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

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.

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Thrombopoietin Receptor Agonist Use, Efficacy and Toxicity in Children with Immune Thrombocytopenia: Data from an Italian Multicenter Survey

Blood ◽

10.1182/blood-2018-99-110652 ◽

2018 ◽

Vol 132 (Supplement 1) ◽

pp. 4997-4997

Author(s):

Paola Giordano ◽

Giuseppe Lassandro ◽

Marco Spinelli ◽

Momcilo Jancovic ◽

Paola Saracco ◽

...

Keyword(s):

Platelet Count ◽

Immune Thrombocytopenia ◽

Conflicts Of Interest ◽

Immunosuppressive Agents ◽

Real Life ◽

Complete Response ◽

Clinical Use ◽

First Line ◽

Thrombopoietin Receptor ◽

Multicenter Survey

Abstract Background: Immune Thrombocytopenia (ITP) is one of the most common conditions encoutered by the pediatric hematologist. Current first-line therapy includes: observation without drug therapy, corticosteroids and intravenous immune globulin. A minority of patients are refractory to first-line approaches. Second-line treatment options are: immunosuppressive agents and thrombopoietin receptor agonists (TPO-RA). Eltrombopag and Romiplostin are TPO-RA licensed for clinical use. Eltrombopag is, actually, the only TPO-RA approved in Italy (since two years ago) for children, over one year old, with a chronic and/or refractory ITP. Real life data of Eltrombopag are limited. Methods: We performed an Italian multicenter retrospective survey to study the clinical on-label use of TPO-RA, focus on Eltrombopag, in pediatric ITP. Our aims were, primarily, to bring out the prevalence of the use in clinical practice and secondarily to collect data on efficacy and toxicity. Results: We enrolled 69 pediatric ITP subjects from 15 Italian treatment centers (TC). 4 patients received Romiplostin as TPO-RA and were excluded by the analysis. 36/65 patients weer female (55%). Median age at ITP diagnosis: 6 years + 6 months (min 1 y + 2 m; max 16 y + 7 m). Median age at first Eltrombopag assumption: 11 years + 5 months (min 2 y + 0 m; max 17 y + 8 m). Accounting in 344 the total number of chronic ITP subjects treated by TC in the same observation period (July 2016-June 2018), we observed an Eltrombopag clinical use prevalence of 0.19 (95% CI 0.15 to 0.26). We underlined a "no response" to Eltrombopag (platelet count persistently less than 30000 per microliter) in 16/65 (25%); a "partial response" (platelet count between 30000 and 100000 per microliter) in 14/65 (21%) and a "complete response" (platelet count persistently up than 100000 per microliter) in 35/65 (54%). The overall response (partial or complete) was described in 49/65 (75%) children. During the follow up was seen in 16/49 (33%) subjects with initial response a platelet rise that waned to no response. There was no evidence of significant adverse events (clinicians are obliged, to monthly surveillance, by Italian drug agency for hypertransaminasemia and peripheral smear cell abnormalities). Conclusions: Our results demonstrate that Eltrombopag is a therapeutic option quite considered by Italian clinicians. Moreover, according with the percentages of clinical trials, Eltrombopag is safe and effective to rise platelet count. Further studies need to emphasize how factors favor a complete response and to know the incidence of long-term adverse effects. A prospective study designed and driven by Italian Association of Pediatric Hematology Oncology (AIEOP) Coagulation Disorders Working Group is, already, in progress. Disclosures No relevant conflicts of interest to declare.

