-
Journal of Vascular and Interventional... Jun 2024To compare the efficacy and safety of a thromboelastography (TEG)-guided platelet transfusion strategy to empirical or on-demand transfusions in patients with cirrhosis...
Thromboelastography-guided vs. standard-of-care or on-demand platelet transfusion in patients with cirrhosis and thrombocytopenia undergoing procedures: A randomized controlled trial.
PURPOSE
To compare the efficacy and safety of a thromboelastography (TEG)-guided platelet transfusion strategy to empirical or on-demand transfusions in patients with cirrhosis and severe thrombocytopenia (platelet counts <50 x10/L) undergoing high-risk invasive procedures.
MATERIALS AND METHODS
This was a single-center, single-blinded, randomized controlled trial. Patients with cirrhosis and severe thrombocytopenia undergoing high-risk invasive procedures were randomized into three groups- TEG group: transfusions based on TEG parameters; SOC group: 3 units of random donor platelets pre-procedure; On-demand group: transfusions based on procedural adverse effects /clinician's discretion. The primary outcome was periprocedural platelet transfusion in each arm.
RESULTS
Eighty-seven patients were randomized (29 in each group) with no significant differences in demographics/coagulation profile/procedures. The median platelet count was 33 x10/L (IQR: 26-43). Percutaneous liver biopsy was the most common procedure (46, 52.9%). Significantly lower number of patients in the TEG group received platelets (4 cases, 13.8%; 95%CI: 3.9-31.7) compared to SOC (100%; 95%CI: 88.1-100) (p<0.001). Four patients in the on-demand group received platelets (13.8%; 95%CI: 3.9-31.7). Minor (WHO grade 2) procedure-related bleeding occurred in 3 (10%; 95%CI: 2.2-27.4) patients in the TEG-guided transfusion group, compared to 1 (3.4%; 95%CI: 0.1-17.8) each in SOC and on-demand groups, respectively (p=0.43) although our sample size was underpowered for comparison of outcomes such as post-procedural bleeding. No bleeding-related mortality was observed in any of the three groups.
CONCLUSION
Thromboelastography-guided transfusion reduces prophylactic transfusions in patients with cirrhosis and severe thrombocytopenia undergoing high-risk invasive procedures. (CTRI/2021/05/033464).
PubMed: 38925267
DOI: 10.1016/j.jvir.2024.06.014 -
Immunity, Inflammation and Disease Jun 2024The ongoing outbreak of the respiratory disease coronavirus disease 2019 (COVID-19) is currently presenting a major global health threat. This pandemic is unprecedented...
OBJECTIVE
The ongoing outbreak of the respiratory disease coronavirus disease 2019 (COVID-19) is currently presenting a major global health threat. This pandemic is unprecedented in recent human history. The objective of this study was to examine the relationship between cycle quantitation (Cq) and laboratory parameters in COVID-19 patients, aiming to determine if Cq levels can provide valuable insights into the COVID-19 disease.
METHODS
This study involved 234 participants who were divided into case and control groups. Real-time PCR tests were used to diagnose COVID-19 cases in the study participants. Blood tests, including complete blood count, C-reactive protein (CRP), erythrocyte sedimentation rate (ESR), lactate dehydrogenase (LDH), D-dimer, IgG, and IgM, were also conducted. Statistical analysis was performed using SPSS 22 software.
RESULTS
The findings showed that COVID-19-positive cases had significantly higher levels of the neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), D-dimer, ESR, CRP, and LDH compared to normal cases. Additionally, the case group had significantly lower lymphocyte and platelet counts. There was a statistically significant positive correlation between Cq levels and lymphocyte count (r = .124, p = .014). Conversely, there was a statistically significant inverse correlation between Cq levels and NLR (r = -.208, p = .017). Furthermore, the evaluation of hematological, inflammatory, and biochemical indexes in COVID-19 patients using the receiver-operating characteristics curve demonstrated statistically appropriate sensitivity and specificity.
