepatic decompensation.
IMPACT AND IMPLICATIONS
We used machine learning models based on widely available laboratory parameters to develop a non-invasive model to predict the severity of portal hypertension in individuals with compensated cirrhosis, who currently require invasive measurement of hepatic venous pressure gradient. We validated our findings in a large multicentre cohort of individuals with advanced chronic liver disease (cACLD) of any cause. Finally, we provide a readily available online calculator, based on 3 (platelet count, bilirubin, international normalised ratio) or 5 (platelet count, bilirubin, activated partial thromboplastin time, gamma-glutamyltransferase, choline-esterase) widely available laboratory parameters, that clinicians can use to predict the likelihood of their patients with cACLD having clinically significant or severe portal hypertension.
Topics: Humans; Liver Cirrhosis; Hypertension, Portal; Portal Pressure; Platelet Count; Bilirubin; Elasticity Imaging Techniques
PubMed: 36152767
DOI: 10.1016/j.jhep.2022.09.012 -
Journal of Clinical Laboratory Analysis Apr 2022Impedance technology has been shown to overestimate platelet (PLT) count in samples with microcytes, while the optical-fluorescence PLT count (PLT-F) by Sysmex has been...
BACKGROUND
Impedance technology has been shown to overestimate platelet (PLT) count in samples with microcytes, while the optical-fluorescence PLT count (PLT-F) by Sysmex has been suggested to be unaffected by microcytosis. The Abbott Alinity hq analyzer employs multi-dimensional optical PLT counting. Our goal was to assess the accuracy of this technology in microcytic samples.
METHODS
Platelet measurements were performed by Alinity hq and the impedance (PLT-I) and PLT-F methods on a Sysmex XN-3000 analyzer on 464 samples. PLT concentration range was 6.56-947 × 10 /L and mean cell volume (MCV) 40.9-123.0 fL. Samples were categorized into normocytic (MCV > 80 fL), microcytic (MCV 65-80 fL), and severely microcytic (MCV < 65 fL) groups.
RESULTS
Alinity hq PLT count showed excellent agreement with PLT-F (r = 1.00). Sysmex PLT-I data showed somewhat weaker correlation with both PLT-F and Alinity hq (r = 0.98). Increasing bias between Sysmex PLT-I and PLT-F was seen with decreasing MCV values, with mean bias of 35.2 × 10 /L in severe microcytosis. An inverse relationship was demonstrated between the PLT-I versus PLT-F bias and MCV (p < 0.0001). Consistent mean bias was observed between Alinity hq and PLT-F across all MCV ranges. Mean platelet volume was suppressed or flagged by Sysmex XN in 50% of the samples in the severely microcytic group, and markedly higher red cell distribution width (RDW) was reported compared to Alinity hq (18.1% vs 13.7%, p < 0.0001).
CONCLUSION
The Sysmex PLT-I method overestimated the PLT count in samples with severe microcytosis. Alinity hq provided PLT counts and PLT and RBC indices that were not impacted by microcytosis.
Topics: Blood Platelets; Erythrocyte Count; Erythrocyte Indices; Humans; Platelet Count; Reproducibility of Results
PubMed: 35274768
DOI: 10.1002/jcla.24218 -
Blood Advances Feb 2020Identifying the cause(s) of postoperative thrombocytopenia is challenging. The postoperative period includes numerous interventions, including fluid administration and...