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Incidence and risk factors associated with postoperative stroke in the elderly patients undergoing hip fracture surgery

Journal of Orthopaedic Surgery and Research ◽

10.1186/s13018-020-01962-6 ◽

2020 ◽

Vol 15 (1) ◽

Author(s):

Lili Yu ◽

Yanbin Zhu ◽

Wei Chen ◽

Hui Bu ◽

Yingze Zhang

Keyword(s):

Risk Factors ◽

Hip Fracture ◽

Elderly Patients ◽

Hip Fractures ◽

Univariate Analysis ◽

Multivariate Logistic Regression Analysis ◽

The Elderly ◽

Individual Risk ◽

Factors Associated ◽

Postoperative Stroke

Abstract Objectives Stroke is one of the rare but devastating complications after hip fracture in the elderly. By far, there is still scarce data on postoperative stroke in elderly patients with hip fractures. Methods This was a retrospective study of prospectively collected data. Between October 2014 to December 2018, patients aged above 65 years who underwent operative treatment for hip fractures were included. Inpatient medical surveillance and scheduled telephone follow-up at 1, 3, 6, and 12 months after operation was conducted to identify who developed an incident stroke. Variables of interests were extracted from patients’ inpatient medical records. Univariate analysis and multivariate logistic regression analysis were used to identify the independent risk factors associated with stroke. Results During the study period, a total of 3743 patients were included, among whom 56 were found to have a stroke after operation, representing an incidence of 1.5% (95% CI, 1.1 to 1.9%). The multivariate analyses showed that advanced age (1-year increment; OR, 1.32; 95% CI, 1.08 to 1.48), history of previous stroke (OR, 4.79; 95% CI, 1.86 to 6.56), ASA III and above (OR, 2.62; 95% CI, 1.27 to 3.68), long-term use of aspirin (OR, 3.63; 95% CI, 1.41 to 4.78), and elevated RDW level (each increment of 1%, OR, 1.21; 95% CI, 1.02 to 1.36) were independently associated with postoperative stroke. Conclusions Although most are not modifiable, these risk factors help in counseling patients regarding the risk of postoperative stroke, individual risk stratification, and targeted optimization of medical conditions and should be firmly kept in treating surgeon’s mind.

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Incidence, Risk Factors and Outcomes of Pulmonary Embolism in Philadelphia Negative Myeloproliferative Neoplasms: A Population Based Study

Blood ◽

10.1182/blood-2021-149847 ◽

2021 ◽

Vol 138 (Supplement 1) ◽

pp. 3654-3654

Author(s):

Luis F. Gonzalez-Mosquera ◽

Bernard Moscoso ◽

Diana Cardenas-Maldonado ◽

Pool Tobar ◽

Alida I. Podrumar ◽

...

Keyword(s):

