Association of Trauma Severity with Antibody Seroconversion in Heparin-Induced Thrombocytopenia: A Multicenter, Prospective Observational Study

2021 ◽  
Author(s):  
Motoo Fujita ◽  
Takuma Maeda ◽  
Shigeki Miyata ◽  
Asumi Mizugaki ◽  
Mineji Hayakawa ◽  
...  
Keyword(s):  
Observational Study ◽  
Prospective Observational Study ◽  
Trauma Patients ◽  
Disappearance Rate ◽  
Heparin Induced Thrombocytopenia ◽  
Trauma Severity ◽  
Heparin Administration ◽  
Severity Scores ◽  
Activation Assay ◽  
Multicenter Prospective Observational Study

Abstract BACKground: Heparin administration can induce the production of anti-platelet factor 4 (PF4)/heparin antibodies with platelet-activating properties, causing heparin-induced thrombocytopenia (HIT). Previous studies have suggested that trauma severity influences HIT immune responses, but their relationship has not been fully explained. This study aimed to clarify this association by multicenter prospective observational study.methods: Trauma patients who met the criteria of age ≥18 years and Injury Severity Scores (ISS) ≥ 9 from March 2018 to February 2019 were included. Patients who did not receive any heparin and those who received it as flushes or for treatment were also included. A total of 184 patients were divided into three groups based on trauma severity (mild (9 ≤ ISS ≤ 15), moderate (16 ≤ ISS ≤ 24), severe (25 ≤ ISS)), and were compared by the seroconversion time and rate, as well as the disappearance rate of antibodies on day 30. RESULTS: Overall, the seroconversion rates of anti-PF4/heparin IgG and HIT antibodies by washed platelet activation assay were 26.6% and 16.3%, respectively. There was a significant difference in the seroconversion rates of anti-PF4/heparin IgG (p = 0.016) and HIT antibodies (p = 0.046) among the groups. Seroconversion rates in both assays increased with increasing trauma severity. The time required to achieve seroconversion was similar (between 5 and 10 days of trauma onset) regardless of heparin administration. Anti-PF4/heparin IgG and HIT antibodies were no longer detected on day 30 in 28.6% and 60.9% of seroconverted patients, respectively.Conclusions: Development of HIT antibodies was observed commonly in severely injured trauma patients. HIT antibody development may related to trauma severity, with high disappearance rate on day 30. HIT should be considered as a differential diagnosis in patients with thrombocytopenia or thromboembolism between 5 and 10 days after trauma.

scholarly journals Hyperglycemia as a positive predictor of mortality in major trauma

2020 ◽  
pp. 102490792091125
Author(s):  
Chia-Peng Chang ◽  
Cheng-Ting Hsiao ◽  
Cheng-Hsien Wang ◽  
Kai-Hua Chen ◽  
I-Chuan Chen ◽  
...  
Keyword(s):  
Observational Study ◽  
Prospective Observational Study ◽  
Major Trauma ◽  
Injury Severity ◽  
Tertiary Hospital ◽  
Trauma Patients ◽  
Reliable Predictor ◽  
Severity Scores ◽  
High Incidence ◽  
Trauma Injury

Background: Hyperglycemia in the acute phase after trauma is a stress response and a metabolic reflection in humans with injury, which could adversely affect outcome in trauma patients. In this study, we attempted to identify if hyperglycemia a reliable predictor for mortality in major trauma patients. Objectives: In order to identify if hyperglycemia a reliable predictor for mortality in major trauma, we designed and proformed a prospective observational study in a tertiary hospital. Method: We performed a prospective observational study to review the records of 601 patients with major trauma (injury severity scores >15) who visited our hospital’s emergency department from August 2012 to July 2015. Logistic regression was performed to assess the effect of hyperglycemia on mortality. Result: Major trauma patients in the hyperglycemia group had low systolic/diastolic blood pressure at triage, low initial Glasgow Coma Scale score, high incidence of hypotension episodes, coagulopathy, acidosis, and anemia. Hyperglycemia was significantly correlated with mortality in major trauma patients in this study (odds ratio: 1.97, 95% confidence interval: 1.04–3.74). Conclusion: In major trauma patients with injury severity scores >15, hyperglycemia has a positive correlation with mortality, which could be a predictor of mortality in clinical practice.

