scholarly journals P-BN49 The predictive role of white cell and platelet count for infective complications following splenectomy

2021 ◽  
Vol 108 (Supplement_9) ◽  
Author(s):  
Ozhin Karadakhy ◽  
Emma Poynton-Smith ◽  
Ian Beckingham
Keyword(s):  
Logistic Regression ◽  
Platelet Count ◽  
White Cell Count ◽  
White Cell ◽  
Stepwise Logistic Regression ◽  
Hospital Records ◽  
Long Term Follow Up ◽  
Infective Complications

Abstract Background Temporary elevation of white cell count (WCC) and platelets are commonly observed after splenectomy and can therefore make it difficult for the surgeon to distinguish a normal physiological response from potential infection. Clinicians are often misled by elevated post-operative WCC after splenectomy, resulting in delayed discharges and prolonged unnecessary hospital stays for patients. The aim of this study was to establish what constitutes a normal rise in WCC and platelets after splenectomy. Methods All 127 patients who had undergone a splenectomy between July 2016 and January 2021 were identified from a search of our centre's hospital episode statistics data.  WCC and platelet count on post-operative days one to seven as well as at least one long-term follow-up result count were identified from electronic hospital records. Hospital records were searched for data on pre-operative steroid administration and peri-operative infections. These cohort data were retrospectively analysed in SPSS using stepwise logistic regression, correlation analysis, and T-tests, as well as descriptive statistics. Results 86 (68%) patients underwent an elective splenectomy and 41 (32%) an emergency splenectomy. 35 (27.6%) patients developed infections post-operatively, while 92 (72.4%) did not. Logistic regression suggested that a raised WCC (above 17.5x109/L) at day 3 post-op was a significant predictor of infection (p < 0.001): average WCC at day 3 for patients with infection was 20.00x109/L (SD = 6.23x109/L) compared to 14.86x109/L (SD = 4.01x109/L) for those without. Infective outcomes were not influenced by whether the surgery was emergency or elective. Overall, average WCCs were 9.63x109/L pre-operatively and 15.07x109/L long-term post-operatively. Even in the absence of infection, splenectomy led to a long-term rise in WCC of 3.8x109/L from baseline, to an average of 13.0x109/L [SD = 5.41x109/L): a T-test on the 56 patients without infection and with both pre-op and long-term WCCs showed a mean rise of 3.76x109/L, p < 0.0001). Platelet count was not correlated with infection, though platelet counts rose from a mean of 261 × 109/L (SD = 103.4x109/L) pre-operatively to 581 × 109/L (SD = 236.3x109/L) at 7-day and 619 × 109/L (SD = 293.5x109/L) at long-term follow up across all patients – an average increase of 357 × 109/L, which did not significantly differ between patients with and without infective complications. Conclusions A rise in WCC and platelet count is normal post-splenectomy.  A rise in WCC>17.5x109/L on day 3 post-splenectomy is strongly correlated with infection (regardless of trauma or platelet count). Long-term follow up suggests that while much of the WCC increase is transient, WCC remains higher than pre-operatively, as does platelet count, in post-splenectomy patients. A raised WCC or platelet count without signs of infection should not preclude timely discharge in otherwise well patients.

Long-term Follow-up of Continuous Flow Left Ventricular Assist Devices: Complications and Predisposing Risk Factors

2017 ◽  
Vol 40 (11) ◽  
pp. 622-628 ◽  
Author(s):  
Tolulope A. Adesiyun ◽  
Rhondalyn C. McLean ◽  
Ryan J. Tedford ◽  
Glenn J.R. Whitman ◽  
Chris M. Sciortino ◽  
...  
Keyword(s):  
Logistic Regression ◽  
Platelet Count ◽  
Continuous Flow ◽  
Left Ventricular ◽  
Ventricular Assist Devices ◽  
Left Ventricular Assist Devices ◽  
Early Complications ◽  
Factors Associated

