scholarly journals Mycoplasma pneumoniae​ pneumonia associated thrombosis at Beijing Children’s Hospital

2019 ◽  
Author(s):  
Jinrong Liu ◽  
Ruxuan He ◽  
Runhui Wu ◽  
Bei Wang ◽  
Hui Xu ◽  
...  
Keyword(s):  
Mycoplasma Pneumoniae ◽  
Anticoagulant Therapy ◽  
Disease Onset ◽  
The Body ◽  
Common Symptom ◽  
Pulmonary Consolidation ◽  
Long Term Prognosis ◽  
Mycoplasma Pneumoniae Pneumonia ◽  
D Dimer

Abstract Background: With the increase of awareness of mycoplasma pneumoniae pneumonia (MPP), we found thrombosis in severe MPP (SMPP) was not rare. The aim of the study was to investigate the clinical characteristics, treatment, and long-term prognosis of MPP-associated thrombosis. Methods: Data from 43 cases of MPP-associated thrombosis were retrospectively analyzed. The results of blood coagulation studies and autoimmune antibody and thrombophilia screening were analyzed. The results of contrast-enhanced lung computed tomography, echocardiography, and blood vessel ultrasonography were analyzed, as were treatment outcomes. Results: Forty-two patients were diagnosed with SMPP. The mean D-dimer level was 11.1 ± 12.4 mg/L. Anticardiolipin-IgM was positive in 60.0% of patients, β2-glycoprotein-IgM in 64.0%, and lupus anticoagulant in 42.1%. Chest imaging revealed pulmonary consolidation with lobe distribution in all patients (2/3–1 lobe in 10 patients, > 1 lobe in 29 patients). Thrombosis can occur in a vessel of any part of the body. It can be initially detected as late as 31 days after disease onset. Thrombosis in the brain and abdomen can occur early, at 5 days after disease onset. Pulmonary vessels were the most commonly involved sites in the current study, and accordingly chest pain was the most common symptom (32.6%), followed by neurological symptoms (14.0%) and abdominal pain (9.3%). Thirty-five percent of patients were asymptomatic with regard to thrombosis. All patients underwent anticoagulant therapy, and thrombus absorption took > 3 months in most patients. All patients were followed until October 2019, at which time 41 were asymptomatic and 2 had mild recurrent cough. Conclusions: SMPP with pulmonary consolidation (> 2/3 lobe) was the most strongly associated risk factor for thrombosis. Thrombosis-associated symptoms may be subtle, even absent. Elevated D-dimer, specifically > 11.1 mg/L, would assist in the early diagnosis of thrombosis. The long-term prognosis of thrombosis was good after timely administration of anticoagulant therapy.

scholarly journals Mycoplasma pneumoniae​ pneumonia associated thrombosis at Beijing Children’s Hospital

2020 ◽  
Author(s):  
Jinrong Liu ◽  
Ruxuan He ◽  
Runhui Wu ◽  
Bei Wang ◽  
Hui Xu ◽  
...  
Keyword(s):  
Mycoplasma Pneumoniae ◽  
Anticoagulant Therapy ◽  
Disease Onset ◽  
Children's Hospital ◽  
Pulmonary Consolidation ◽  
Children’S Hospital ◽  
Long Term Prognosis ◽  
Mycoplasma Pneumoniae Pneumonia ◽  
D Dimer

