Risk factors associated with intracranial hemorrhage in adults with immune thrombocytopenia: A study of 27 cases

2016 ◽  
Vol 91 (12) ◽  
pp. E499-E501 ◽  
Author(s):  
Sara Melboucy‐Belkhir ◽  
Mehdi Khellaf ◽  
Alexandre Augier ◽  
Marouane Boubaya ◽  
Vincent Levy ◽  
...  
Keyword(s):  
Risk Factors ◽  
Intracranial Hemorrhage ◽  
Immune Thrombocytopenia ◽  
Factors Associated

scholarly journals Intracranial hemorrhages in children with immune thrombocytopenia

2021 ◽  
Vol 20 (3) ◽  
pp. 92-101
Author(s):  
E. V. Suntsova ◽  
M. N. Sadovskaya ◽  
O. V. Spichak ◽  
S. S. Ozerov ◽  
S. P. Khomyakova ◽  
...  
Keyword(s):  
Risk Factors ◽  
Intracranial Hemorrhage ◽  
Immune Thrombocytopenia ◽  
Scientific Research ◽  
Intracranial Hemorrhages ◽  
Hemorrhagic Complications ◽  
Primary Immune Thrombocytopenia ◽  
Life Threatening ◽  
Clinical Cases

Primary immune thrombocytopenia is a benign and self-limiting process in the majority of children. Severe life-threatening hemorrhages, including intracranial, develop rarely. Risk factors predisposing for development of severe hemorrhagic complications have not been determined. In order to decrease the severity of neurological consequences and mortality in intracranial hemorrhages, timely combined urgent therapy is neсessary. There are four clinical cases of intracranial hemorrhage in immune thrombocytopenia in children with different outcomes in this article. The parents of the patients agreed to use the information, including photos of children, in scientific research and publications.

scholarly journals Immediate Pre-Splenectomy Platelet Count Predicts Splenectomy Response in Adult Immune Thrombocytopenia Patients

Blood ◽  
2020 ◽  
Vol 136 (Supplement 1) ◽  
pp. 11-11
Author(s):  
O. A. Soboleva ◽  
K. I. Ntanisian ◽  
E. K. Egorova ◽  
A. L. Melikyan ◽  
E. G. Gemdzhian ◽  
...  
Keyword(s):  
Risk Factors ◽  
Platelet Count ◽  
Immune Thrombocytopenia ◽  
Conflicts Of Interest ◽  
Univariate Analysis ◽  
Multivariate Logistic Regression Analysis ◽  
Complete Response ◽  
Preoperative Treatment ◽  
Female Ratio ◽  
Factors Associated

Background: Immune thrombocytopenia (ITP) is an autoimmune disorder characterized by isolated thrombocytopenia. Splenectomy remains an effective and safe treatment for ITP. Objective: Identify and estimate risk factors associated with no response (platelet count < 30 x 109/L) to splenectomy for adult ITP patients. Patients and Methods: The study conducted at National Research Center for Hematology (Moscow) from 03/2015 to 11/2019 included all patients (in total, 111) with ITP, who underwent laparoscopic splenectomy. Median (Med) platelet count at admission was 12 x 109/L (range from 1 to 239 x 109/L). The time from diagnosis of ITP to splenectomy varied from 3 months to 51 years. All patients had received from 1 to 3 lines of treatment prior to splenectomy. Pre-splenectomy treatment was carried out at platelet count < 20 x 109/L and/or in the presence of bleeding. Results: Of the 111 patients 31 were male (Med age 43 years [IQR 27-55]) and 80 were female (Med age 37 [IQR 29-49]). The male/female ratio was 1:2.6. Complete response to splenectomy (platelet count > 100 x 109/L) was achieved in 79/111 (71.2%) cases, 11/111 (9.9%) patients had partial response (platelet count: 30-100 x 109/L) and 21/111 (18.9%) failed to respond (platelet count < 30 x 109/L). Patients who achieved complete response to splenectomy had a significantly higher immediate pre-splenectomy platelet count than non-responders: Med platelet count (95% CI): 47 (35-58) vs 16 (9-20) (x 109/L), Mann-Whitney U test, P < 0.001 (CI, confidence interval) (Figure 1). Multivariate logistic regression analysis was carried out to identify factors associated with splenectomy outcome (response/no response). Multivariate analysis included patient's gender and age, duration of ITP, grade of bleeding at admission, platelet count at admission, preoperative platelet count and number of prior lines of therapy. Continuous variables were dichotomized using ROC analysis, in particular, cut-off point for preoperative platelet count was 23 x 109/L. As a result, following statistically significant (Wald test) factors were selected: • an unfavorable predictor: immediate pre-splenectomy platelet count < 23 x 109/L, RR (95% CI): 2.5 (1.1-8.6), P = 0.001 (RR, relative risk) (Figure 1) and • combined unfavorable risk factor: male gender in the age over 60 (compared to men in the age ≤60 and women in general), RR (95% CI): 2.0 (0.9-7.1), P = 0.05 (Figure 2). Response rate was negatively correlated (in univariate analysis) with the number of treatment lines prior to splenectomy (negative Spearman's rank correlation coefficient, −0.30; P = 0.01). When preoperative platelet count ≥ 23 x 109/L was achieved, probability of complete response to splenectomy was 80% (Figure 3). The rate of postoperative complications was 12.6%. According to our follow-up data (up to 5 years) 66/79 (83.5%) patients maintained complete response. Conclusions: High-risk groups were identified: patients with immediate pre-splenectomy platelet count < 23 x 109/L (i.e. with no effect of preoperative treatment) and men over the age of 60. Identified risk factors could be taken into account in decision-making process. Disclosures No relevant conflicts of interest to declare.