Risk Factors ◽

Pulmonary Embolism ◽

Conflicts Of Interest ◽

Myeloproliferative Neoplasms ◽

Private Insurance ◽

Univariate Analysis ◽

Primary Myelofibrosis ◽

Factors Associated ◽

Nationwide Inpatient Sample Database ◽

Modifiable Factors

Abstract Introduction: Thromboembolism is a well-recognized complication of patients with Philadelphia negative myeloproliferative neoplasms (MPN), potentially due to an endothelial injury caused by the activation of inflammatory cytokines. Among the MPNs, Polycythemia vera (PV) seemed to be the most associated with thrombotic events; however, essential thrombocytosis (ET) and primary myelofibrosis (PMF) are also at higher risk than the general population. Furthermore, arterial and venous thromboembolisms account for higher mortality in this population, causing approximately 45% of all disease-associated fatal events. Previous studies have explored the combined outcomes of venous thromboembolism (VTE) on MPN patients; however, none of them focused primarily on pulmonary embolism (PE). Therefore, we aimed to identify any potential demographic, socioeconomic, or clinical characteristics associated with PE in a large cohort of MPN patients admitted to US hospitals. Methods: We inquired the Nationwide Inpatient Sample database to identify patients diagnosed with MPN from 2016-2018. We used the ICD-10 codes to identify the different types of MPN and compare patients with and without PE. The main outcomes were risk factors associated with PE and in-hospital mortality. We computed the chi-squared test and the Mann-Whitney U-test to compare the outcomes of patients with and without PE. We first conducted a univariate analysis. Clinically relevant characteristics and variables with a significant association (p<0.05) with the development of PE in the univariate analysis were considered for the multivariate model. We identified the risk factors associated with PE using multivariate logistic regression. Our analyses were conducted using Stata Statistical Software version 14 (StataCorp, College Station, TX). Results: Among 82,087 identified patients with MPN, most of them were white (67.4%), female (54.6%), and had a median age of 63 (IQR 49-76). Of them, 1982 (2.4%) had a PE event during admission. There were no significant differences in age and sex between PE patients and non-PE patients. While there were higher proportions of White (68.3% vs. 67.4%) and Black patients (18.6% vs. 17%) in the PE group, there was a lower proportion of Hispanics (8.7% vs. 9.7%; p=0.007). Patients with PE also had a higher median Elixhauser comorbidity index (5 vs. 4, p<0.001). There were fewer Medicare beneficiaries (48.5% vs. 52.4%) and a higher proportion of private insurance usage (26.8% vs. 22.3%; p<0.001) in the PE patients compared to those without PE. In the multivariate analysis, age, sex, race, or income quartile were not significantly associated with PE development. Compared to PV, patients with PMF had a protective effect for developing PE (OR: 0.35; CI 95%: 0.22-0.54). The comorbidities associated with higher odds for having a PE were coagulopathies (OR: 1.99; CI 95%: 1.71-2.30) and obesity (OR: 1.47; CI 95%: 1.29-1.67). See Table 1 for all the variables. Patients with PE had a higher length of stay (6 days vs. 5 days; p<0.001) and higher mortality than the non-PE group (6.1% vs. 2.8%; p<0.001). Conclusions: In this large epidemiological study, we found that patients with MPN and PE had higher mortality than those without PE. Risk factors associated with the development of PE were concomitant obesity and coagulopathy. In addition to the known preventive therapies such as aspirin, phlebotomy, and cytoreductive agents, this study highlights the importance of controlling modifiable factors such as obesity in MPN patients. Future studies should confirm our findings and investigate strategies to prevention PE in this vulnerable population. Figure 1 Figure 1. Disclosures No relevant conflicts of interest to declare.

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Analysis of risk factors associated with flexor pollicis longus injury after volar plating of distal radius fractures

Journal of International Medical Research ◽

10.1177/03000605211031438 ◽

2021 ◽

Vol 49 (8) ◽

pp. 030006052110314

Author(s):

Yang-Xun Lv ◽

Mang-Mang Chen ◽

Chen-Xian Su ◽

Hao-Nan Ye ◽

Jie Yang ◽

...

Keyword(s):

Risk Factors ◽

Distal Radius ◽

Univariate Analysis ◽

Multivariate Logistic Regression Analysis ◽

Distal Radius Fractures ◽

Volar Plating ◽

Multivariate Logistic Regression ◽

Radius Fractures ◽

Plate Removal ◽

Factors Associated

Objective This study was performed to analyze the risk factors associated with flexor pollicis longus (FPL) attrition or rupture after volar plating of distal radius fractures. Methods Three hundred thirty-eight patients with distal radius fractures were included in this retrospective study. Univariate analysis and multivariate logistic regression analysis were performed to predict risk factors. Results Univariate analysis showed that sex, volar tilt, the Soong grade, the plate-to-critical line distance (PCLD), the plate-to-volar rim distance (PVRD), and the time of plate removal were significantly associated with FPL attrition or rupture. Multivariate logistic regression analysis demonstrated that decreased volar tilt, Soong grade 2, PCLD of >2 mm, PVRD of <3 mm, and plate removal at ≥1 year were the risk factors significantly associated with FPL attrition or rupture. Conclusions Reduced volar tilt, Soong grade 2, PCLD of >2 mm, and PVRD of <3 mm appear to be risk factors that are significantly associated with FPL attrition or rupture. The findings of this study also suggest that the risk of tendon rupture is lower if a Soong grade 2 plate is removed, the PCLD is >2 mm, the PVRD is <3 mm, or reduced volar tilt is achieved earlier (at <1 year).