CONCLUSION
Our outcomes indicated a significant association between Cq levels and PLR, NLR, D-dimer, CRP, and ESR in COVID-19 patients. Consequently, including the report of laboratory parameters alongside Cq values offers a promising prognosis.
Topics: Humans; COVID-19; Male; Female; Middle Aged; SARS-CoV-2; Adult; C-Reactive Protein; Fibrin Fibrinogen Degradation Products; Blood Sedimentation; Aged; Neutrophils; Platelet Count; L-Lactate Dehydrogenase; Case-Control Studies; Lymphocytes
PubMed: 38923849
DOI: 10.1002/iid3.1326 -
Neurosurgical Review Jun 2024Coagulopathy development in traumatic brain injury (TBI) is among the significant complications that can negatively affect the clinical course and outcome of TBI...
Coagulopathy development in traumatic brain injury (TBI) is among the significant complications that can negatively affect the clinical course and outcome of TBI patients. Timely identification of this complication is of utmost importance in the acute clinical setting. We reviewed TBI patients admitted to our trauma center from 2015 to 2021. Demographic data, mechanism of injury, findings on admission, imaging studies, procedures during hospitalization, and functional outcomes were gathered. INR with a cutoff of 1.3, platelet count less than 100 × 10⁹/L, or partial thromboplastin time greater than 40s were utilized as the markers of coagulopathy. A total of 4002 patients were included. Coagulopathy occurred in 38.1% of the patients. Age of the patients (Odds Ratio (OR) = 0.993, 95% Confidence Interval (CI) = 0.986-0.999, p = 0.028), systolic blood pressure (OR = 0.993, 95% CI = 0.989-0.998, p = 0.005), fibrinogen level (OR = 0.998, 95% CI = 0.996-0.999, p < 0.001), and hemoglobin level (OR = 0.886, 95% CI = 0.839-0.936, p < 0.001) were independently associated with coagulopathy. Furthermore, coagulopathy was independently associated with higher mortality rates and longer ICU stays. Coagulopathy had the most substantial effect on mortality of TBI patients (OR = 2.6, 95% CI = 2.1-3.3, p < 0.001), compared to other admission clinical characteristics independently associated with mortality such as fixed pupillary light reflex (OR = 1.8, 95% CI = 1.5-2.4, p < 0.001), GCS (OR = 0.91, 95% CI = 0.88-0.94, p < 0.001), and hemoglobin level (OR = 0.93, 95% CI = 0.88-0.98, p = 0.004). Early coagulopathy in TBI patients can lead to higher mortality rates. Future studies are needed to prove that early detection and correction of coagulopathy and modifiable risk factors may help improve outcomes of TBI patients.
Topics: Humans; Brain Injuries, Traumatic; Female; Male; Adult; Middle Aged; Retrospective Studies; Blood Coagulation Disorders; Incidence; Aged; Risk Factors; Young Adult; Cohort Studies; Partial Thromboplastin Time
PubMed: 38922506
DOI: 10.1007/s10143-024-02523-9 -
ACS Applied Bio Materials Jun 2024β-Thalassemia especially transfusion-dependent thalassemia (TDT) associates with a hypercoagulable state, which is the main cause of thromboembolic events (TEE). Plasma...
A Compact Differential Dynamic Microscopy-based Device (cDDM): An Approach Tool for Early Detection of Hypercoagulable State in Transfusion-Dependent-β-Thalassemia Patients.
