scholarly journals Analysis of Platelet Count and New Cancer Diagnosis Over a 10-Year Period

2022 ◽  
Vol 5 (1) ◽  
pp. e2141633
Author(s):  
Vasily Giannakeas ◽  
Joanne Kotsopoulos ◽  
Matthew C. Cheung ◽  
Laura Rosella ◽  
Jennifer D. Brooks ◽  
...  
Blood ◽  
2020 ◽  
Vol 136 (Supplement 1) ◽  
pp. 52-53
Author(s):  
Yasmin Arafah ◽  
Taha Al-Juhaishi ◽  
Ghaith Abu Zeinah ◽  
Lalitha V. Nayak ◽  
Sadeer Al-Kindi

Background: Risk stratification of venous thromboembolism (VTE) in patients with cancer is essential to evaluate the need for extended thromboprophylaxis. The Khorana score is widely used to guide VTE risk stratification in patients with cancer based on clinical parameters: cancer type, platelet count, hemoglobin level, leukocyte count, and body mass index. We sought to validate Khorana score to predict 1-year risk of VTE in a large multi-institutional, diverse, real-world cohort of patients with cancer. Methods: Using aggregated de-identified electronic medical record data from >300 major hospitals in the in the United States (IBM Watson Explorys), we performed a retrospective cohort study of all patients who had a diagnosis of cancer. We identified cancer type, platelet count, hemoglobin level, leukocyte count, and body mass index (for calculation of Khorana score) within 7 days of cancer diagnosis and followed patients for diagnosis of VTE for 1 year post cancer diagnosis. Logistic regression models were used to evaluate association between patient characteristics and VTE risk. Receiver operating characteristics with area under the curve were used to evaluate model discrimination. All analyses were performed in Statistical Package for Social Sciences. Results: A total of 2,112,260 patients with cancer were included: 52.9% females, 11.1% African Americans, 44.3% intermediate risk cancers (lymphoma, lung, breast, gynecologic, testicular and bladder), 4.5% high risk cancers (stomach and pancreas), 19.8% had Platelet counts ≥ 350,000/µL, 29% had hemoglobin <10 g/dL, 32.3% had leukocyte count >11,000/µL, and 15.1% had body mass index ≥ 35 kg/m2. Overall, 227,170 (10.8%) had a diagnosis of VTE at 1 year following cancer diagnosis. In multivariable analysis (table 1), VTE risk was associated with cancer type (intermediate vs low risk: OR 1.08 [95% CI: 1.07-1.09]; high vs low risk: OR 1.48 [95% CI: 1.45-1.51]), Platelet ≥ 350,000 (OR 1.27 [95% CI: 1.26-1.29]), hemoglobin <10 g/dL (OR 1.43 [95% CI: 1.41-1.44]), leukocyte count > 11,000 (OR 1.15 [95% CI: 1.14-1.16]), body mass index ≥ 35 kg/m2 (OR 1.29 [95% CI: 1.27-1.30]), table 1. Risk of VTE increased linearly with Khorana score between 7.7% (score = 0) to 18% (score = 6), figure 1. Khorana score had weak to modest discrimination (Area Under Receiver Operating Characteristics 0.565 [95% CI: 0.564-0.566]), figure 2. Conclusion: In this very large real-world study of diverse patients with cancer, Khorana score was a weak predictor of 1-year risk of VTE, suggesting that VTE prediction in patients with cancer is very complex. Disclosures No relevant conflicts of interest to declare.


Blood ◽  
2021 ◽  
Vol 138 (Supplement 1) ◽  
pp. 3156-3156
Author(s):  
Kasper Adelborg ◽  
Katalin Veres ◽  
Erzsébet Horváth-Puhó ◽  
Mary Clouser ◽  
Hossam A Saad ◽  
...  