Purpose To assess LVAD complications and their overall effect on mortality and determine factors associated with development of early and long-term complications. Methods A retrospective cohort study of patients who underwent continuous flow LVAD placement between January 1, 2000 and November 30, 2013 was performed. The incidence of complications (sepsis or bacteremia, driveline infections, gastrointestinal bleeding, pump thrombosis, cerebrovascular accidents and anemia requiring transfusion) was collected and logistic regression and Cox proportional hazards analyses were performed. Results 108 patients met our inclusion criteria. Median length of follow-up was 2.2 years. In univariable logistic regression analysis, higher blood urea nitrogen (BUN), creatinine clearance <60, no prior inotrope use, higher INTERMACS class and lower platelet count were associated with early complications. On multivariable analysis, factors associated with early complications included higher BUN (odds ratio (OR) 1.03, 95% confidence interval (CI) 1.001-1.06 per mg/dL BUN), no prior inotrope use (OR 4.92, 95% CI 1.64- 14.7) and lower platelet count (OR 4.29, 95% CI 1.45-12.7 <200 10(3) cu mm); 24% of patients developed early complications and 18.5% developed an early and late complication. Early complications were significantly associated with death (p = 0.017). The presence of 2 or more complications was associated with a 2.7-fold increase in the odds of death (p = 0.016) and odds of death increased by 20% with each subsequent complication (p = 0.004). Conclusions LVADs are associated with significant long-term complications including stroke and sepsis and minimizing time on LVADs may decrease the risk of complications and subsequent morbidity and mortality.

Long-term outcomes in adults with chronic ITP after splenectomy failure

Blood ◽  
2004 ◽  
Vol 104 (4) ◽  
pp. 956-960 ◽  
Author(s):  
Robert McMillan ◽  
Carol Durette
Keyword(s):  
Platelet Count ◽  
Autoimmune Disorder ◽  
Corticosteroid Treatment ◽  
Long Term Outcomes ◽  
Normal Platelet ◽  
Resistant Disease ◽  
Long Term Follow Up ◽  
Additional Therapy

AbstractAdult chronic immune thrombocytopenic purpura (ITP) is an autoimmune disorder manifested by thrombocytopenia from the effects of antiplatelet autoantibodies and T lymphocyte–mediated platelet cytotoxicity. Multiple studies show that corticosteroid treatment and splenectomy, alone or together, increase platelet counts to safe levels in 60% to 70% of patients. However, there is little information on the outcomes of ITP patients refractory to splenectomy. We studied 114 patients with ITP for whom splenectomy failed and who required additional therapy; long-term follow-up was available on 105 (92%) patients. Seventy-five (71.4%) patients attained stable partial (platelet count greater than 30 × 109/L) or complete (normal platelet count) remission; 51 patients remained in remission after therapy was discontinued, whereas 24 patients required continued treatment. Median time to remission after splenectomy failure was 46 months (range, 1-437 months). Median remission durations were 60 months (range, 10-212 months) for patients off therapy and 48 months (range, 2-167 months) for patients on therapy. Thirty (29.6%) patients remained unresponsive to treatment. Thirty-two patients died, 17 (15.7%) of ITP (bleeding, 11 patients; therapy complications, 6 patients) and 15 (13.9%) of unrelated causes. We conclude that most patients with refractory ITP attain stable remission, though on average this occurs slowly. However, a subpopulation with severe, resistant disease experiences significant morbidity and mortality.

THE STOCKHOLM 20-YEAR FOLLOW-UP OF ANEURYSMAL SUBARACHNOID HEMORRHAGE OUTCOME

Neurosurgery ◽  
2007 ◽  
Vol 60 (6) ◽  
pp. 1017-1024 ◽  
Author(s):  
Göran Edner ◽  
Håkan Almqvist
Keyword(s):  
Subarachnoid Hemorrhage ◽  
De Novo ◽  
Aneurysmal Subarachnoid Hemorrhage ◽  
Hospital Records ◽  
Long Term Outcome ◽  
Aneurysm Formation ◽  
Long Term Follow Up ◽  
De Novo Aneurysm