Identifying the cause(s) of postoperative thrombocytopenia is challenging. The postoperative period includes numerous interventions, including fluid administration and transfusion of blood products, medication use (including heparin), and increased risk of organ dysfunction and infection. Understanding normal thrombopoietin physiology and the associated expected postoperative platelet count changes is the crucial first step in evaluation. Timing of thrombocytopenia is the most important feature when differentiating causes of postoperative thrombocytopenia. Thrombocytopenia within 4 days of surgery is commonly caused by hemodilution and increased perioperative platelet consumption prior to thrombopoietin-induced platelet count recovery and transient platelet count overshoot. A much broader list of possible conditions that can cause late-onset thrombocytopenia (postoperative day 5 [POD5] or later) is generally divided into consumptive and destructive causes. The former includes common (eg, infection-associated disseminated intravascular coagulation) and rare (eg, postoperative thrombotic thrombocytopenic purpura) conditions, whereas the latter includes such entities as drug-induced immune thrombocytopenia or posttransfusion purpura. Heparin-induced thrombocytopenia is a unique entity associated with thrombosis that is typically related to intraoperative/perioperative heparin exposure, although it can develop following knee replacement surgery even in the absence of heparin exposure. Very late onset (POD10 or later) of thrombocytopenia can indicate bacterial or fungal infection. Lastly, thrombocytopenia after mechanical device implantation requires unique considerations. Understanding the timing and severity of postoperative thrombocytopenia provides a practical approach to a common and challenging consultation.
Topics: Anemia; Disseminated Intravascular Coagulation; Heparin; Humans; Platelet Count; Postoperative Period
PubMed: 32097460
DOI: 10.1182/bloodadvances.2019001414 -
Frontiers in Immunology 2023During clinical practice, routine blood tests are commonly performed following pancreaticoduodenectomy (PD). However, the relationship between blood cell counts,...
BACKGROUND
During clinical practice, routine blood tests are commonly performed following pancreaticoduodenectomy (PD). However, the relationship between blood cell counts, inflammation-related indices, and postoperative complications remains unclear.
METHOD
We conducted a retrospective study, including patients who underwent PD from October 2018 to July 2023 at the First Hospital of Chongqing Medical University, and compared baseline characteristics and clinical outcomes among different groups. Neutrophil count (NC), platelet count (PLT), lymphocyte count (LC), systemic immune-inflammation index (SII), platelet-to-lymphocyte ratio (PLR), neutrophil-to-lymphocyte ratio (NLR), and the product of platelet count and neutrophil count (PPN) were derived from postoperative blood test results. We investigated the association between these indicators and outcomes using multivariable logistic regression and restricted cubic spline analysis. The predictive performance of these indicators was assessed by the area under the curve (AUC) of the receiver operating characteristic (ROC) curve and decision curve analysis (DCA).
RESULT
A total of 232 patients were included in this study. Multivariate logistic regression and restricted cubic spline analysis showed that all indicators, except for PLT, were associated with clinical postoperative pancreatic fistula (POPF). SII, NLR, and NC were linked to surgical site infection (SSI), while SII, NLR, and PLR were correlated with CD3 complication. PLT levels were related to postoperative hemorrhage. SII (AUC: 0.729), NLR (AUC: 0.713), and NC (AUC: 0.706) effectively predicted clinical POPF.
CONCLUSION
In patients undergoing PD, postoperative inflammation-related indices and blood cell counts are associated with various complications. NLR and PLT can serve as primary indicators post-surgery for monitoring complications.
Topics: Humans; Pancreaticoduodenectomy; Retrospective Studies; Inflammation; Lymphocyte Count; Platelet Count
PubMed: 38077320
DOI: 10.3389/fimmu.2023.1303283 -
Biology of Blood and Marrow... Mar 2020Prolonged thrombocytopenia after hematopoietic stem cell transplantation (HSCT) is a strong risk factor for transplantation-related morbidity and mortality, and no... (Review)
Review
Prolonged thrombocytopenia after hematopoietic stem cell transplantation (HSCT) is a strong risk factor for transplantation-related morbidity and mortality, and no standard treatment guideline exists. Thrombopoietin receptor agonists (TPO-RAs), eltrombopag and romiplostim, increases the platelet production, and are being increasingly used in various conditions with thrombocytopenia. In this review, we present an overview of these TPO-RAs and review their efficacy and safety in prolonged post-HSCT thrombocytopenia. Through a systematic literature search, we identified 25 reports describing their use for this indication. Thirteen reports (8 case series and 5 case reports) described the use of eltrombopag in 78 patients with prolonged isolated thrombocytopenia (PIT) and 43 patients with secondary failure of platelet recovery (SFPR). A consistent and durable response with a rise in platelet counts >50 × 10 /L for 7 consecutive days without platelet transfusion was seen in 85 of 121 patients (overall response rate [ORR], 70%). The responders included 56 patients with PIT (ORR for PIT, 72%) and 29 patients with SFPR (ORR for SFPR, 67%). No serious grade 3 or 4 adverse effects were reported. Similarly, 12 reports (6 case series and 6 case reports) described the use of romiplostim in prolonged post-HSCT thrombocytopenia (in 17 patients with PIT and 32 patients with SFPR). Response with the increment of platelet count was described in 40 out of 49 patients (ORR, 82%). Among the responders, 10 patients had PIT (ORR for PIT, 59%) and 30 patients had SFPR (ORR for SFPR, 94%). Our data show that TPO-RAs have an overall favorable response rate for both PIT and SFPR with a reasonable safety profile. However, given the lack of control groups, study heterogeneity, and the potential publication bias, these results should be interpreted with caution.