Abstract Introduction: Despite the large body of research in cancer and increasing numbers of cancer survivors, knowledge about the risks and prognoses related to thrombocytopenia in the clinical care setting is scarce. Such information is important to understanding the need and potential impact of platelet transfusion and emerging drug therapies for thrombocytopenia. In this study, we examined the risk of thrombocytopenia among patients with incident cancer. Further, we studied the extent to which thrombocytopenia was associated with adverse clinical outcomes. Methods: This population-based cohort study was conducted using data from the Danish Cancer Registry. All patients diagnosed with incident hematologic malignancies and solid tumors (age of ≥18 years) during 2015─2018 were identified. Data were linked with routine laboratory test results from the primary care and hospital settings, as recorded in the Danish Register of Laboratory Results for Research. Based on platelet count levels (x 10 9/L), thrombocytopenia was categorized as grade 0 (any count)<150; grade 1:<100; grade 2:<75; grade 3:<50; and grade 4: <25. We tabulated the prevalence of thrombocytopenia at study inclusion and calculated the cumulative incidence proportion (risk) of thrombocytopenia, accounting for the competing risk of death. Each patient with thrombocytopenia was matched up to 5 cancer patients without thrombocytopenia by age, sex, cancer type, cancer stage, and time from cancer diagnosis and index date. Cox proportional hazards regression analysis was used to compute hazard ratios (HRs) with 95% confidence intervals (CIs) of adverse clinical outcomes, including any bleeding leading to hospitalization, site-specific bleeding leading to hospitalization, transfusion (red blood cell, platelet, or fresh frozen plasma), and death. HRs were adjusted for Charlson Comorbidity Index scores and matching factors by design. Results: The analytic cohort comprised 11,785 patients with hematologic malignancies and 57,600 patients with solid tumors (median age=70 years). Any thrombocytopenia was observed during the 6 months preceding study inclusion among 18% of patients with hematologic malignancies (grades 1-2: 6% and grades 3-4: 5%) and 4% of patients with solid tumors (grades 1-2: 1% and grades 3-4: 0%). The 1-year and 4-year risks of new-onset thrombocytopenia were 30% and 40% for hematologic malignancies and 21% and 28% for solid tumors, respectively (Figure 1). Among patients who initiated chemotherapy following their cancer diagnosis (n=33,165), the 1-year and 4-year risks of thrombocytopenia were 50% and 62% for hematologic malignancies and 39% and 49% for solid tumors, respectively (Figure 2). Patients with grade 4 thrombocytopenia had higher rates of any bleeding leading to hospitalization than patients without thrombocytopenia [hematologic malignancies: HR=2.31 (95% CI: 1.43-3.73) and solid tumors: HR=4.52 (95% CI: 2.00-10.24)], while grades 1-3 thrombocytopenia did not confer a significantly increased rate of hospitalization for bleeding (Table 1). All grades of thrombocytopenia were associated with an increased rate of transfusion [overall for hematologic malignancies: HR=2.06 (95% CI: 1.91-2.23), and overall for solid tumors: HR=2.13 (95% CI: 1.83-2.48)] and with death [overall for hematologic malignancies: HR=2.01 (95% CI: 1.84-2.20), and overall for solid tumors: HR=1.44 (95% CI: 1.39-1.49)]. These associations increased in magnitude with decreasing platelet count levels. Conclusions: The risk of thrombocytopenia was substantial following a diagnosis of incident hematologic malignancy and solid tumors, with higher risks among patients who initiated chemotherapy. While only severe thrombocytopenia was a predictor of any hospitalization for bleeding, all grades of thrombocytopenia were associated with increased rates of transfusion and death. Our findings support the need for regular assessment of platelet count levels to identify cancer patients at risk of serious clinical outcomes. Figure 1 Figure 1. Disclosures Clouser: Amgen: Current Employment, Other: This work is related to Chemotherapy Induced Thrombocytopenia as a disease state, in this essence it is not directly related to an Amgen product; CIT is an area of scientific interest to Amgen with Romiplostim under development for this potential indicati. Saad: Amgen: Current Employment, Current equity holder in publicly-traded company.


2019 ◽  
Author(s):  
Yue-ming Sun ◽  
Shuangling Li ◽  
Shu-Peng Wang ◽  
Chen Li ◽  
Gang Li ◽  
...  

Abstract Objectives: The requirement of prolonged mechanical ventilation (PMV) is associated with increased medical care demand and expenses, high early and long-term mortality, and worse life quality. However, no study has assessed the prognostic factors associated with 1-year mortality among PMV patients, not less than 21 days after surgery. This study analyzed the predictors of 1-year mortality in patients requiring PMV in intensive care units (ICUs) after surgery. Design: Multicenter, retrospective cohort study Setting: ICUs at 5 tertiary hospitals in Beijing Participants: Patients who required PMV after surgery between January 2007 and June 2016 were enrolled. Interventions: None Measurements and Main Results: Of the 124 patients enrolled, the cumulative 1-year mortality was 74.2% (92/124). From the multivariable Cox proportional hazard analysis, cancer diagnosis (hazard ratio [HR] 2.14, 95% confidence interval [CI] 1.37-3.35; P<0.01), no tracheostomy (HR 2.01, 95% CI 1.22-3.30; P<0.01), enteral nutrition intolerance (HR 1.88, 95% CI 1.19-2.97; P=0.01), blood platelet count ≤150´10 9 /L (HR 1.77, 95% CI 1.14-2.75; P=0.01), requirement of vasopressors (HR 1.78, 95% CI 1.13-2.80; P=0.02), and renal replacement therapy (HR 1.71, 95% CI 1.01-2.91; P=0.047) on the 21 st day of mechanical ventilation were associated with shortened 1-year survival. Conclusions: For patients who required PMV after surgery, cancer diagnosis, no tracheostomy, enteral nutrition intolerance, blood platelet count ≤150´10 9 /L, vasopressor requirement, and renal replacement therapy on the 21 st day of mechanical ventilation were associated with shortened 1-year survival. The prognosis in PMV patients in ICUs can facilitate the decision-making process of physicians and patients’ family members on treatment schedule.