Abstract OBJECTIVE To assess the clinical and radiological long-term outcome after aneurysmal subarachnoid hemorrhage (SAH) in a defined referral area regarding recurrent SAH and de novo aneurysm formation. METHODS One hundred and two 1-year survivors after aneurysmal SAH, who were treated at the Neurosurgical Clinic, South Hospital, Stockholm, Sweden, between 1983 and 1985, were followed for 20 years. Forty-nine surviving patients were reevaluated. Hospital records and death certificates were scrutinized for all 53 nonsurviving patients. Clinical history penetration, Mini Mental Status, Rankin Disability Score, and Barthel Index were used to evaluate the outcome. Computed tomographic angiography was used to investigate the cerebral arteries. RESULTS One hundred and two patients were traced. Fifty-three patients were deceased. One patient had a hospital record of sustaining an aneurysmal SAH from a known but not clipped aneurysm. Three patients had nonaneurysmal intracerebral hemorrhage and two sustained traumatic SAH. There were 49 surviving patients. Six refused follow-up. None of these patients had hospital records of intracranial disease. Three of the 43 remaining patients could not be tested. None of the survivors had experienced a new SAH. Aneurysm base remnants were observed in 1% (eight patients, 790 person-years of follow-up) and de novo aneurysms were observed in 0.9% (seven patients, 790 person-years of follow-up). CONCLUSION From this epidemiological survey of patients with aneurysmal SAH, it was found that none of the patients experienced a recurrent subarachnoid bleed from the treated aneurysm during a 20-year follow-up period. Thus, a routine extreme long-term follow-up period is not necessary. De novo aneurysm formation and possible enlargements of aneurysm base remnants were observed in almost 2% of patients per person year and should, therefore, be subject of a routine, long-term follow-up.

scholarly journals Effects of Intensive Phase Antituberculous Therapy on Hepatic and Haematological Parameters in Patients at the University Teaching Hospital in Lusaka, Zambia

2020 ◽  
Vol 4 (1) ◽  
pp. 35-42
Author(s):  
Glorious Mwaba ◽  
◽  
Derick Munkombwe ◽  
Patrick Kaonga ◽  
Mwangana Mubita ◽  
...  
Keyword(s):  
Logistic Regression ◽  
Adverse Effects ◽  
Cell Count ◽  
White Cell Count ◽  
Haemoglobin Concentration ◽  
Alanine Transaminase ◽  
White Cell ◽  
University Teaching ◽  
Full Blood Count

Objectives and study design: Zambia is a high tuberculosis burden country. Antituberculous medicines are the mainstay of tuberculosis management. There have been several reports of antituberculous drug-related haematological and hepatic adverse effects noted in other settings. Adverse events have healthcare cost and morbidity implications. Prevalence and severity of these adverse effects are understudied in patients at University Teaching Hospitals hence the purpose of this study was to identify haematological and hepatic abnormalities and compare parameters before treatment and after completion of the intensive phase among the patients. Factors associated with abnormalities were also determined. A prospective longitudinal study was undertaken at Chest Clinic between April 2018 and July 2018. Study patients were followed up for 2 months. Full blood count and liver function tests were recorded at baseline and at follow-up. Abnormalities were defined according to the 2017 Department of AIDS Table for Grading the Severity of Adult and Paediatric Adverse Events. Data were analysed using SPSS version 22.0. Paired t-test and Wilcoxon matched-pairs signed-rank test were used to compare parameters. Logistic regression was performed to determine factors that were predictive of abnormalities. A p< 0.05 was considered statistically significant. Results: A total of 37 patients were involved in the study. 56.8% of patients were male. The mean age of patients was 36.2 years (19 – 57 years) while body mass index was 21.9 kg/m2. Only 37.8% of patients were sputum smear-positive at baseline. 56.8% of patients had HIV co-infection. 45.9% of patients were on antiretroviral therapy.45.2% of patients had grade 1-3 aspartate transaminase derangements at follow-up compared to 29.7% at baseline. 5.4% of the patients had grade 1-3 alanine transaminase derangements at baseline while 9.7% of patients had grade 1 at follow-up. Fewer patients (16.1%) had grade 1-2 anaemia at follow-up while 62.2% of patients at baseline had grade 1-4 anaemia. More patients (46.2%) had platelet derangements at follow-up compared to 25.8% at baseline. Fewer patients had differential white cell count derangements at follow-up compared to baseline. Statistically significant differences in haematological parameters: haemoglobin concentration, haematocrit, red, and white cell, eosinophil and neutrophil counts at baseline and follow-up were found. However, no statistically significant differences in red cell indices were observed. Changes in alanine transaminase levels at baseline and follow-up were statistically significant. Logistic regression was performed to determine the effects of age, gender, body mass index, HIV infection, antiretroviral therapy, sputum smear status, and appropriate baseline full blood count/liver function test parameters on the likelihood of study patients having deranged haemoglobin concentration, white cell count and alanine transaminase at follow-up. Logistic regression models to predict deranged haemoglobin concentration and white cell count were statistically insignificant. None of the predictor variables were associated with the likelihood of derangements in alanine transaminase. Conclusion: Findings of this study show that haematological and hepatic adverse effects were relatively fewer at follow-up and were mostly grades 1-3 in severity. Antituberculous therapy is relatively safe for patients during the initial phase.