scholarly journals Segmentation of Intracranial Hemorrhage Using Semi-Supervised Multi-Task Attention-Based U-Net

2020 ◽  
Vol 10 (9) ◽  
pp. 3297 ◽  
Author(s):  
Justin L. Wang ◽  
Hassan Farooq ◽  
Hanqi Zhuang ◽  
Ali K. Ibrahim
Keyword(s):  
Risk Factors ◽  
Intracranial Hemorrhage ◽  
Learning Strategy ◽  
Ground Truth ◽  
Dice Coefficient ◽  
Model Accuracy ◽  
Ground Truth Data ◽  
Training Strategy ◽  
Factors Associated ◽  
The One

Intracranial Hemorrhage (ICH) has high rates of mortality, and risk factors associated with it are sometimes nearly impossible to avoid. Previous techniques to detect ICH using machine learning have shown some promise. However, due to a limited number of labeled medical images available, which often causes poor model accuracy in terms of the Dice coefficient, there is much to be improved. In this paper, we propose a modified u-net and curriculum learning strategy using a multi-task semi-supervised attention-based model, initially introduced by Chen et al., to segment ICH sub-groups from CT images. Using a modified inverse-sigmoid-based curriculum learning training strategy, we were able to stabilize Chen’s algorithm experimentally. This semi-supervised model produced higher Dice coefficient values in comparison to a supervised counterpart, regardless of the amount of labeled data used to train the model. Specifically, when training with 80% of the ground truth data, our semi-supervised model produced a Dice coefficient of 0.67, which was higher than 0.61, obtained by a comparable supervised model. This result also surpassed by a greater margin the one obtained by using the out-of-the-box u-net by Hssayeni et al.

scholarly journals Temporal Trends of Intracranial Hemorrhage Among Immune Thrombocytopenia Hospitalizations in the United States from 2007-2016

Blood ◽  
2019 ◽  
Vol 134 (Supplement_1) ◽  
pp. 55-55
Author(s):  
Mayank Sharma ◽  
Parth Bhatt ◽  
Marian Ayensu ◽  
Kuhoo Bhal ◽  
Fredrick Dapaah-Siakwan ◽  
...  
Keyword(s):  
Length Of Stay ◽  
Intracranial Hemorrhage ◽  
Teaching Hospital ◽  
Immune Thrombocytopenia ◽  
Chi Square ◽  
Large Hospital ◽  
Factors Associated ◽  
Icd 10 ◽  
Chi Square Test ◽  
Gi Bleed

