Prospective assessment of the diagnostic and prognostic utility of rotational thromboelastometry for canine disseminated intravascular coagulation

2018 ◽  
Vol 183 (22) ◽  
pp. 692-692 ◽  
Author(s):  
Anthony Barthélemy ◽  
Céline Pouzot-Nevoret ◽  
Benoît Rannou ◽  
Isabelle Goy-Thollot
Keyword(s):  
Disseminated Intravascular Coagulation ◽  
Multivariate Analyses ◽  
Medical Condition ◽  
Mortality Rates ◽  
Intravascular Coagulation ◽  
Risk Of Death ◽  
Diagnosis And Prognosis ◽  
Increased Risk ◽  
Prognostic Utility ◽  
Prospective Assessment

This study compared the haematological, haemostatic and thromboelastometric (TEM) parameters between dogs with and without suspected disseminated intravascular coagulation (DIC). Seventy-six dogs with a medical condition known to predispose to DIC were prospectively included in the study. Thirty-eight dogs (50 per cent) presented with haemorrhagic diatheses. DIC was diagnosed in 32 dogs (42 per cent). Thirty-five dogs (46 per cent) had a normal TEM profile, 25 dogs (33 per cent) had a hypercoagulable profile and 16 dogs (21 per cent) had a hypocoagulable profile. Except for the lysis parameters, all TEM parameters were significantly correlated with the presence of DIC in univariate and multivariate analyses. Mortality rates were significantly higher in dogs with DIC (50 per cent) than in dogs without DIC (27 per cent, P=0.043; OR 2.667, 95 per cent CI 1.049 to 6.701), and mortality rates were significantly higher in dogs with a hypocoagulable profile (69 per cent) than in dogs with a hypercoagulable (24 per cent, P=0.017; OR 4.800, 95 per cent CI 1.241 to 16.220) or a normal profile (31 per cent, P=0.046; OR 3.429; 95 per cent CI 1.006 to 11.470). All TEM parameters were significantly associated with mortality in univariate and multivariate analyses. Thromboelastometry appears to be a valuable tool for the diagnosis and prognosis of dogs with suspected DIC, especially those with a hypocoagulable profile that was associated with increased risk of death and increased risk of haemorrhagic diatheses.

Bilirubin adsorption for the treatment of severe hyperbilirubinemia after cardiac surgery: A retrospective cohort study

2021 ◽  
pp. 039139882199784
Author(s):  
Xiaolan Chen ◽  
Lu Li ◽  
Ming Bai ◽  
Shiren Sun ◽  
Xiangmei Chen
Keyword(s):  
Cardiac Surgery ◽  
Total Bilirubin ◽  
Serum Bilirubin ◽  
Multivariate Analyses ◽  
Reduction Rate ◽  
Mortality Rates ◽  
Increased Risk ◽  
Bilirubin Adsorption ◽  
Severe Hyperbilirubinemia ◽  
Post Cardiac Surgery

Objective: Severe hyperbilirubinemia after cardiac surgery increases in-hospital and 1-year mortality. Our present study aimed to analyze the safety and efficacy of bilirubin adsorption (BA) in patients with post-cardiac-surgery severe hyperbilirubinemia. Methods: We retrospectively included patients who underwent BA due to severe hyperbilirubinemia after cardiac surgery in our center between January 2015 and December 2018. The change of serum bilirubin, alanine aminotransferase, aspartate aminotransferase, and 30-day and 1-year mortality were assessed as endpoints. Univariate and multivariate analyses were employed to identify the risk factors of patient 30-day mortality. Result: A total of 25 patients with 44 BA treatments were included. One BA treatment reduced total bilirubin (TB) concentration from 431.65 ± 136.34 to 324.83 ± 129.44 µmol/L ( p < 0.001), with a reduction rate of 24.8%. No clinically relevant thrombosis of the extracorporeal circuit occurred during the BA treatment. The 30-day and 1-year mortality rates were 68% ( n = 18) and 84% ( n = 21), respectively. Multivariate analysis identified that TB level before BA treatment (odds ratio [OR] 1.010, 95% confidence interval [CI] 1.000–1.019; p = 0.043) was an independent risk factor of 30-day mortality. Conclusions: BA treatment should be considered as an effective and safe method for the reduction of serum bilirubin in patients with post-cardiac-surgery severe hyperbilirubinemia. Patients with higher TB level before BA treatment had a relatively increased risk of 30-day mortality. Further studies are needed to evaluate the timing of BA for severe hyperbilirubinemia after cardiac surgery.