β-Thalassemia especially transfusion-dependent thalassemia (TDT) associates with a hypercoagulable state, which is the main cause of thromboembolic events (TEE). Plasma viscosity and rheological parameters could be essential markers for determining hypercoagulable state in β-thalassemia patients. The traditional methods for measuring viscosity are often limited by large sample volumes and are impractical for routine clinical monitoring. The compact differential dynamic microscopy-based device (cDDM), an optical microscopy for quantitative rheological assessment, was developed and applied for prognosis of the hypercoagulable state in β-TDT with and without splenectomy. The device was performed plasma viscosity measurement using low plasma volume (8 μL) and revealed a value as modulus of complex viscosity |η(ω)| in 7 min. We also parallelly demonstrated the correlation of the viscosity and related-coagulable parameters: complete blood count, prothrombin time (PT), activated partial thromboplastin time (APTT), protein C (PC), protein S (PS), CD62P and CD63 expression, and platelet aggregation test. The thalassemia plasma exhibited a higher value of |η(ω)| than healthy plasma, which can represent a different viscoelastic property among the groups. Even all related-coagulable parameters indicated hypercoagulable state in both nonsplenectomies and splenectomies β-TDT patients when compared to control, only high platelet numbers significantly correlated to high plasma viscosity in the splenectomy group. However, the other coagulable parameters have shown a trend of positive relationship with high plasma viscosity in all β-1thalassemia TDT patients. The relative results suggested that our device would be an approach tool for early detection of hypercoagulable state in transfusion-dependent-β-thalassemia patients, which can help to prevent TEE and the critical consequent-complications.
PubMed: 38920024
DOI: 10.1021/acsabm.4c00516 -
Cureus May 2024Dengue, an arboviral illness, is notorious for inducing thrombocytopenia, leading to bleeding and heightened mortality risk. leaf extract has shown efficacy in...
Dengue, an arboviral illness, is notorious for inducing thrombocytopenia, leading to bleeding and heightened mortality risk. leaf extract has shown efficacy in elevating platelet counts. A 35-year-old male presented with fever, fatigue, and body pain persisting for four days. Additionally, he complained of severe back pain, ocular discomfort, and brief episodes of nosebleeds. Testing revealed a positive NS1 antigen, prompting the initiation of intravenous normal saline, paracetamol, and papaya extract tablets. Despite initial platelet levels of 74,000, a subsequent decline to 30,650 was observed following another nosebleed. Subsequently, the patient's spouse administered freshly prepared papaya leaf extract orally three to four times daily, resulting in a platelet count of 120,320 on day 14. Timely recognition of declining platelet levels and the commencement of leaf extract contributed significantly to averting mortality risks.
PubMed: 38919218
DOI: 10.7759/cureus.61090 -
Journal of Cardiothoracic Surgery Jun 2024Arteriosclerosis obliterans (ASO) is a chronic arterial disease that can lead to critical limb ischemia. Endovascular therapy is increasingly used for limb salvage in...
BACKGROUND
Arteriosclerosis obliterans (ASO) is a chronic arterial disease that can lead to critical limb ischemia. Endovascular therapy is increasingly used for limb salvage in ASO patients, but the outcomes vary. The development of prediction models using unsupervised machine learning may lead to the identification of novel subtypes to guide patient prognosis and treatment.
METHODS
This retrospective study analyzed clinical data from 448 patients with ASOs who underwent endovascular therapy. Unsupervised machine learning algorithms were employed to identify subgroups. To validate the precision of the clustering outcomes, an analysis of the postoperative results of the clusters was conducted. A prediction model was constructed using binary logistic regression.
RESULTS
Two distinct subgroups were identified by unsupervised machine learning and characterized by differing patterns of clinical features. Patients in Cluster 2 had significantly worse conditions and prognoses than those in Cluster 1. For the novel ASO subtypes, a nomogram was developed using six predictive factors, namely, platelet count, ankle brachial index, Rutherford category, operation method, hypertension, and diabetes status. The nomogram achieved excellent discrimination for predicting membership in the two identified clusters, with an area under the curve of 0.96 and 0.95 in training cohort and internal test cohort.
CONCLUSION
This study demonstrated that unsupervised machine learning can reveal novel phenotypic subgroups of patients with varying prognostic risk who underwent endovascular therapy. The prediction model developed could support clinical decision-making and risk counseling for this complex patient population. Further external validation is warranted to assess the generalizability of the findings.
Topics: Humans; Female; Male; Endovascular Procedures; Retrospective Studies; Unsupervised Machine Learning; Arteriosclerosis Obliterans; Aged; Middle Aged; Nomograms; Prognosis; Machine Learning
PubMed: 38918804
DOI: 10.1186/s13019-024-02913-6 -
BMC Cancer Jun 2024Despite evidence supporting the high correlation of the novel platelet-to-albumin ratio (PAR) with survival in diverse malignancies, its prognostic relevance in...