Abstract Background: With the increase of awareness of mycoplasma pneumoniae pneumonia (MPP), we found thrombosis in severe MPP (SMPP) was not rare. The aim of the study was to investigate the clinical characteristics, treatment, and long-term prognosis of MPP-associated thrombosis. Methods: We retrospectively reviewed the medical records of 43 children with MPP-associated thrombosis between January 2013 and June 2019 at Beijing Children’s Hospital. The results of blood coagulation studies, autoimmune antibody, thrombophilia screening, contrast-enhanced lung computed tomography, echocardiography, and blood vessel ultrasonography were analyzed, as were treatment outcomes. Results: Forty-two patients were diagnosed with SMPP. D-dimer was higher than 5.0 mg/L in 58.1% (25/43) of patients. The mean D-dimer level was 11.1 ± 12.4 mg/L. Anticardiolipin-IgM was positive in 60.0% of patients, β2-glycoprotein-IgM in 64.0%, and lupus anticoagulant in 42.1%. Chest imaging revealed pulmonary consolidation with lobe distribution in all patients (2/3–1 lobe in 10 patients, > 1 lobe in 29 patients). In our experience, thrombosis can occur in a vessel of any part of the body, and it can be initially detected as late as 31 days after disease onset. Thrombosis in the brain and abdomen can occur early, at 5 days after disease onset. Pulmonary vessels were the most commonly involved sites in the current study, and accordingly chest pain was the most common symptom (32.6%), followed by neurological symptoms (14.0%) and abdominal pain (9.3%). Thirty-five percent of patients were asymptomatic with regard to thrombosis. All patients underwent anticoagulant therapy, and thrombus absorption took > 3 months in most patients. All patients were followed until October 2019, at which time 41 were asymptomatic and 2 had mild recurrent cough. Conclusions: SMPP with pulmonary consolidation (> 2/3 lobe) was the most strongly associated risk factor for thrombosis. Thrombosis-associated symptoms may be subtle, even absent. Elevated D-dimer, specifically > 11.1 mg/L (even > 5.0mg/L), would assist in the early diagnosis of thrombosis. The long-term prognosis of thrombosis was good after timely administration of anticoagulant therapy.

scholarly journals Is visceral obesity the cause of obesity paradox?

2017 ◽  
Vol 62 (6) ◽  
pp. 33-39 ◽  
Author(s):  
Daria A. Borodkina ◽  
Olga V. Gruzdeva ◽  
Ludmila V. Kvitkova ◽  
Olga L. Barbarash
Keyword(s):  
Visceral Obesity ◽  
Diabetes Type 2 ◽  
Obesity Paradox ◽  
Epidemiological Studies ◽  
Overweight And Obesity ◽  
The Body ◽  
Markers Of Inflammation ◽  
Obesity And Overweight ◽  
Long Term Prognosis

Obesity is one of the 10 risk factors of death. Many epidemiological studies have shown that overweight and obesity are associated with 44% cases of diabetes type 2, and 23% of cases of coronary heart disease. The body mass index (BMI) is traditionally a diagnostic marker of obesity and overweight are considered. However, in the last 15 years, there has been work on the «paradox» of obesity. So the obese long-term prognosis and stroke are more favorable than individuals without excess weight and obesity. A deeper analysis of the data showed that the highest risk of developing cardiovascular disease and disorders of carbohydrate metabolism associated with visceral obesity. This is largely due to metabolic disorders occurring on the background of visceral obesity, such as insulin resistance, hyperglycemia, dyslipidemia, an imbalance of adipokines and markers of inflammation. These changes in individuals with visceral obesity can occur regardless of the value of BMI.

scholarly journals Joint analysis of D-dimer, N-terminal pro b-type natriuretic peptide, and cardiac troponin I on predicting acute pulmonary embolism relapse and mortality

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Xiaoyu Liu ◽  
Liying Zheng ◽  
Jing Han ◽  
Lu Song ◽  
Hemei Geng ◽  
...  
Keyword(s):  
Pulmonary Embolism ◽  
Survival Rate ◽  
Adverse Events ◽  
Acute Pulmonary Embolism ◽  
Troponin I ◽  
All Cause Mortality ◽  
Long Term Prognosis ◽  
D Dimer