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The Day 1 Postoperative Platelet Count Predicts Splenectomy Response in Patients with Immune Thrombocytopenia (ITP)

Blood ◽

10.1182/blood.v124.21.1448.1448 ◽

2014 ◽

Vol 124 (21) ◽

pp. 1448-1448

Author(s):

Shylaja Mani ◽

Hashim Abbas ◽

Akhil Parashar ◽

Keith R. McCrae

Keyword(s):

Logistic Regression ◽

Platelet Count ◽

Medical Therapy ◽

Immune Thrombocytopenia ◽

Conflicts Of Interest ◽

Cleveland Clinic ◽

Complete Response ◽

Stepwise Logistic Regression ◽

Severe Thrombocytopenia ◽

Platelet Counts

Abstract Background: Immune thrombocytopenia (ITP) in adults is generally a chronic disorder that may lead to severe thrombocytopenia and bleeding. Though several medical modalities such as thrombopoietin receptor agonists have become available for the management of ITP withinin the last decade, splenectomy remains a valuable option for management of refractory ITP, with approximately 2/3 of treated patients remaining in complete remission 10 years afterwards. However, there are no consistent and reliable predictors of splenectomy response for an individual patient with ITP. Since patients with ITP who fail to respond to splenectomy can develop significant bleeding in the postoperative period it is important to identify those individuals early after their surgical procedure so that aggressive medical intervention may be employed. Despite this concern, there is little information available on the value of postoperative platelet counts obtained soon after splenectomy in predicting the ultimate outcome of surgery. Objectives: The goal of this study was to define the value of platelet counts determined soon after splenectomy on the ultimate success of splenectomy in inducing remission of ITP. Methods: We reviewed the medical records of 66 patients who underwent splenectomy for ITP at the Cleveland Clinic from 2000-2013. A complete response was defined as a stable platelet count >100 x109/L two months after splenectomy without medical therapy. Stepwise logistic regression with backward selection was used to identify significant predictors of complete response. Results: The 66 patients had a median age of 41(IQR 21-56) with a male:female ratio of 1:2. The median platelet count at the time of diagnosis was 12 x 109/L and 43% of the patients had severe ITP (defined per IWG guidelines as bleeding that mandates treatment). Ninety percent of patients were steroid dependent, and 39%, 15% and 5% had been treated with rituximab, eltrombopag or romiplostim respectively. The median time to splenectomy from diagnosis of ITP was 22 months (IQR 6-44 months). At a median follow up of 35 months after splenectomy, 39 patients (59%) achieved a complete response. The median platelet count prior to and 24 hours after splenectomy in responders and non-responders is shown in Table 1. Logistic regression analyses identified a post-op day 1 platelet count greater than the median platelet count of 112 x 109/L (OR- 3.72, CI- 1.14-12.16, p<0.03) and post-operative day 3 platelet count greater than median platelet count of 175x 109/L (OR- 4.87, CI- 1.37-17.2, p<0.01) as a significant predictor of splenectomy response. The probability of response based on the post-operative day 1 platelet count is depicted in Figure 1. The difference between the pre-splenectomy and post-operative day 1 platelet count was also a significant predictor of response (OR 1.01 (1.0001-1.02), p=0.04), (figure 2). The log of the time from the diagnosis of ITP to splenectomy (OR- 0.61, CI 0.40-0.94, p<0.02) was also a weak, but significant predictor. Increased numbers of prior treatments for ITP prior to splenectomy correlated with a decreased response, although this relationship was not statistically significant. Conclusion: The platelet count on postoperative day 1 is a significant predictor of long term response to splenectomy, with almost 4-fold increased probability of achieving remission if this value is >112 x 109/L .This is among the first studies to examine the prognostic value of the platelet count obtained this early after splenectomy, and suggests that in patients with severe ITP and a persistently low postoperative platelet count on day 1, medical therapy should be considered to prevent bleeding. Our data also suggests that responses to splenectomy may be less frequent in patients with a longer interval between ITP diagnosis and splenectomy. Disclosures No relevant conflicts of interest to declare.