Prognostic significance of platelet‑to‑albumin ratio in patients with nasopharyngeal carcinoma receiving concurrent chemoradiotherapy: a retrospective study of 858 cases.
BACKGROUND
Despite evidence supporting the high correlation of the novel platelet-to-albumin ratio (PAR) with survival in diverse malignancies, its prognostic relevance in nasopharyngeal carcinoma (NPC) remains underexplored. This study aimed to examine the link between PAR and overall survival (OS) in NPC and to establish a predictive model based on this biomarker.
METHODS
We retrospectively assembled a cohort consisting of 858 NPC patients who underwent concurrent chemoradiotherapy (CCRT). Utilizing the maximally selected log-rank method, we ascertained the optimal cut-off point for the PAR. Subsequently, univariate and multivariate Cox proportional hazards models were employed to discern factors significantly associated with OS and to construct a predictive nomogram. Further, we subjected the nomogram's predictive accuracy to rigorous independent validation.
RESULTS
The discriminative optimal PAR threshold was determined to be 4.47, effectively stratifying NPC patients into two prognostically distinct subgroups (hazard ratio [HR] = 0.53; 95% confidence interval [CI]: 0.28-0.98, P = 0.042). A predictive nomogram was formulated using the results from multivariate analysis, which revealed age greater than 45 years, T stage, N stage, and PAR score as independent predictors of OS. The nomogram demonstrated a commendable predictive capability for OS, with a C-index of 0.69 (95% CI: 0.64-0.75), surpassing the performance of the conventional staging system, which had a C-index of 0.56 (95% CI: 0.65-0.74).
CONCLUSIONS
In the context of NPC patients undergoing CCRT, the novel nutritional-inflammatory biomarker PAR emerges as a promising, cost-efficient, easily accessible, non-invasive, and potentially valuable predictor of prognosis. The predictive efficacy of the nomogram incorporating the PAR score exceeded that of the conventional staging approach, thereby indicating its potential as an enhanced prognostic tool in this clinical setting.
Topics: Humans; Female; Male; Retrospective Studies; Middle Aged; Nasopharyngeal Carcinoma; Chemoradiotherapy; Prognosis; Nomograms; Nasopharyngeal Neoplasms; Adult; Blood Platelets; Aged; Serum Albumin; Neoplasm Staging; Young Adult; Proportional Hazards Models; Platelet Count; Biomarkers, Tumor
PubMed: 38918690
DOI: 10.1186/s12885-024-12499-w -
Asian Pacific Journal of Cancer... Jun 2024Presently, ovarian cancer remains the leading cause of death in gynecological malignancies. The survival rate of these patients is low, which might be caused by early... (Meta-Analysis)
Meta-Analysis
OBJECTIVE
Presently, ovarian cancer remains the leading cause of death in gynecological malignancies. The survival rate of these patients is low, which might be caused by early metastases and delayed diagnosis. Therefore, it is crucial to investigate novel practical markers that provide early prognostic value which helps construct individualized treatment.
METHODS
A thorough investigation of the neutrophil-lymphocyte ratio (NLR) and lymphocyte ratio (PLR) in ovarian cancer patients was conducted using article selection from PubMed, Cochrane, Science Direct, and Google Scholar databases. The outcomes and hazard ratio (HR) were obtained using Review Manager 5.4, and the 95% Confidence Interval (CI) result was calculated. The chief endpoints of interest in this study include overall survival (OS) and progression-free survival (PFS).
RESULTS
Sixteen studies with 3,862 patients were included with a mean age of 50.6 years and a mean follow-up of 45.84 months. Multivariate studies demonstrated that a higher NLR is associated with worse PFS and OS, HR 1.35;95% CI [1.05-1.74] and HR 1.46; 95% CI [1.16-1.83] respectively. Similar results are observed with PLR and poorer PFS and OS, HR 1.62; 95% CI [1.09-2.43] and HR 1.66; 95% CI [1.12-2.46].