AbstractPrevious studies on the adverse events of acute pulmonary embolism (APE) were mostly limited to single marker, and short follow-up duration, from hospitalization to up to 30 days. We aimed to predict the long-term prognosis of patients with APE by joint assessment of D-dimer, N-Terminal Pro-Brain Natriuretic Peptide (NT-ProBNP), and troponin I (cTnI). Newly diagnosed patients of APE from January 2011 to December 2015 were recruited from three hospitals. Medical information of the patients was collected retrospectively by reviewing medical records. Adverse events (APE recurrence and all-cause mortality) of all enrolled patients were followed up via telephone. D-dimer > 0.50 mg/L, NT-ProBNP > 500 pg/mL, and cTnI > 0.40 ng/mL were defined as the abnormal. Kaplan–Meier curve was used to compare the cumulative survival rate between patients with different numbers of abnormal markers. Cox proportional hazard regression model was used to further test the association between numbers of abnormal markers and long-term prognosis of patients with APE after adjusting for potential confounding. During follow-up, APE recurrence and all-cause mortality happened in 78 (30.1%) patients. The proportion of APE recurrence and death in one abnormal marker, two abnormal markers, and three abnormal markers groups were 7.69%, 28.21%, and 64.10% respectively. Patients with three abnormal markers had the lowest survival rate than those with one or two abnormal markers (Log-rank test, P < 0.001). After adjustment, patients with two or three abnormal markers had a significantly higher risk of the total adverse event compared to those with one abnormal marker. The hazard ratios (95% confidence interval) were 6.27 (3.24, 12.12) and 10.7 (4.1, 28.0), respectively. Separate analyses for APE recurrence and all-cause death found similar results. A joint test of abnormal D-dimer, NT-ProBNP, and cTnI in APE patients could better predict the long-term risk of APE recurrence and all-cause mortality.

scholarly journals Evaluation of variation in coagulation among children with Mycoplasma pneumoniae pneumonia: a case–control study

2017 ◽  
Vol 45 (6) ◽  
pp. 2110-2118 ◽  
Author(s):  
Tianhua Li ◽  
Haiying Yu ◽  
Weina Hou ◽  
Zhiyong Li ◽  
Chunfang Han ◽  
...  
Keyword(s):  
Mycoplasma Pneumoniae ◽  
Operating Characteristic ◽  
Case Control Study ◽  
Case Control ◽  
Healthy Children ◽  
Thrombin Time ◽  
Receiver Operating Characteristic Curves ◽  
Mycoplasma Pneumoniae Pneumonia ◽  
Control Study ◽  
D Dimer

Objective Acute organ embolism in children with Mycoplasma pneumoniae pneumonia (MPP) has been reported, but changes in coagulation are unclear. This study aimed to investigate changes in coagulation in children with MPP. Methods A total of 185 children with MMP (cases) and 117 healthy children (controls) were recruited. We measured prothrombin time (PT), activated partial thromboplastin time (APTT), thrombin time (TT), and plasma fibrinogen (FIB) and D-dimer levels. Results Plasma FIB (3.39 ± 0.96 g/L vs 2.93 ± 0.6 6g/L, t = 4.50) and D-dimer (326.45 ± 95.62mg/L vs 263.93 ± 103.32mg/L, t=5.36) in MPP children were higher than controls and PT (9.54 ± 4.97S vs 11.48 ± 5.96S, t=3.05) and APTT (31.41 ± 12.01S vs 38.38 ± 11.72S, t=4.95) were shorter than controls. FIB, D-dimer, PT, and APTT were not different between the high IgM-titre and low-titre groups. The areas under the receiver operating characteristic curves in cases and controls for plasma FIB and D-dimer levels were 0.654 (95% confidence interval [CI], 0.593–0.716, P = 0.031) and 0.682 (95% CI, 0.619–0.744, P = 0.032), respectively. Conclusions Children with MPP have a higher risk of blood coagulation and thrombosis. Controlling these problems should be considered as soon as possible.

scholarly journals Identifying clinical factors associated with Fulminant Mycoplasma pneumoniae pneumonia in children