Mortality following new-onset Rheumatoid Arthritis: has modern Rheumatology had an impact?

2017 ◽  
Vol 77 (1) ◽  
pp. 85-91 ◽  
Author(s):  
Marie Holmqvist ◽  
Lotta Ljung ◽  
Johan Askling
Keyword(s):  
Rheumatoid Arthritis ◽  
General Population ◽  
Excess Mortality ◽  
Disease Onset ◽  
Mortality Rates ◽  
Calendar Time ◽  
Risk Of Death ◽  
Quality Register ◽  
Increased Risk ◽  
New Onset

ObjectiveTo investigate if, and when, patients diagnosed with rheumatoid arthritis (RA) in recent years are at increased risk of death.MethodsUsing an extensive register linkage, we designed a population-based nationwide cohort study in Sweden. Patients with new-onset RA from the Swedish Rheumatology Quality Register, and individually matched comparators from the general population were followed with respect to death, as captured by the total population register.Results17 512 patients with new-onset RA between 1 January 1997 and 31 December 2014, and 78 847 matched general population comparator subjects were followed from RA diagnosis until death, emigration or 31 December 2015. There was a steady decrease in absolute mortality rates over calendar time, both in the RA cohort and in the general population. Although the relative risk of death in the RA cohort was not increased (HR=1.01, 95% CI 0.96 to 1.06), an excess mortality in the RA cohort was present 5 years after RA diagnosis (HR after 10 years since RA diagnosis=1.43 (95% CI 1.28 to 1.59)), across all calendar periods of RA diagnosis. Taking RA disease duration into account, there was no clear trend towards lower excess mortality for patients diagnosed more recently.ConclusionsDespite decreasing mortality rates, RA continues to be linked to an increased risk of death. Thus, despite advancements in RA management during recent years, increased efforts to prevent disease progression and comorbidity, from disease onset, are needed.

scholarly journals Predictors of Disseminated Intravascular Coagulation in Patients with Septic Shock

2013 ◽  
Vol 2013 ◽  
pp. 1-6 ◽  
Author(s):  
Diana J. Kelm ◽  
Juan Carlos Valerio-Rojas ◽  
Javier Cabello-Garza ◽  
Ognjen Gajic ◽  
Rodrigo Cartin-Ceba
Keyword(s):  
Septic Shock ◽  
Antiplatelet Therapy ◽  
Disseminated Intravascular Coagulation ◽  
Tertiary Care ◽  
Multivariate Logistic Regression Model ◽  
Care Hospital ◽  
Clinical Predictors ◽  
Intravascular Coagulation ◽  
Early Goal Directed Therapy ◽  
Increased Risk

Purpose. The goal of this study was to identify potential clinical predictors for the development of disseminated intravascular coagulation (DIC) in patients with septic shock. Material and Methods. We performed a retrospective analysis of a cohort of adult (>18 years of age) patients with septic shock admitted to a medical ICU in a tertiary care hospital from July 2005 until September 2007. A multivariate logistic regression model was used to determine the association of risk factors with overt DIC. Results. In this study, a total of 390 patients with septic shock were analyzed, of whom 66 (17%) developed overt DIC. Hospital mortality was significantly greater in patients who developed overt DIC (68% versus 38%, P<0.001). A delay in the timing of antibiotics was associated with an increased risk of the development of overt DIC (P<0.001). Patients on antiplatelet therapy prior to hospital admission and who that received adequate early goal-directed therapy (EGDT) were associated with a decreased risk of overt DIC (P<0.001). Conclusions. In our cohort of patients with septic shock, there was a risk reduction for overt DIC in patients on antiplatelet therapy and adequate EGDT, while there was an increased risk of DIC with antibiotic delay.

scholarly journals Outcomes of surgery in patients aged ≥90 years in the general surgical setting