Long-Term Follow-Up of 21 Patients with Thrombotic Thrombocytopenic Purpura (TTP) and Severe ADAMTS13 Deficiency: Demonstration of Persistent ADAMTS13 Deficiency and Neurocognitive Abnormalities.

Blood ◽  
2004 ◽  
Vol 104 (11) ◽  
pp. 856-856 ◽  
Author(s):  
Deirdra R. Terrell ◽  
Jedidiah J. Perdue ◽  
Johanna Kremer-Hovinga ◽  
Bernhard Lammle ◽  
James N. George ◽  
...  
Keyword(s):  
Platelet Count ◽  
Clinical Importance ◽  
Adamts13 Activity ◽  
Recent Memory ◽  
New Learning ◽  
Long Term Follow Up ◽  
Adamts13 Deficiency ◽  
Initial Episode

Abstract Many patients who have recovered from TTP report cognitive abnormalities, often described as difficulty with attention, comprehension, and memory. These abnormalities have never been objectively documented. Also there have been reports of patients with continued abnormal ADAMTS13 activity following complete hematologic recovery; the frequency, duration, and clinical importance of persistent ADAMTS13 deficiency has not been described in a cohort of consecutive patients with long-term follow-up. To evaluate these unresolved issues, we measured neurocognitive function, ADAMTS13 activity, platelet count, and hematocrit (hct) in patients from the Oklahoma TTP-HUS Registry. The Registry has measured ADAMTS13 activity on 172/193 (89%) consecutive patients treated with plasma exchange for their initial episode of clinically diagnosed TTP-HUS from 11/13/1995 to 4/30/2003. 4/30/2003 was selected to assess patients with at least 1 year of follow-up after their initial episode. 29/172 (17%) patients with apparently acquired TTP had ADAMTS13 activity <10% at the onset of their initial episode; 22 patients survived. Although severe ADAMTS13 deficiency characteristic of TTP is usually defined as <5%, our 6 surviving patients with initial ADAMTS13 activity of 5–9% all had ADAMTS13 inhibitors; 2 have relapsed and had ADAMTS13 activity of <5% at the time of their 2nd episode. 21/22 patients, who have had follow-up of 0.25–8.25 years from their most recent episode, were evaluated. 9/21 (43%) patients have had between 1–4 relapses. None of the patients had symptoms or signs of TTP at the time of this assessment. The Rey Auditory-Verbal Learning Test (RAVLT) assesses new learning and recent memory. For new learning 11 (52%) patients and for recent memory 7 (33%) patients were below the 16th percentile for age/gender specific norms (p<0.01 and p=0.03 respectively). The Digit Span (DS) score, which assesses attention and concentration, was below the 25th percentile in 8 (38%) patients (p=0.17). 11/20 (55%) had moderate-severe depression symptoms documented by the Beck Depression Inventory-Second Edition (BDI–II) (8 patients) or by prescribed medication for depression (3 patients). ADAMTS13 activity was abnormal (<50%) in 11/21 patients (52%); 2 patients, who were 4.0 and 8.25 years from their most recent episode, had activity <3% with inhibitors; in the other 9 abnormal patients ADAMTS13 activity was 14–50% (median 35%). 19 patients were not thrombocytopenic (platelet counts 174–659, median 286). 1 patient (ADAMTS13 > 100%) with a platelet count of 105 had developed systemic lupus erythematosus after his initial TTP episode; 1 patient (ADAMTS13=50%) with a platelet count of 134 has had intermittent, mild thrombocytopenia since her initial episode 7 years ago. Five patients had mild anemia (hct 32–40%). Relapses, cognitive function, symptoms of depression, platelet count, and hct were not significantly different between patients with normal or abnormal ADAMTS13 activity. The neurocognitive abnormalities documented here may be related to the initial diffuse thrombotic disease. Depression may contribute to these abnormalities. Persistent abnormal ADAMTS13 activity many years after apparent recovery is common but of uncertain clinical importance since ADAMTS13 levels were not associated with clinical outcomes.