CONCLUSION
Pre-treatment PLR and NLR were found to be prognostic factors in determining PFS and OS in ovarian cancer. High values in pre-treatment PLR and NLR may indicate worse clinical outcomes.
Topics: Humans; Female; Ovarian Neoplasms; Neutrophils; Prognosis; Lymphocytes; Biomarkers, Tumor; Blood Platelets; Lymphocyte Count; Survival Rate; Platelet Count
PubMed: 38918652
DOI: 10.31557/APJCP.2024.25.6.1921 -
Radiology Jun 2024A 15-year-old male patient presented with a 3-week history of inner left thigh pain provoked by activity and experienced occasionally at rest. The patient denied...
A 15-year-old male patient presented with a 3-week history of inner left thigh pain provoked by activity and experienced occasionally at rest. The patient denied nighttime pain, fever, or chills. Laboratory investigation revealed the following normal values: hemoglobin level of 15.6 g/dL (normal range, 13-16 g/dL), platelet count of 240 × 103/µL (normal range, 140-440 × 103/µL), and total leukocyte count of 7100 cells/µL (normal range, 4500-11 000 cells/µL). The percentage of neutrophils was considered low at 44% (normal range, 54%-62%), and the percentage of eosinophils was slightly high at 3.7% (normal range, 0%-3%). An anteroposterior radiograph of the left hip is shown. Physical therapy was initiated, with no improvement after 2 weeks of therapy. The patient was referred to an orthopedist for further evaluation. At physical examination, the patient endorsed marked left hip pain with hip flexion to 90°, limited internal and external rotation (5° and 15°, respectively), and antalgic gait favoring the left leg. Hip MRI and further serologic analysis were requested for further evaluation. Although the serologic testing was performed at an outside laboratory, the physician reported positive immunoglobulin-G Lyme titers, normal C-reactive protein level, and normal erythrocyte sedimentation rate. Pelvic CT was requested. The patient was prescribed a course of doxycycline (100 mg twice daily for 28 days), with reported resolution of symptoms 2 weeks after initiation of treatment. Three weeks later, the patient presented to our department with recurrent left hip pain, which was similar in severity compared with the initial presentation. A second MRI examination of the left hip was performed 4 months after the initial presentation.
Topics: Humans; Male; Adolescent; Osteoma, Osteoid; Magnetic Resonance Imaging; Diagnosis, Differential; Bone Neoplasms; Hip Joint
PubMed: 38916512
DOI: 10.1148/radiol.230629 -
European Journal of Gastroenterology &... Jun 2024The aim of this study was to establish a simple, nonalcoholic fatty liver disease (NAFLD) screening model using readily available variables to identify high-risk...
OBJECTIVE
The aim of this study was to establish a simple, nonalcoholic fatty liver disease (NAFLD) screening model using readily available variables to identify high-risk individuals in Western Xinjiang, China.
METHODS
A total of 40 033 patients from the National Health Examination were divided into a training group (70%) and a validation group (30%). Univariate regression and least absolute shrinkage and selection operator models optimized feature selection, while a multivariate logistic regression analysis constructed the prediction model. The model's performance was evaluated using the area under the receiver operating characteristic curve, and its clinical utility was assessed through decision curve analysis.
RESULTS
The nomogram assessed NAFLD risk based on factors such as sex, age, diastolic blood pressure, waist circumference, BMI, fasting plasma glucose, alanine aminotransferase, platelet count, total cholesterol, triglycerides, low-density lipoprotein-cholesterol, and high-density lipoprotein-cholesterol. The area under the receiver operating characteristic curves were 0.829 for men and 0.859 for women in the development group, and 0.817 for men and 0.865 for women in the validation group. The decision curve analysis confirmed the nomogram's clinical usefulness, with consistent findings in the validation set.
CONCLUSION
A user-friendly nomogram prediction model for NAFLD risk was successfully developed and validated for Western Xinjiang, China.
PubMed: 38916218
DOI: 10.1097/MEG.0000000000002807