2018 ◽  
Vol 100 (3) ◽  
pp. 172-177 ◽  
Author(s):  
A Sudlow ◽  
H Tuffaha ◽  
AT Stearns ◽  
IA Shaikh
Keyword(s):  
Surgical Procedures ◽  
Emergency Surgery ◽  
Tertiary Care ◽  
Gastrointestinal Surgery ◽  
Care Facility ◽  
Mortality Rates ◽  
Emergency Procedures ◽  
Risk Of Death ◽  
Increased Risk ◽  
The Impact

Introduction An increasing proportion of the population is living into their nineties and beyond. These high risk patients are now presenting more frequently to both elective and emergency surgical services. There is limited research looking at outcomes of general surgical procedures in nonagenarians and centenarians to guide surgeons assessing these cases. Methods A retrospective analysis was conducted of all patients aged ≥90 years undergoing elective and emergency general surgical procedures at a tertiary care facility between 2009 and 2015. Vascular, breast and endocrine procedures were excluded. Patient demographics and characteristics were collated. Primary outcomes were 30-day and 90-day mortality rates. The impact of ASA (American Society of Anesthesiologists) grade, operation severity and emergency presentation was assessed using multivariate analysis. Results Overall, 161 patients (58 elective, 103 emergency) were identified for inclusion in the study. The mean patient age was 92.8 years (range: 90–106 years). The 90-day mortality rates were 5.2% and 19.4% for elective and emergency procedures respectively (p=0.013). The median survival was 29 and 19 months respectively (p=0.001). Emergency and major gastrointestinal operations were associated with a significant increase in mortality. Patients undergoing emergency major colonic or upper gastrointestinal surgery had a 90-day mortality rate of 53.8%. Conclusions The risk for patients aged over 90 years having an elective procedure differs significantly in the short term from those having emergency surgery. In selected cases, elective surgery carries an acceptable mortality risk. Emergency surgery is associated with a significantly increased risk of death, particularly after major gastrointestinal resections.

scholarly journals Risk of death among people with rare autoimmune diseases compared to the general population in England during the 2020 COVID-19 pandemic

Rheumatology ◽  
2020 ◽  
Author(s):  
Emily Peach ◽  
Megan Rutter ◽  
Peter Lanyon ◽  
Matthew J Grainge ◽  
Richard Hubbard ◽  
...  
Keyword(s):  
General Population ◽  
Healthcare Services ◽  
Mortality Rates ◽  
Published Data ◽  
Risk Of Death ◽  
Increased Risk ◽  
Specific Mortality ◽  
Population Mortality ◽  
The Uk ◽  
Recorded Diagnosis

Abstract Objectives To quantify the risk of death among people with rare autoimmune rheumatic diseases (RAIRD) during the UK 2020 COVID-19 pandemic compared with the general population, and compared with their pre-COVID risk. Methods We conducted a cohort study in Hospital Episode Statistics for England 2003 onwards, and linked data from the NHS Personal Demographics Service. We used ONS published data for general population mortality rates. Results We included 168 691 people with a recorded diagnosis of RAIRD alive on 01/03/2020. Their median age was 61.7 (IQR 41.5–75.4) years, and 118 379 (70.2%) were female. Our case ascertainment methods had a positive predictive value of 85%. 1,815 (1.1%) participants died during March and April 2020. The age-standardised mortality rate (ASMR) among people with RAIRD (3669.3, 95% CI 3500.4–3838.1 per 100 000 person-years) was 1.44 (95% CI 1.42–1.45) times higher than the average ASMR during the same months of the previous 5 years, whereas in the general population of England it was 1.38 times higher. Age-specific mortality rates in people with RAIRD compared with the pre-COVID rates were higher from the age of 35 upwards, whereas in the general population the increased risk began from age 55 upwards. Women had a greater increase in mortality rates during COVID-19 compared with men. Conclusion The risk of all-cause death is more prominently raised during COVID-19 among people with RAIRD than among the general population. We urgently need to quantify how much risk is due to COVID-19 infection and how much is due to disruption to healthcare services.

scholarly journals Severity of Vitamin D Deficiency Predicts Mortality in Ischemic Stroke Patients