2019 ◽  
Author(s):  
Yue-ming Sun ◽  
Shuangling Li ◽  
Shu-Peng Wang ◽  
Chen Li ◽  
Gang Li ◽  
...  

Abstract Objectives: The requirement of prolonged mechanical ventilation (PMV) is associated with increased medical care demand and expenses, high early and long-term mortality, and worse life quality. However, no study has assessed the prognostic factors associated with 1-year mortality among PMV patients, not less than 21 days after surgery. This study analyzed the predictors of 1-year mortality in patients requiring PMV in intensive care units (ICUs) after surgery. Design: Multicenter, retrospective cohort study Setting: ICUs at 5 tertiary hospitals in Beijing Participants: Patients who required PMV after surgery between January 2007 and June 2016 were enrolled. Interventions: None Measurements and Main Results: Of the 124 patients enrolled, the cumulative 1-year mortality was 74.2% (92/124). From the multivariable Cox proportional hazard analysis, cancer diagnosis (hazard ratio [HR] 2.14, 95% confidence interval [CI] 1.37-3.35; P<0.01), no tracheostomy (HR 2.01, 95% CI 1.22-3.30; P<0.01), enteral nutrition intolerance (HR 1.88, 95% CI 1.19-2.97; P=0.01), blood platelet count ≤150´10 9 /L (HR 1.77, 95% CI 1.14-2.75; P=0.01), requirement of vasopressors (HR 1.78, 95% CI 1.13-2.80; P=0.02), and renal replacement therapy (HR 1.71, 95% CI 1.01-2.91; P=0.047) on the 21 st day of mechanical ventilation were associated with shortened 1-year survival. Conclusions: For patients who required PMV after surgery, cancer diagnosis, no tracheostomy, enteral nutrition intolerance, blood platelet count ≤150´10 9 /L, vasopressor requirement, and renal replacement therapy on the 21 st day of mechanical ventilation were associated with shortened 1-year survival. The prognosis in PMV patients in ICUs can facilitate the decision-making process of physicians and patients’ family members on treatment schedule.


2020 ◽  
Author(s):  
Yue-ming Sun ◽  
Shuangling Li ◽  
Shupeng Wang ◽  
Chen Li ◽  
Gang Li ◽  
...  

Abstract Objectives: The requirement of prolonged mechanical ventilation (PMV) is associated with increased medical care demand and expenses, high early and long-term mortality, and worse life quality. However, no study has assessed the prognostic factors associated with 1-year mortality among PMV patients, not less than 21 days after surgery. This study analyzed the predictors of 1-year mortality in patients requiring PMV in intensive care units (ICUs) after surgery. Design: Multicenter, retrospective cohort study Setting: ICUs at 5 tertiary hospitals in Beijing Participants: Patients who required PMV after surgery between January 2007 and June 2016 were enrolled. Interventions: None Measurements and Main Results: Of the 124 patients enrolled, the cumulative 1-year mortality was 74.2% (92/124). From the multivariable Cox proportional hazard analysis, cancer diagnosis (hazard ratio [HR] 2.14, 95% confidence interval [CI] 1.37-3.35; P<0.01), no tracheostomy (HR 2.01, 95% CI 1.22-3.30; P<0.01), enteral nutrition intolerance (HR 1.88, 95% CI 1.19-2.97; P=0.01), blood platelet count ≤150´10 9 /L (HR 1.77, 95% CI 1.14-2.75; P=0.01), requirement of vasopressors (HR 1.78, 95% CI 1.13-2.80; P=0.02), and renal replacement therapy (HR 1.71, 95% CI 1.01-2.91; P=0.047) on the 21 st day of mechanical ventilation were associated with shortened 1-year survival. Conclusions: For patients who required PMV after surgery, cancer diagnosis, no tracheostomy, enteral nutrition intolerance, blood platelet count ≤150´10 9 /L, vasopressor requirement, and renal replacement therapy on the 21 st day of mechanical ventilation were associated with shortened 1-year survival. The prognosis in PMV patients in ICUs can facilitate the decision-making process of physicians and patients’ family members on treatment schedule.


2007 ◽  
Vol 177 (4S) ◽  
pp. 156-156
Author(s):  
Andrea Salonia ◽  
Pierre I. Karakiewicz ◽  
Andrea Gallina ◽  
Alberto Briganti ◽  
Tommaso C. Camerata ◽  
...  

2010 ◽  
Author(s):  
Susan Sharp ◽  
Ashleigh Golden ◽  
Cheryl Koopman ◽  
Eric Neri ◽  
David Spiegel

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