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Serum Epidemiological Analysis and Risk Factors Associated with Leptospira spp. in Cattle in the State of Piauí

Acta Scientiae Veterinariae ◽

10.22456/1679-9216.80723 ◽

2017 ◽

Vol 45 (1) ◽

pp. 11

Author(s):

Siluana Benvindo Ferreira ◽

Katiene Régia Silva Sousa ◽

Vanessa Castro ◽

Sabrina Thabla Pereira Lopes ◽

Sávio Benvindo Ferreira ◽

...

Keyword(s):

Risk Factors ◽

Logistic Regression ◽

Regression Analysis ◽

Logistic Regression Analysis ◽

Statistical Significance ◽

Univariate Analysis ◽

Multivariate Logistic Regression Analysis ◽

Control Measures ◽

Factors Associated ◽

Leptospira Spp

Background: Leptospirosis is a cosmopolitan zoonosis caused by pathogenic spirochetes of the genus Leptospira spp. and it is considered one of the main causes of reproductive problems in cattle. Therefore, the aim of this study was to determine the occurrence of anti-Leptospira antibodies and identify the prevalent serovars and risk factors associated with infection in cattle herds, in the microregion of Floriano, Piaui State, Brazil.Materials, Methods & Results: A total of 414 bovine sera samples were collected (390 females aged over 24 months and 24 bulls) from 22 properties (farms) in the municipalities that compose the study area. The samples were analyzed using the Microscopic Agglutination Test (MAT) to detect anti-Leptospira antibodies from 23 pathogenic serovars. An epidemiological questionnaire was applied in each farm to evaluate the risk factors, using a univariate analysis of the variables of interest, by Pearson’s Chi-square test (χ2) or Fisher’s exact test, when it was necessary. Then, each independent variable was crossed with the dependent variable and those that presented statistical significance <0.20 were selected for multivariate analysis, using logistic regression, adopting a significance level of 5%. This research identified 143 positive animals (MAT> 1: 100) in the 22 evaluated farms; all of them had at least one positive animal, resulting in a prevalence of 34.54%, with 32,8% females (136) and 1,7% males (07), and 8,93% (37) of co-agglutination. Nineteen of the 23 tested serovars were identified; among them, Icterohaemorrhagiae (42.48%), Hardjo (31.2%), Pomona (4.3%), and Castellonis (4.3%) stood out. Absence of quarantine (OR = 16.172, P = 0.024), vaccination (OR = 0.090, P = 0.037) and isolation of diseased animals (OR = 0.006, P = 0.030) were identified, by the multivariate logistic regression analysis, as risk factors for any serovar of Leptospira spp.Discussion: The results of the present study showed that leptospirosis is present in all studied municipalities, in which the prevalence may be related to the variety of factors that influence the occurrence of the disease, such as climatic and environmental conditions, transit of animal, practices of management adopted in the herd, and the lack of information about the disease. The occurrence of co-agglutination can be explained by the possibility of multiple and concomitant contaminations with several serovars. Icterohaemorrhagiae was the most prevalent serovar, which has significant importance to public health since it is considered the main serovar of leptospirosis in humans, associated with the presence of rodents. On the other hand, the serovar Hardjo is related to the chronic leptospirosis in cattle, demonstrated through reproductive problems. The serovars Castellonis and Pomona were also observed in bovine herds, suggesting a possible transmission of the microorganism between animal species, probably due to exposure to the same sources of infection. In fact, the large number of serovarieties of Leptospira spp. indicates the presence of one or more maintenance hosts, which are natural reservoirs of this infection. The risk factors confirmed in the logistic regression analysis probably occur due to failures in sanitary management. It is concluded that Leptospira spp. is disseminated in cattle in the studied region, with the presence of several serovars, which reinforces the need for intensifying the prevention and control measures, such as vaccination.

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Search for and Extraction of Accessory Spleen in Refractory Immune Cytopenias. Effective or a Waste in Resources?