2019 ◽  
Vol 2019 ◽  
pp. 1-10 ◽  
Author(s):  
Jarosław Wajda ◽  
Maciej Świat ◽  
Aleksander J. Owczarek ◽  
Aniceta Brzozowska ◽  
Magdalena Olszanecka-Glinianowicz ◽  
...  
Keyword(s):  
Vitamin D ◽  
Ischemic Stroke ◽  
Secondary Hyperparathyroidism ◽  
Functional Status ◽  
Fibroblast Growth Factor 23 ◽  
Mortality Rates ◽  
Mortality Data ◽  
Risk Of Death ◽  
Increased Risk ◽  
Cox Proportional Hazard Regression

Background. Vitamin D (VD) deficiency is considered an independent risk factor for death due to cardiovascular events including ischemic stroke (IS). We assessed the hypothesis that decreased levels of 25-hydroxyvitamin D (25-OH-D) are associated with increased risk of mortality in patients with IS. Methods. Serum 25-OH-D, intact parathyroid hormone (iPTH), and intact fibroblast growth factor 23 (iFGF23) levels were assessed in serum of 240 consecutive patients admitted within the 24 hours after the onset of IS. Mortality data was obtained from the local registry office. Results. Only three subjects (1.3%) had an optimal 25-OH-D level (30-80 ng/mL), 25 (10.4%) had a mildly reduced (insufficient) level, 61 (25.4%) had moderate deficiency, and 151 (62.9%) had a severe VD deficiency. 20% subjects had secondary hyperparathyroidism. The serum 25-OH-D level was significantly lower than that in 480 matched subjects (9.9±7.1 vs. 21.0±8.7 ng/mL). Of all the patients, 79 (32.9%) died during follow-up observation (44.9 months). The mortality rates (per year) were 4.81 and 1.89 in a group with and without severe VD deficiency, respectively (incidence rate ratio: 2.52; 95% CI: 1.44–4.68). There was no effect of secondary hyperparathyroidism and iFGF23 levels on mortality rates. Age, 25−OH−D<10 ng/mL, and functional status (modified Rankin scale) were significant factors increasing the risk of death in multivariable Cox proportional hazard regression test. Conclusions. Severe VD deficiency is an emerging, strong negative predictor for survival after IS, independent of age and functional status. VD supplementation in IS survivals may be considered due to high prevalence of its deficiency. However, it is uncertain whether it will improve their survival.

scholarly journals Advance in the Management of Sepsis-Induced Coagulopathy and Disseminated Intravascular Coagulation

2019 ◽  
Vol 8 (5) ◽  
pp. 728 ◽  
Author(s):  
Toshiaki Iba ◽  
Jerrold Levy ◽  
Aditya Raj ◽  
Theodore Warkentin
Keyword(s):  
Disseminated Intravascular Coagulation ◽  
Statistical Significance ◽  
Phase Iii ◽  
Endothelial Glycocalyx ◽  
Absolute Difference ◽  
Sepsis Management ◽  
Intravascular Coagulation ◽  
Intravascular Thrombosis ◽  
Increased Risk ◽  
Recombinant Thrombomodulin

Coagulopathy commonly occurs in sepsis as a critical host response to infection that can progress to disseminated intravascular coagulation (DIC) with an increased mortality. Recent studies have further defined factors responsible for the thromboinflammatory response and intravascular thrombosis, including neutrophil extracellular traps, extracellular vesicles, damage-associated molecular patterns, and endothelial glycocalyx shedding. Diagnosing DIC facilitates sepsis management, and is associated with improved outcomes. Although the International Society on Thrombosis and Haemostasis (ISTH) has proposed criteria for diagnosing overt DIC, these criteria are not suitable for early detection. Accordingly, the ISTH DIC Scientific Standardization Committee has proposed a new category termed “sepsis-induced coagulopathy (SIC)” to facilitate earlier diagnosis of DIC and potentially more rapid interventions in these critically ill patients. Therapy of SIC includes both treatment of the underlying infection and correcting the coagulopathy, with most therapeutic approaches focusing on anticoagulant therapy. Recently, a phase III trial of recombinant thrombomodulin was performed in coagulopathic patients. Although the 28-day mortality was improved by 2.6% (absolute difference), it did not reach statistical significance. However, in patients who met entry criteria for SIC at baseline, the mortality difference was approximately 5% without increased risk of bleeding. In this review, we discuss current advances in managing SIC and DIC.