Long Term Follow-Up of Patients with Immune Thrombocytopenic Purpura (ITP) Whose Initial Response to Rituximab Lasted a Minimum of 1 Year.

Blood ◽  
2006 ◽  
Vol 108 (11) ◽  
pp. 479-479 ◽  
Author(s):  
Vivek Patel ◽  
Nino Mihatov ◽  
Nichola Cooper ◽  
Roberto Stasi ◽  
Susanna Cunningham-Rundles ◽  
...  
Keyword(s):  
Platelet Count ◽  
B Cell ◽  
Treatment Algorithm ◽  
Specific Treatment ◽  
Initial Response ◽  
Chronic Itp ◽  
Duration Of Response ◽  
Long Term Follow Up

Abstract Objective: Rituximab was licensed (1997) to treat B-cell lymphomas. As a consequence of its B-cell depleting effect, Rituxmab has been widely used in autoimmune conditions including ITP. This study assessed the long term efficacy of Rituximab in patients with chronic ITP. Methods: All patients with responses lasting more than 1 year (yr) to Rituximab treatment were included in this IRB approved study to determine the duration of response to Rituximab. Forty six patients fulfilled these criteria; thus far complete data are available for 31. The median follow up (f/u) was 2 3/4 yrs. At onset of Rituximab treatment, the 31 patients had platelet counts &lt;30 x 10 9/l, had received two or more previous ITP treatments, and 14 (44%) had undergone splenectomy. The median age and duration of ITP were 32 yrs (range 12–65) and 1 3/4 yrs respectively. The patients received Rituximab at 375 mg/m2 weekly for 4 weeks. The 15 patients for which data are not available had similar characteristics. Results: The figure outlines what happens more than one yr from Rituximab treatment for those patients whose response lasted &gt; 1 yr. Fourteen of the 31 patients have relapsed within the f/u period giving a 5 yr response rate of 55%. Eleven of the 14 relapsers did so within 2 1/2 yrs of their first infusion whereas 14 of the 17 patients with ongoing responses had f/u &gt; 2 1/2 yrs. The data suggest that patients whose response is &gt; 2 1/2 yrs have a low likelihood of relapse before 5 years. While duration of ITP prior to Rituximab treatment was significantly shorter (p&lt; 0.001) for patients responding over 3 years (median=39 weeks) than it was for those responding between 1 and 3 years (median=176 weeks), no specific duration of ITP prior to which Rituximab should be instituted was evident. None of age, sex, time to a platelet count &gt; 30 x 109/l, and splenectomy status predicted duration of response to Rituximab. Out of the original 31 responders, there were 25 complete responses (CR: platelet count &gt;150 x 109/l) and 6 partial responses (PR: platelet count 30–150 x 109/l). Fifteen (60%) of the CRs and 2 of the PRs (33%) remain in lasting remission (p=NS). Characteristics such as median age, duration of ITP, gender, splenectomy status, and median duration of response were similar for both PRs and CRs. Data on toxicity are less well-developed; no serious infections, malignancies, or other major toxicities were seen in this group of patients. In conclusion, several studies including our own (Cooper Brit J Haem 2004) demonstrated that approximately 1/3 of Rituximab treated patients would have a duration of response lasting &gt; 1 yr. Among this 1/3, now with considerable additional f/u, lasting responses to Rituximab were seen in more than half. Taken together, these findings imply that responses &gt; 2 1/2 yrs in duration would occur in approximately 1/6 of the starting population of Rituximab-treated patients with chronic ITP with little further relapse in the subsequent 2 1/2 yrs. While informing the long term response to Rituximab, this study cannot yet provide a specific treatment algorithm. Duration of Response to Rituximab in 31 Patients with Chronic ITP with a Response Greater than 1 Year Duration of Response to Rituximab in 31 Patients with Chronic ITP with a Response Greater than 1 Year