Blood ◽

10.1182/blood-2020-140454 ◽

2020 ◽

Vol 136 (Supplement 1) ◽

pp. 10-11

Author(s):

José Miguel Alvarez Blanco ◽

Ana Sierra Salazar ◽

Juan Rangel-Patiño ◽

Roberta Demichelis

Keyword(s):

Risk Factors ◽

Protective Factor ◽

Response Rate ◽

Conflicts Of Interest ◽

Accessory Spleen ◽

Complete Response ◽

First Line ◽

Factors Associated ◽

Line Therapy

Background: Splenectomy is an effective second line therapy for patients with immune cytopenias. Fifteen percent of patients are going to relapse after splenectomy. These patients are categorized as refractory and their treatment is challenging. The incidence of an accessory spleen diagnosed by gammagraphy is estimated to be 8-20% in this scenario. Current treatment guidelines do not address the issue of searching for an accessory spleen or performing accessory splenectomy as a treatment strategy for these patients. The aim of this study was to identify risk factors for the presence of accessory spleen diagnosed by gammagraphy in patients with refractory immune cytopenias and analyze the response rate of its removal. Methods: It is a case control, single center, retrospective study. We included adult patients with refractory immune cytopenias who underwent gammagraphy to search for an accessory spleen, from 1996 to 2016. Cases were patients with a positive gammagraphy, controls were those with a negative gammagraphy. Patients who failed to have at least one year of follow-up after splenectomy or accessory splenectomy, were excluded. A logistic regression was performed to determine factors associated with the presence of an accessory spleen. Results: We analyzed 71 refractory patients with a gammagraphy performed searching for an accessory spleen, 87.3% with a diagnosis of immune thrombocytopenia (IT), 7% autoimmune hemolytic anemia (AHA) and 5.6% Evans Syndrome. Fourteen percent of the patients had secondary immune cytopenias all of them due to autoimmune diseases. There was a predominance of women with 74.6% of the subjects studied. Patients received a median of 2 (0-4) lines of treatment before the splenectomy. The majority of patients (98.6%) had received, as first line of treatment corticosteroids, with an overall response rate (ORR) of 84% and a complete response (CR) rate of 38.6%. Of the 71 patients, splenectomy achieved an ORR of 83.1% with CR in 80.3%. The incidence of accessory spleen diagnosed by gammagraphy at their relapse was 15.5% (11 patients). In the multivariate analysis, we found two factors associated with positivity of the gammagraphy: CR to corticosteroids pre-splenectomy with an OR of 5.2 (CI 95% 1.24-21.78; p=0.021) and the presence of Howell Jolly bodies (HJb) with an OR of 0.088 (CI95% 0.02-0.37; p=0.001) as a protective factor. We developed a risk score consisting of: 0 risk factors, 1 risk factor (CR to corticosterois pre-splenectomy or abscense of HJb) and 2 risk factors. The percentage of patients who were positive by gammagraphy using this score was 83.3%, 25.6% and 3% for 2, 1 and no risk factors respectively (p<0.001) (Figure1). Eight patients underwent accesory splenectomy, all of them achieved responses with CR of 87.5%, and none experienced complications associated with the procedure. Seven patients acquired the presence of HJb after accesory splenectomy (Table 1). With a median follow-up of 60.2 months (1.54-194.56), 62.5% mantained the response obtained with the accesory splenectomy. One patient didn´t acquire HJb post accesory splenectomy, he relapsed and was diagnosed with a new accesory spleen. He underwent a second accesory splenectomy and is now in CR with the presence of HJb in the blood smear. Conclusions: The search for an accesory spleen in patients with refractory immune cytopenias with risk factors (absence of Howell Jolly bodies and or complete response to steroids as first line therapy) is usefull. Accesory splenectomy is a safe and effective therapeutic strategy in the treatment of these patients. Disclosures No relevant conflicts of interest to declare.

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Characteristics of Sarcoidosis-Associated Immune Thrombocytopenia: a Consecutive Study of 20 Cases.

Blood ◽

10.1182/blood.v114.22.2407.2407 ◽

2009 ◽

Vol 114 (22) ◽

pp. 2407-2407

Author(s):

Matthieu Mahévas ◽

Laurent Chiche ◽

Medhi Khellaf ◽

Yurdagu Uzunhan ◽

Anne-Sophie Morin ◽

...