Coagulation Abnormalities in Covid-19 Positive Patients at Covid Hospital of Hassan Institute of Medical Sciences, Hassan

2021 ◽  
Vol 8 (02) ◽  
pp. 85-90
Author(s):  
Shivakumarswamy Udasimath ◽  
Nagesha K.R ◽  
Kumar Naik H.K. ◽  
Puruhotham R
Keyword(s):  
Platelet Count ◽  
Venous Thromboembolism ◽  
Prothrombin Time ◽  
Disseminated Intravascular Coagulation ◽  
Medical Sciences ◽  
Laboratory Findings ◽  
Blood Samples ◽  
Intravascular Coagulation ◽  
Increased Risk ◽  
D Dimer

BACKGROUND Throughout the world, millions of people are affected by corona virus disease 2019 (Covid-19). 16 % of infected Covid-19 people may need hospitalisation. Patients with severe respiratory or systemic manifestations are at increased risk of venous thromboembolism. Thrombocytopenia, elevated D-Dimer, prolonged prothrombin time, and features of disseminated intravascular coagulation laboratory findings are included in initial reports on Covid-19 patients’ blood samples. METHODS This cross-sectional study was conducted at pathology laboratory, Hassan Institute of Medical Sciences, Hassan, between June 01, 2020 to August 29, 2020. 4096 patients’ blood samples with Covid-19 positivity in Covid Hospital of Hassan Institute of Medical Sciences, Hassan, were analysed in detail and statistical reports were derived from the fresh samples for platelet count, prothrombin time and D-Dimer. The results were compared with severity of infection. RESULTS Analysis of 4096 Covid-19 blood sample results, revealed significant abnormal mean values in critical cases for platelet count in which it was severely decreased (35,000 cells / cumm), prothrombin time was prolonged for more than 180 seconds and D-Dimer values were 3.74 microgram per ml. CONCLUSIONS As the pandemic is spreading, we highlight the importance of laboratory and clinical findings of coagulation disorders in Covid-19 infected patients. To prevent death of Covid-19 infected patients, noticing the laboratory findings related to coagulation will help in early detection of critical patients. This is very important for relevant treatment and may prevent mortality in Covid-19 infected patients. KEYWORDS Coagulation, Coronavirus, Venous Thromboembolism (VTE), Prothrombin Time, Disseminated intravascular coagulation (DIC)

Conditional Survival and Cause-Specific Mortality in Patients Undergoing Allogeneic Hematopoietic Cell Transplantation (alloHCT) for Hematologic Malignancy Over Three Decades

Blood ◽  
2012 ◽  
Vol 120 (21) ◽  
pp. 606-606
Author(s):  
Saro H. Armenian ◽  
Can-Lan Sun ◽  
Tabitha Vase ◽  
George Mills ◽  
Liezl Atencio ◽  
...  
Keyword(s):  
General Population ◽  
Hematologic Malignancy ◽  
Survival Rates ◽  
Mortality Rates ◽  
Conditional Survival ◽  
Risk Of Death ◽  
Increased Risk ◽  
Risk Of Relapse ◽  
Treatment Related Mortality ◽  
Related Mortality