2020 ◽  
Author(s):  
yaoyao ling ◽  
Tongqiang Zhang ◽  
wei guo ◽  
Zhenli Zhu ◽  
Jiao Tian ◽  
...  
Keyword(s):  
Pleural Effusion ◽  
Mycoplasma Pneumoniae ◽  
Laboratory Data ◽  
Clinical Manifestations ◽  
Multivariate Logistic Regression Analysis ◽  
Clinical Factors ◽  
Radiological Findings ◽  
Related Factors ◽  
Mycoplasma Pneumoniae Pneumonia ◽  
D Dimer

Abstract BACKGROUND: Analyze the clinical characteristics of Fulminant Mycoplasma pneumoniae pneumonia (FMPP), and identify the related factors predicting FMPP.METHODS: A retrospective case-control study was performed on 345 children with Mycoplasma pneumoniae pneumonia (MPP) hospitalized in our hospital from January 2017 to June 2019. The clinical features, laboratory data and radiological findings were compared between the FMPP group, refractory Mycoplasma pneumoniae pneumonia (RMPP)group and general Mycoplasma pneumoniae pneumonia (GMPP) group. RESULTS: FMPP patients (n=69) had a higher incidence of extra-pulmonary complications and more serious radiological findings(P<0.05), besides the days of fever and the days in the hospitals were longer. FMPP patients also need more complicated treatments(P<0.05). Meanwhile, the levels of white blood cell count(WBC), C-reactive protein(CRP), lactic dehydrogenase (LDH), interleukin (IL)-6, ferritin, D-dimer, fibrinogen(FG), alanine aminotransferase(ALT) and the percentage of neutrophils in the FMPP group were significantly higher than those in the RMPP group and the GMPP group (P<0.05). In ROC curve analysis, the percentage of neutrophils, WBC, CRP, LDH, IL-6, ferritin, D-dimer and ALT were contributed to identify FMPP patients. Multivariate logistic regression analysis showed that ferritin>174.15 ng/mL, IL-6>25.475pg/ml and pleural effusion have significant predictive effects on the early diagnosis of FMPP (P<0.01).CONCLUSION: FMPP patients presented more serious clinical manifestations. Ferritin>174.15 ng/mL, IL-6>25.475pg/ml and pleural effusion were clinical factors for FMPP.

scholarly journals Clinical significance of D-dimer level in refractory Mycoplasma pneumoniae pneumonia

2020 ◽  
Author(s):  
Xia Huang ◽  
Dan Li ◽  
Feng Liu ◽  
Deyu Zhao ◽  
Yifan Zhu ◽  
...  
Keyword(s):  
Logistic Regression ◽  
Inflammatory Response ◽  
Clinical Significance ◽  
Mycoplasma Pneumoniae ◽  
Multivariate Logistic Regression Analysis ◽  
Multivariate Logistic Regression ◽  
Good Ability ◽  
Excessive Inflammatory Response ◽  
Mycoplasma Pneumoniae Pneumonia ◽  
D Dimer

Abstract Background: The levels of serum D-dimer (D-D) in children with Mycoplasma pneumoniae pneumonia (MPP) were assessed to explore the clinical significance of D-D levels in refractory MPP (RMPP). Method: A total of 430 patients with MPP were enrolled between January 2015 and December 2015 and divided into a general MPP (GMPP) group (n=306) and a RMPP group (n=124). Clinical data, D-D level, white blood cell (WBC) count, proportion of neutrophils (N%), C-reactive protein (CRP), erythrocyte sedimentation rate (ESR), alanine transaminase (ALT), aspartate aminotransferase (AST), and lactate dehydrogenase (LDH) were compared between the two groups. Multivariate logistic regression was performed to identify independent predictors of RMPP. Results: (1) Hospitalization time, preadmission fever duration, total fever duration, WBC, N %, CRP, LDH, ESR, ALT, AST, and D-D were significantly higher in the RMPP group than those in the GMPP group (all P<0.05). (2) Correlation analysis showed that D-D was positively correlated with WBC, CRP, ESR, and LDH, and could be used to jointly evaluate the severity of the disease. (3) Multivariate logistic regression analysis identified preadmission fever duration, CRP, LDH and DD as independent risk factors for RMPP (all P<0. 05). D-D had the highest predictive power for RMPP (P<0.01). The D-D level also had a good ability to predict pleural effusion and liver injury (all P<0.01). Conclusion: Serum D-D levels were significantly increased in patients with RMPP, indicating that excessive inflammatory response and vascular endothelial injury with prolonged duration existed in this patient population. Increased levels of serum D-D may be used as an early predictor of RMPP and the occurrence of complications. Our findings provide a theoretical basis for the early diagnosis of RMPP, early intervention and excessive inflammatory response in the pathogenesis of mycoplasma.