Keyword(s):

Platelet Count ◽

Partial Response ◽

Immune Thrombocytopenia ◽

Conflicts Of Interest ◽

Respir Crit ◽

Standard Form ◽

Complete Response ◽

Biological Data ◽

Long Term Outcome

Abstract Abstract 2407 Poster Board II-384 Introduction: Although sarcoidosis is far from being a classical cause of secondary-immune thrombocytopenic purpura (ITP), isolated thrombocytopenia may occur during the course of the disease. To better assess the main characteristics and outcome of patients with a sarcoidosis-associated ITP, a survey was initiated throughout the French study group on sarcoidosis and the national referral center for adult's immune cytopenias. The data of the 20 first cases are reported. Patients and Methods: To be included, all patients had to fulfil the following criteria: 1) Definite diagnosis of sarcoidosis according to the standard international criteria (Am J Respir Crit Care Med 1999; 736-55) and 2) Presence of an immune thrombocytopenia according to the ASH criteria twith platelet count below 100 × 109/L on at least two separate occasions 2 weeks. Drug-induced thrombocytopenia were excluded as well as patients with a hypogammaglobulinemia suggesting a underlying common variable immunodeficiency (CVI) and thrombocytopenia related to hypersplenism. All clinical and biological data were reviewed and analyzed by the same investigator by using a standard form. A complete response (CR) was defined as sustained (> 3months) platelet count > 100 × 109/L with at least a twofold increase for baseline. A partial response (PR) was defined as a platelet count 30×109/L or more and at least twice the initial value. Results: Twenty patients (50% men) were included. Median age at ITP diagnosis was 37.5 years (21 to 83) and median age at sarcoidosis diagnosis was 36 yrs (10 to 83). In 4 patients, ITP preceded the diagnosis of sarcoidosis (median: 67.5 months; 15 to 153). In 11 patients (55%), ITP occurred in the course of prior diagnosed sarcoidosis with a median of 48 mths (6 to 216), and concomitantly with the diagnosis of sarcoidosis in 5 patients (25%). In 13 patients (65%), an active localization of sarcoidosis was present at the diagnosis of ITP. Median platelet count at onset was 11×109/L (3 to 90) and nadir platelet count was 10×109/L (1 to 60). Seven patients (35%) had severe (mucosal) bleeding manifestations and a bleeding score ≥ 8 (described by Khellaf et al). Regarding sarcoidosis, during the follow up, 17 patients (85%) had thoracic involvement, and an extra-thoracic involvement was found in 14 patients (70%) including: eye (n=7), liver (n=5), sinus (n=4), peripheral lymph nodes (n=4), skin (n=3), salivary gland (n=2), spleen (n=1) and kidney (n=1). Nineteen out of the 20 patients were treated specifically for their secondary ITP. After the first line therapy (prednisone at 1mg/kg/day for at least 3 consecutive weeks in all patients associated with IVIg in 10 patients), 12/19 (63%) patients achieved a complete response (CR), 6 a partial response (PR) (32%) and only 1 patient failed to respond. The course of ITP was chronic in 4 patients, among them 2 underwent splenectomy and achieved a CR and 2 were treated with Rituximab (375mg/m2, 4 infusions) and achieved a PR at one year. After a median follow up of 70 months (12 to142), 18 patients (90%) were in CR and 2 in PR with chronic ITP. Eight patients were in remission off therapy whereas 12 patients (60%) were still on corticosteroids at time of analysis with a median dose of 10mg/day (5 to 30). During the follow-up period, 11 patients (55%) had a relapse or flare of sarcoidosis (intra thoracic in 5 patients, extra-thoracic in 6 patients). In 2 patients, a simultaneous relapse of both sarcoidoisis and associated-ITP was observed. Comments: Our preliminary data suggest that the association of sarcoidosis and ITP is not fortuitous and that sarcoidosis should be considered as a potential cause of secondary ITP. ITP in this setting is frequently initially severe and symptomatic and therefore requiring treatment. The overall response rate to treatments commonly used in primary ITP is however good and the long term outcome is favorable suggesting that patients with sarcoidosis-associated ITP should be managed as patients with primary ITP. In contrast, relapse of sarcoidosis is frequent and frequently affect extra-thoracic sites. That a majority of the patients had an active and/or relapsing sarcoidosis during the course of ITP suggests that granuloma may be a predisposing condition for triggering autoimmunity and especially ITP as observed in some cases of CVI-associated immune thrombocytopenia. Disclosures: No relevant conflicts of interest to declare.