Background: Intracranial hemorrhage (ICH) is a rare but severe complication in patients with immune thrombocytopenia (ITP). It is unclear whether the incidence of ICH has changed over time. We aimed study the incidence of ICH among ITP hospitalizations and factors associated with its occurrence from 2007-2016. Additionally, we examined the outcomes of ITP hospitalizations with ICH and resource utilization (length of stay, cost of hospitalization) during this time period. Methods: We used data from the National Inpatient Sample (NIS) database from 2007-2016. ITP hospitalizations were identified using International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) code '287.31' and ICD-10-CM code 'D69.3'. Pertinent ICD-9-CM and ICD-10-CM codes were used to identify ICH. Baseline characteristics of ITP hospitalizations with and without ICH were compared using chi-square test and Wilcoxon rank-sum test for categorical and continuous variables, respectively. For trend analysis, chi-square test of trend for proportions was used with Cochrane Armitage test. Survey logistic regression was used to analyze factors associated with the occurrence of ICH and mortality in ITP hospitalizations with ICH. To account for the complex design of NIS, hierarchical regression was used to analyze the factors associated with of length of stay (LOS) and cost of hospitalization (COH). Beta coefficient and 95% confidence intervals (CI) were reported. P-value <0.05 was considered significant for all analyses. Results: Between 2007 and 2016, 348,906 ITP hospitalizations were identified. The incidence of ICH was 0.98% (n=3,408). Median age of patients with reported ICH was significantly higher than those without ICH [63.4 (range 47.1-76.7) vs. 51.6 (28.6-70.0), P<0.001]. Rates of mortality (26.6% vs. 3.2%, P<0.001), LOS (4.8 days vs. 2.6 days, P<0.001), and COH ($20,081 s. $8,355, P<0.001) were higher in hospitalizations with ICH. While the overall incidence of ICH remained stable during the study period (P=0.3), it varied by age, gender, and hospital region. Incidence significantly decreased in age ≤24 years (0.7% to 0.4%). On the contrary, it significantly increased among those ≥65 years (1.5% to 1.9%), females (0.9% to 1.1%), and hospitalizations in Northeast region (0.9% to 1.1%). Similarly, trend of mortality in hospitalizations with ICH increased from 28.1% in 2007-08 to 34.6% in 2015-16 (P<0.001). On multivariate regression analysis, factors associated with higher likelihood of ICH were (Table 1): age 25-64 years [odds ratio (OR) 2.23; 95% CI 1.51-3.31], ≥65 years (OR 3.69; 95% CI 2.34-5.84), gastrointestinal (GI) bleed (OR 1.60; 95% CI 1.18-2.16), other bleed (OR 1.69; 95% CI 1.19-2.42), hospitalization in the West region (OR 1.62; 95% CI 1.26-2.08), in a medium (OR 1.64; 95% CI 1.08-2.47) or large hospital (OR 2.42; 95% CI 1.65-3.55) and in an urban-teaching hospital (OR 2.73; 95% CI 1.80-4.13). Female gender (OR 0.81; 95% CI 0.68-0.97) was associated with lower likelihood of ICH. Similarly, factors were associated with higher likelihood of mortality in ICH hospitalizations were: age 25-64 years (OR 6.73; 95% CI 4.11-11.03), ≥ 65 years (OR 16.94; 95% CI 10.14-28.30), GI bleed (OR 3.13; 95% CI 2.72-3.60), other bleeds (OR 1.66; 95% CI 1.31-2.10), hospitalizations at a large hospital (OR 1.17; 95% CI 1.00-1.37), and an urban teaching hospital (OR 1.23; 95% CI 1.02-1.48). Increasing age was associated with longer LOS, which also translated into higher COH (Table 2). Comorbidities such as GI bleed (2.5 days, 95% CI 2.1-2.9; $9,391, 95% CI 8,210-10,572), hematuria (1.1 days, 95% CI 0.6-1.6; $3,586, 95% CI 1,941-5,230), and other bleeding (1.1 days, 95% CI 0.7-1.5; $5,931, 95% CI 4,565-7,296) were also associated with longer LOS and higher COH. LOS decreased from 2007 to 2016 [-0.2 days, 95% CI (-0.3)-(-0.1)], however, the COH did not change. Conclusion: The overall incidence of ICH among ITP hospitalizations is low and remained stable from 2007-2016, which is reassuring. Nonetheless, a quarter of these hospitalizations resulted in mortality. ICH also significantly increased healthcare utilization in ITP hospitalizations through high LOS and COH. Older age and male gender were associated with higher ICH incidence and mortality. Future studies should reassess the ICH trends to study the impact of novel therapeutic options such as thrombopoietin receptor agonists. Disclosures No relevant conflicts of interest to declare.

Risk factors associated with substance use

2014 ◽  
Author(s):  
Ariel M. Barber ◽  
Alexandra Crouch ◽  
Stephen Campbell
Keyword(s):  
Risk Factors ◽  
Substance Use ◽  
Factors Associated
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