scholarly journals Clinical characteristics and risk factors of Fulminant Mycoplasma pneumoniae pneumonia in children

2020 ◽  
Author(s):  
yaoyao ling ◽  
Tongqiang Zhang ◽  
Zhenli Zhu ◽  
Jiao Tian ◽  
yongsheng xu ◽  
...  
Keyword(s):  
Risk Factors ◽  
Pleural Effusion ◽  
Mycoplasma Pneumoniae ◽  
Clinical Characteristics ◽  
Laboratory Data ◽  
Clinical Manifestations ◽  
Multivariate Logistic Regression Analysis ◽  
Radiological Findings ◽  
Mycoplasma Pneumoniae Pneumonia ◽  
D Dimer

Abstract BACKGROUND: Analyze the clinical characteristics of Fulminant Mycoplasma pneumoniae pneumonia (FMPP), and explore the related factors predicting FMPP. METHODS: A retrospective case-control study was performed on 345 children with Mycoplasma pneumoniae pneumonia (MPP) hospitalized in our Hospital from January 2017 to June 2019. The clinical features, laboratory data and radiological findings were compared between the FMPP group, refractory Mycoplasma pneumoniae pneumonia (RMPP)group and general Mycoplasma pneumoniae pneumonia (GMPP) group. RESULTS: FMPP patients (n=69) had more severe presentations, higher incidence of extra-pulmonary complications and more serious radiological findings(P<0.05). And the days of fever and the days in hospital were longer, and FMPP patients also need more complicated treatments(P<0.05). Meanwhile, the levels of white blood cell count(WBC) ,C-reactive protein(CRP), lactic dehydrogenase (LDH), interleukin (IL)-6,ferritin, D-dimer, fibrinogen(FG),alanine aminotransferase(ALT) and the percentage of neutrophils in the FMPP group were significantly higher than those in the RMPP group and the GMPP group (both P<0.05). In ROC curve analysis, the percentage of neutrophils, WBC, CRP, LDH, IL-6, ferritin, D-dimer and ALT were contributed to identify FMPP patients. Multivariate logistic regression analysis showed that ferritin>174.15 ng/mL, IL-6>25.475pg/ml and pleural effusion had significant predictive effects on the early diagnosis of FMPP (P<0.01). Conclusion: FMPP patients presented more serious clinical manifestations. Ferritin>174.15 ng/mL, IL-6>25.475pg/ml and pleural effusion were high risk factors for FMPP.

scholarly journals Unresolved atelectasis in refractory Mycoplasma pneumoniae pneumonia: Predictive factors and the influence of corticosteroids and bronchoscopy lavage therapy

2020 ◽  
Author(s):  
Jianhua Liu ◽  
Jinrong Liu ◽  
Bei Wang ◽  
Yajing Liu ◽  
Chengsong Zhao ◽  
...  
Keyword(s):  
Mycoplasma Pneumoniae ◽  
Early Recognition ◽  
Multiple Logistic Regression Analysis ◽  
Disease Onset ◽  
Chest Imaging ◽  
Corticosteroid Administration ◽  
Starting Time ◽  
Group A ◽  
The Impact ◽  
Mycoplasma Pneumoniae Pneumonia