Bone health among prostate cancer survivors: Long-term follow-up from the Prostate Cancer Outcomes Study (PCOS).

2013 ◽  
Vol 31 (6_suppl) ◽  
pp. 106-106
Author(s):  
Alicia Katherine Morgans ◽  
Kang-Hsien Fan ◽  
Tatsuki Koyama ◽  
Peter C. Albertsen ◽  
Michael Goodman ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
Logistic Regression ◽  
Bone Health ◽  
Medication Use ◽  
Prostate Cancer Survivors ◽  
Patient Reported ◽  
Long Term Follow Up ◽  
The Relationship

106 Background: Bone complications of androgen deprivation therapy (ADT) have been described using administrative databases and smaller prospective studies with relatively short follow-up. Prospectively acquired data with long term follow-up are lacking. We assessed the relationship of patient-reported bone health and ADT exposure in a population-based prospective cohort of prostate cancer survivors followed longitudinally for 15 years from diagnosis. Methods: Using PCOS 15 year patient-reported survey data, we identified men with non-metastatic prostate cancer diagnosed from 1994-1995 and followed through 2009-2010. We evaluated subgroups receiving >1 yr, ≤1 yr, and no ADT. We then queried participants regarding the development of osteoporosis, fracture, and use of osteoporosis medications. We assessed the relationship between duration of ADT and bone health outcomes using univariable logistic regression models, and evaluated the association between ADT and osteoporosis medications using multivariable logistic regression adjusted for PSA and geographic location. Results: Among 961 men who completed 15 year surveys, 157 received >1 yr ADT, 120 received ≤1 yr ADT, and 684 did not receive ADT. During the study period, 12 men developed bone metastases and were excluded from the fracture analysis (7 received >1 yr ADT, 2 received ≤1 yr ADT, and 3 did not receive ADT). Men receiving >1 yr ADT were more likely to report osteoporosis (OR 4.29, 95% CI 2.38-7.71) or fracture (OR 1.73, 95% CI 1.04-2.89) than men not receiving ADT. When compared with men not receiving ADT, men receiving >1 yr ADT were more likely to report bone mineral density testing (OR 4.59, 95% CI 3.09-6.83), and bone medication use (OR 3.22, 95% CI 2.19-4.72). Half (50.3%) of men treated for >1 yr ADT reported bone medication use. Among men who reported use of bone medications, 94% reported calcium or vitamin D use and 6% reported bisphosphonate use. Conclusions: Men treated with prolonged ADT (>1 yr) reported higher rates of osteoporosis and fracture at 15 year follow up. Accordingly, they reported more frequent screening and treatment for osteoporosis, with 50% of men receiving prolonged ADT reporting use of bone medications.

Therapy and prevention for mental health: What if mental diseases are mostly not brain disorders?

2019 ◽  
Vol 42 ◽  
Author(s):  
John P. A. Ioannidis
Keyword(s):  
Mental Health ◽  
Mental Disease ◽  
Brain Disorders ◽  
Social Stressors ◽  
Labor Education ◽  
Mental Diseases ◽  
Long Term Follow Up ◽  
Political Decisions

AbstractNeurobiology-based interventions for mental diseases and searches for useful biomarkers of treatment response have largely failed. Clinical trials should assess interventions related to environmental and social stressors, with long-term follow-up; social rather than biological endpoints; personalized outcomes; and suitable cluster, adaptive, and n-of-1 designs. Labor, education, financial, and other social/political decisions should be evaluated for their impacts on mental disease.

Sign in / Sign up

Export Citation Format

Share Document