Abstract Abstract 606 Background: alloHCT is offered with curative intent to patients with hematologic malignancies, and conventionally-computed survival estimates are offered for prognosticating outcomes. However, conventionally-computed survival estimates do not take into account elapsed time (and changing hazards with time survived); conditional survival overcomes these limitations, by calculating the probability of survival after having already survived a certain period of time – such data are unavailable for alloHCT recipients. We describe cause-specific (relapse-, GvHD-, treatment-related) conditional survival after alloHCT, providing clinically relevant information for patients who have survived 6 mos, 1, 2, and 5y after alloHCT. Methods: From 1976 to 2006, 2,427 consecutive patients received alloHCT for a hematologic malignancy at a single institution (median age: 34.7y [0.6–72.5]). Vital status and cause of death were determined using National Death Index, Social Security Death Index and medical records. Results: As of 12/31/2007, a total of 1413 deaths (58% of the cohort) were observed; 39% attributed to recurrent disease; 34% to GvHD; 12% to infection; 5% to cardiopulmonary disease; 2% to subsequent malignant neoplasm (SMNs); and 8% to other causes. Conventionally-computed probability of survival was 44.6% at 5y and 41.2% at 10y from alloHCT. On the other hand, conditional on survival for 6 mo, 1, 2, and 5y after alloHCT, 5-y survival rates were 62%, 75%, 83%, and 93%, respectively (Figure A). The cohort was at a 40-fold increased risk of any death compared with the general population (95%CI=38.2–42.4); at a 25.6-fold increased risk of death due to pulmonary complications, 3.3-fold risk due to SMNs, and 2.3-fold risk due to cardiovascular complications. Among patients followed for 15+y after HCT, the risk of all-cause mortality was 2.6-fold that of the general population (95%CI=1.8–3.7). Standardized mortality ratios (SMR) and cause-specific conditional mortality rates by primary diagnosis are summarized in the Table. Individuals who survived the first 5y had negligible (≤5%) risk of relapse- and GvHD-related mortality over the subsequent 5y. Treatment-related mortality increased over time; among those who survived 5y, treatment-related mortality rates exceeded relapse-related mortality (Figure B). After adjustment for demographics, underlying diagnosis and treatment era, individuals with chronic GVHD (cGVHD) had a significantly lower risk of relapse-related mortality (RR=0.43, 95%CI=0.4–0.5) compared to those without cGVHD. Conclusions: The projected 5-y survival rates improve conditional on time survived from alloHCT; 5-y survival exceeds 93% for those who have already survived 5y. However, alloHCT recipients who have survived 15+y continue to remain at increased risk of death compared to the general population. cGVHD is associated with decreased risk of relapse-related mortality. Both relapse-related and GvHD-related mortality rates decline with time, such that, among those who have survived 5y, treatment-related mortality exceeds relapse-related mortality. Conditional survival estimates provide clinically relevant prognostic information, helping inform preventive and interventional strategies. Disclosures: No relevant conflicts of interest to declare.

scholarly journals Risk of recurrent venous thromboembolism in COPD patients: results from a prospective cohort study

2017 ◽  
Vol 50 (1) ◽  
pp. 1700094 ◽  
Author(s):  
Raphael Le Mao ◽  
Cécile Tromeur ◽  
Amélie Bazire ◽  
Maelenn Gouillou ◽  
Marie Guegan ◽  
...  
Keyword(s):  
Venous Thromboembolism ◽  
Prospective Cohort ◽  
Multivariate Analyses ◽  
Anticoagulation Therapy ◽  
Secondary Outcome ◽  
Risk Of Death ◽  
Copd Patients ◽  
Increased Risk ◽  
Recurrent Venous Thromboembolism ◽  
Recurrent Vte

We aimed to assess the risk of recurrent venous thromboembolism (VTE) in patients with chronic obstructive pulmonary disease (COPD) following cessation of anticoagulation therapy.In a prospective cohort of 1468 patients with a documented episode of VTE, followed for up to 5 years after cessation of anticoagulation therapy, the diagnosis of COPD was confirmed in 136. The main outcome was recurrent VTE. The secondary outcome was overall mortality. Univariate and multivariate analyses were performed to identify the risk factors of recurrence.Of the 1468 patients included, recurrent VTE was observed in 306 (34 with COPD and 272 without) during a median follow-up period of 36.5 months. The incidence rate of recurrent VTE was 9.1% (95% CI 6.5–12.8) for COPD patients and 7.0% (95% CI 6.2–7.9) for non-COPD patients. COPD was not associated with an increased risk of VTE recurrence on univariate or multivariate analyses (hazard ratio: 1.0 (95% CI 0.7–1.4)). The risk of death, adjusted for demographic and clinical characteristics, showed no increase in COPD patients, as compared to non-COPD patients.In patients with COPD who had an acute episode of VTE, the risk of recurrent VTE was not any higher than that in non-COPD patients.

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