Abstract Background Unresolved atelectasis occurs in some children with refractory mycoplasma pneumoniae pneumonia (RMPP). The aim was to analyze factors predicting unresolved atelectasis in RMPP and the impact of corticosteroids and bronchoscopy lavage therapy (BLT) on developing atelectasis.Methods We retrospectively analyzed data for 230 pediatric RMPP from January 2013 to June 2017 in Beijing Children’s Hospital. In this study, we diagnosed RMPP when patients' clinical and radiological findings deteriorated after 7 days of macrolide therapy, peripheral blood C-reactive protein (CRP) was higher than 40mg/L, and chest imaging showed consolidation with high density > 1/2 pulmonary lobe. We divided patients into two groups according to the presence/absence of atelectasis on chest imaging after a 6-month follow-up. We calculated the predictive value of fever duration, levels of CRP and lactate dehydrogenase (LDH), and the size of lobe consolidation, regarding atelectasis. Additionally, we compared the starting time and dosage of corticosteroids and the starting time of BLT between the two groups.Results Ninety-five patients developed atelectasis (atelectasis group/group A), and 135 patients did not (non-atelectasis group/group NA). Chest imaging showed > 2/3 pulmonary lobe consolidation in 93.7% of patients in group A and 54.1% of patients in group NA. Multiple logistic regression analysis showed that fever duration, CRP and LDH levels, and lobe consolidation were related to developing atelectasis. Areas under the curve revealed that CRP ≥ 137 mg/L had 82.11% sensitivity and 80.07% specificity, and LDH ≥ 471 IU/L had 62.65% sensitivity and 60.31% specificity to predict atelectasis. Fewer patients receiving corticosteroids and BLT within 10 days after illness onset developed atelectasis.Conclusions Fever duration>10 days, CRP and LDH levels, and lobe consolidation are risk factors for developing atelectasis in RMPP. CRP ≥ 137 mg/L, LDH ≥ 471 IU/L, and >2/3 pulmonary lobe consolidation were significant predictors of atelectasis, which can aid in early recognition. Corticosteroid administration and subsequent BLT within 10 days of the disease onset, and increased corticosteroid dosage may help reduce the incidence of atelectasis in these RMPP patients.

scholarly journals D-Dimer Predicts Disease Severity but Not Long-Term Prognosis in Acute Pulmonary Embolism

2019 ◽  
Vol 25 ◽  
pp. 107602961986349 ◽  
Author(s):  
Fabian Geissenberger ◽  
Florian Schwarz ◽  
Michael Probst ◽  
Sabine Haberl ◽  
Stefanie Gruetzner ◽  
...  
Keyword(s):  
Pulmonary Embolism ◽  
Disease Severity ◽  
Troponin I ◽  
Left Ventricular ◽  
Pulmonary Arterial ◽  
Long Term Prognosis ◽  
Pulmonary Arterial Obstruction ◽  
Acute Pe ◽  
D Dimer

D-dimer might be correlated with prognosis in pulmonary embolism (PE). The predictive value of plasma D-dimer for disease severity and survival was investigated in the lowest and highest D-dimer quartile among 200 patients with PE. Patients with high D-dimers were significantly more often hypotensive ( P = .001), tachycardic ( P = .016), or hypoxemic ( P = .001). Pulmonary arterial obstruction index (PAOI) values were significantly higher in the high D-dimer quartile ( P < .001). Elevated troponin I (TNI) levels ( P < .001), simplified PE severity indices ≥1 ( P < .001), right-to-left ventricular (RV/LV) diameter ratios ≥1 ( P < .001), and thrombolysis ( P = .001) were more frequent in the high D-dimer quartile. D-dimer was associated with RV/LV ratios ≥1 ( P = .021), elevated PAOI ( P < .001) or TNI levels ( P < .001), hypotension ( P < .001), tachycardia ( P = .003), and hypoxemia ( P < .001), but not with long-term all-cause mortality. D-dimer predicts disease severity but not long-term prognosis in acute PE, possibly due to a more aggressive treatment strategy in severely affected patients.

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