Topics: Hematopoietic Stem Cell Transplantation; Humans; Hydrazines; Platelet Count; Platelet Transfusion; Receptors, Thrombopoietin; Recombinant Fusion Proteins; Thrombocytopenia; Thrombopoietin
PubMed: 31830528
DOI: 10.1016/j.bbmt.2019.12.003 -
Biomarkers in Medicine Feb 2021This study aimed to evaluate the clinical values of platelet parameters in patients with digestive tumors. A total of 974 people were classified into three groups:...
This study aimed to evaluate the clinical values of platelet parameters in patients with digestive tumors. A total of 974 people were classified into three groups: malignant group, patients with digestive malignant tumors; benign group, patients with benign tumors; and normal group: healthy individuals. Compared with the benign and normal groups, the malignant group showed significantly increased platelet count (PLT) and plateletcrit (PCT) and significantly reduced mean platelet volume (MPV) and platelet-large cell rate (P-LCR, p < 0.001). Elevated PLT and PCT and reduced MPV and P-LCR indicated poor overall survival in patients with digestive tumors. PLT, PCT, MPV and P-LCR were proven to be predictive biomarkers for patients with digestive malignant tumors. Elevated PLT and PCT or decreased MPV and P-LCR indicated poor overall survival.
Topics: Adult; Humans; Male; Mean Platelet Volume; Middle Aged; Platelet Count
PubMed: 33474972
DOI: 10.2217/bmm-2020-0203 -
Platelets Dec 2023The association between endometriosis and autoimmune diseases is well known, however no acquired platelet function defect has been described so far. We describe the case...
The association between endometriosis and autoimmune diseases is well known, however no acquired platelet function defect has been described so far. We describe the case of two patients with endometriosis associated with an antiplatelet glycoprotein VI (anti-GPVI) antibody. The two women with deep pelvic endometriosis associated with secondary infertility presented a mild bleeding tendency, a deficient platelet aggregation response to collagen, convulxin or CRP and a severe GPVI deficiency. Immunoblot revealed a combined FcRγ deficiency but no indication of GPVI cleavage. In the first case, platelet count was normal and an anti-GPVI IgG was detected in plasma. A first corticosteroids administration normalized platelet functions but further administrations were unsuccessful. Three IVF attempts failed. Conservative laparoscopic surgery was carried out after antifibrinolytic treatment without bleeding. The second case presented with a history of moderate thrombocytopenia and a weak anti-GPVI in the context of infertility and autoimmune disease, the Sjögren syndrome resolved after corticosteroids and hydroxychloroquine treatment. Acquired GPVI deficiencies are rare. It would be useful to determine whether the association with endometriosis is coincidental or not by more systematic investigations. It does not seem that in these patients, GPVI deficiency is associated with an increased risk of bleeding.
Topics: Humans; Female; Platelet Membrane Glycoproteins; Endometriosis; Antibodies; Platelet Count; Infertility; Blood Platelets
PubMed: 37350057
DOI: 10.1080/09537104.2023.2226756