Endoscope‐assisted transoral accessory parotid mass excision: Multicenter prospective observational study

2019 ◽  
Vol 130 (5) ◽  
pp. 1218-1226 ◽  
Author(s):  
Jin Pyeong Kim ◽  
Dong Kun Lee ◽  
Jeong Hwan Moon ◽  
Jun Sun Ryu ◽  
Seung Hoon Woo
Keyword(s):  
Observational Study ◽  
Prospective Observational Study ◽  
Multicenter Prospective Observational Study

scholarly journals Eye Tumors in Childhood as First Sign of Tumor Predisposition Syndromes: Insights from an Observational Study Conducted in Germany and Austria

Cancers ◽  
2021 ◽  
Vol 13 (8) ◽  
pp. 1876
Author(s):  
Madlen Reschke ◽  
Eva Biewald ◽  
Leo Bronstein ◽  
Ines B. Brecht ◽  
Sabine Dittner-Moormann ◽  
...  
Keyword(s):  
Optic Nerve ◽  
Observational Study ◽  
Ciliary Body ◽  
Prospective Observational Study ◽  
Genetic Data ◽  
Detailed History ◽  
Cancer Early Detection ◽  
Physical Examinations ◽  
Eye Tumors ◽  
Multicenter Prospective Observational Study

Retinoblastoma and other eye tumors in childhood are rare diseases. Many eye tumors are the first signs of a genetic tumor predisposition syndrome and the affected children carry a higher risk of developing other cancers later in life. Clinical and genetic data of all children with eye tumors diagnosed between 2013–2018 in Germany and Austria were collected in a multicenter prospective observational study. In five years, 300 children were recruited into the study: 287 with retinoblastoma, 7 uveal melanoma, 3 ciliary body medulloepithelioma, 2 retinal astrocytoma, 1 meningioma of the optic nerve extending into the eye. Heritable retinoblastoma was diagnosed in 44% of children with retinoblastoma. One child with meningioma of the optic nerve extending into the eye was diagnosed with neurofibromatosis 2. No pathogenic constitutional variant in DICER1 was detected in a child with medulloepithelioma while two children did not receive genetic analysis. Because of the known association with tumor predisposition syndromes, genetic counseling should be offered to all children with eye tumors. Children with a genetic predisposition to cancer should receive a tailored surveillance including detailed history, physical examinations and, if indicated, imaging to screen for other cancer. Early detection of cancers may reduce mortality.

scholarly journals Helicobacter pylori eradication in patients with type 2 diabetes mellitus: Multicenter prospective observational study

2019 ◽  
Vol 7 ◽  
pp. 205031211983209 ◽  
Author(s):  
Seung-Joo Nam ◽  
Sung Chul Park ◽  
Sang Hoon Lee ◽  
Dong Wook Choi ◽  
Sung Joon Lee ◽  
...  
Keyword(s):  
Helicobacter Pylori ◽  
Observational Study ◽  
Prospective Observational Study ◽  
Eradication Rate ◽  
Laboratory Data ◽  
P Value ◽  
Diabetic Patients ◽  
Multicenter Prospective Observational Study ◽  
H Pylori

Objective: To compare Helicobacter pylori ( H. pylori) eradication rate of type 2 diabetic patients with non-diabetic subjects. Methods: In this multicenter prospective observational study, H. pylori-infected subjects were enrolled from three university-affiliated hospitals. Eradication regimen was triple therapy with standard dose of proton pump inhibitors (b.i.d), amoxicillin (1.0 g b.i.d), and clarithromycin (500 mg b.i.d) for 7 days. Urea breath test was performed 4 weeks after treatment. Various clinical and laboratory data were collected for identification of factors associated with successful eradication. Results: Totally, 144 subjects were enrolled and 119 (85 non-diabetic and 34 diabetic patients) were finally analyzed. Eradication rate was 75.6% and there was no difference between diabetic patients and non-diabetic subjects (73.5% vs 76.5%, p value: 0.814). Adverse drug reactions were reported in 44.5% of patients. In multivariate analysis for predicting H. pylori eradication in diabetic patients, HbA1c (⩾7.5%) was a significant factor affecting eradication rate (adjusted odds ratio: 0.100, 95% confidence interval: 0.011–0.909, p value: 0.041). Conclusion: Diabetes itself is not a major factor affecting H. pylori eradication. However, poor glucose control may harmfully affect H. pylori eradication.

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