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Risk factors associated with progression of diabetic retinopathy in eyes treated with panretinal photocoagulation

Scientific Reports ◽

10.1038/s41598-021-93384-5 ◽

2021 ◽

Vol 11 (1) ◽

Author(s):

Sung Uk Baek ◽

Min Seon Park ◽

Bum-Joo Cho ◽

In Won Park ◽

Soonil Kwon

Keyword(s):

Risk Factors ◽

Visual Acuity ◽

Diabetic Retinopathy ◽

Platelet Count ◽

Multivariate Logistic Regression Analysis ◽

Panretinal Photocoagulation ◽

Lower Baseline ◽

Uncontrolled Diabetes ◽

High Platelet Count ◽

Baseline Visual Acuity

AbstractUncontrolled diabetes has been associated with progression of diabetic retinopathy (DR) in several studies. Therefore, we aimed to investigate systemic and ophthalmic factors related to worsening of DR even after completion of panretinal photocoagulation (PRP). We retrospectively reviewed DR patients who had completed PRP in at least one eye with a 3-year follow-up. A total of 243 eyes of 243 subjects (mean age 52.6 ± 11.6 years) were enrolled. Among them, 52 patients (21.4%) showed progression of DR after PRP (progression group), and the other 191 (78.6%) patients had stable DR (non-progression group). The progression group had higher proportion of proliferative DR (P = 0.019); lower baseline visual acuity (P < 0.001); and higher platelet count (P = 0.048), hemoglobin (P = 0.044), and hematocrit, (P = 0.042) than the non-progression group. In the multivariate logistic regression analysis for progression of DR, baseline visual acuity (HR: 0.053, P < 0.001) and platelet count (HR: 1.215, P = 0.031) were identified as risk factors for progression. Consequently, we propose that patients with low visual acuity or high platelet count are more likely to have progressive DR despite PRP and require careful observation. Also, the evaluation of hemorheological factors including platelet counts before PRP can be considered useful in predicting the prognosis of DR.

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A population-based exposure assessment of risk factors associated with gastrointestinal pathogens: a Campylobacter study

Epidemiology and Infection ◽

10.1017/s0950268812001641 ◽

2012 ◽

Vol 141 (5) ◽

pp. 976-986 ◽

Cited By ~ 8

Author(s):

L. A. MacRITCHIE ◽

C. J. HUNTER ◽

N. J. C. STRACHAN

Keyword(s):

Risk Factors ◽

Population Density ◽

Exposure Assessment ◽

Disease Incidence ◽

Univariate Analysis ◽

Age Groups ◽

Multivariate Logistic Regression Analysis ◽

Environmental Water ◽

Population Based ◽

Elevated Exposure

SUMMARYA questionnaire survey was undertaken to determine the exposure of a study population to campylobacteriosis source risk factors (environmental, water, food) and results were stratified by age, population density and deprivation. Data were gathered using an exposure assessment carried out by telephone in the Grampian region of Scotland. Univariate analysis showed that children aged 5–14 years, living in low population density (0–44·4 persons/km2) and affluent areas had elevated exposure to environmental and water risk factors. Multivariate logistic regression analysis revealed that younger age groups and lower population density were significant indicators for most environmental risk factors. The results compared to reported disease incidence in Grampian showed that greater exposure to risk factors does not necessarily coincide with greater disease incidence for age groups, particularly for the 0–4 years age group. Further research is required to explain the relationship between exposure and disease incidence.

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