scholarly journals CytoSorb Therapy in COVID-19 (CTC) Patients Requiring Extracorporeal Membrane Oxygenation: A Multicenter, Retrospective Registry

2021 ◽  
Vol 8 ◽  
Author(s):  
Tae Song ◽  
Jeremiah Hayanga ◽  
Lucian Durham ◽  
Lawrence Garrison ◽  
Paul McCarthy ◽  
...  
Keyword(s):  
Extracorporeal Membrane Oxygenation ◽  
Critically Ill ◽  
Icu Mortality ◽  
Patient Level Data ◽  
Risk Of Death ◽  
Patient Level ◽  
Membrane Oxygenation ◽  
Level Data ◽  
Icu Discharge ◽  
D Dimer

Introduction: CytoSorb extracorporeal blood purification therapy received FDA Emergency Use Authorization (EUA) to suppress hyperinflammation in critically ill COVID-19 patients. The multicenter CTC Registry was established to systematically collect patient-level data, outcomes, and utilization patterns of CytoSorb under the EUA.Methods: Patient-level data was entered retrospectively at participating centers. The primary outcome of the registry was ICU mortality. Patient disposition of death, continuing ICU care, or ICU discharge was analyzed up to Day 90 after start of CytoSorb therapy. Demographics, comorbidities, COVID-19 medications, inflammatory biomarkers, and details on CytoSorb use were compared between survivors and non-survivors in the veno-venous extracorporeal membrane oxygenation (ECMO) cohort.Results: Between April 2020 and April 2021, 52 patients received veno-venous ECMO plus CytoSorb therapy at 5 U.S. centers. ICU mortality was 17.3% (9/52) on day 30, 26.9% (14/52) on day 90, and 30.8% (16/52) at final follow-up of 153 days. Survivors had a trend toward lower baseline D-Dimer levels (2.3 ± 2.5 vs. 19.8 ± 32.2 μg/mL, p = 0.056) compared to non-survivors. A logistic regression analysis suggested a borderline association between baseline D-Dimer levels and mortality with a 32% increase in the risk of death per 1 μg/mL increase (p = 0.055). CytoSorb was well-tolerated without any device-related adverse events reported.Conclusions: CytoSorb therapy for critically ill COVID-19 patients on ECMO was associated with high survival rates suggesting potential therapeutic benefit. Elevated baseline D-Dimer levels may suggest increased risk of mortality. Prospective controlled studies are warranted to substantiate these results.Clinical Trial Registration:https://clinicaltrials.gov/ct2/show/NCT0439192, identifier: NCT04391920.

Risk of treatment-related death in carriers of pathogenic DPYD polymorphisms treated with fluoropyrimidine chemotherapy: A systematic review and patient-level analysis.

2019 ◽  
Vol 37 (15_suppl) ◽  
pp. e15132-e15132 ◽  
Author(s):  
Karan Rai ◽  
Bhavina D O Batukbhai ◽  
Gabriel A. Brooks
Keyword(s):  
Systematic Review ◽  
Standard Dose ◽  
Patient Level Data ◽  
Risk Of Death ◽  
Patient Level ◽  
Level Data ◽  
Increased Risk ◽  
Risk Of Treatment ◽  
Treatment Related Mortality ◽  
Related Mortality

e15132 Background: Polymorphisms of the DPYD gene are present in 3-5% of the population and are associated with increased risk for grade ≥3 toxicity during treatment with fluoropyrimidine (FP) chemotherapy. Fatal toxicities in carriers of DPYD polymorphisms have been described in published reports, however reliable estimates of the risk of treatment-related mortality are lacking. Methods: We conducted a systematic review of the MEDLINE database to identify relevant manuscripts published before January 28, 2018. We searched for published studies of patients receiving standard-dose FP chemotherapy (5-fluorouracil or capecitabine) who had pre-treatment testing for ≥1 of 4 pathogenic DPYD polymorphisms (c.1236G > A/HapB3, c.1679T > G, c.1905+1G > A/*2A, and c.2846A > T) and who were systematically assessed for treatment-related toxicities. In the case of retrospective studies, we required that the cohort be defined by pretreatment characteristics (e.g., patients were not included on the basis of observed toxicity). Two reviewers extracted study- and patient-level data, with discrepancies resolved by consensus. The pooled data were analyzed to estimate the risk of treatment-related mortality among polymorphism carriers. Results: Of the 1290 references screened, 37 publications were included in the final analysis. Patient-level data identified 485 of 14,377 patients (3.4%) with pathogenic DPYD polymorphisms. There were 12 deaths among polymorphism carriers, resulting in a 2.5% risk of treatment-related mortality (95% CI 1.3-4.4%). Only 2 treatment-related deaths were reported in 13,892 patients without identified polymorphisms. Risk of death by genotype is shown in the table; two decedents were compound heterozygotes. Conclusions: Patients with pathogenic DPYD polymorphisms who are treated with standard-dose FP chemotherapy are at significant risk of death and can be prospectively identified through pharmacogenetic testing. [Table: see text]

scholarly journals Effect of tranexamic acid by baseline risk of death in acute bleeding patients: a meta-analysis of individual patient-level data from 28 333 patients

2020 ◽  
Vol 124 (6) ◽  
pp. 676-683 ◽  
Author(s):  
Francois-Xavier Ageron ◽  
Angele Gayet-Ageron ◽  
Katharine Ker ◽  
Timothy J. Coats ◽  
Haleema Shakur-Still ◽  
...  
Keyword(s):  
Tranexamic Acid ◽  
Meta Analysis ◽  
Baseline Risk ◽  
Acute Bleeding ◽  
Patient Level Data ◽  
Individual Patient Level ◽  
Risk Of Death ◽  
Patient Level ◽  
Level Data

scholarly journals Amalgamation of cloud-based colonoscopy videos with patient-level metadata to facilitate large-scale machine learning

2021 ◽  
Vol 09 (02) ◽  
pp. E233-E238
Author(s):  
Rajesh N. Keswani ◽  
Daniel Byrd ◽  
Florencia Garcia Vicente ◽  
J. Alex Heller ◽  
Matthew Klug ◽  
...  
Keyword(s):  
Machine Learning ◽  
Large Scale ◽  
Medical Center ◽  
Academic Medical Center ◽  
Procedure Time ◽  
Image Capture ◽  
Common Procedure ◽  
Patient Level Data ◽  
Patient Level ◽  
Level Data

Abstract Background and study aims Storage of full-length endoscopic procedures is becoming increasingly popular. To facilitate large-scale machine learning (ML) focused on clinical outcomes, these videos must be merged with the patient-level data in the electronic health record (EHR). Our aim was to present a method of accurately linking patient-level EHR data with cloud stored colonoscopy videos. Methods This study was conducted at a single academic medical center. Most procedure videos are automatically uploaded to the cloud server but are identified only by procedure time and procedure room. We developed and then tested an algorithm to match recorded videos with corresponding exams in the EHR based upon procedure time and room and subsequently extract frames of interest. Results Among 28,611 total colonoscopies performed over the study period, 21,170 colonoscopy videos in 20,420 unique patients (54.2 % male, median age 58) were matched to EHR data. Of 100 randomly sampled videos, appropriate matching was manually confirmed in all. In total, these videos represented 489,721 minutes of colonoscopy performed by 50 endoscopists (median 214 colonoscopies per endoscopist). The most common procedure indications were polyp screening (47.3 %), surveillance (28.9 %) and inflammatory bowel disease (9.4 %). From these videos, we extracted procedure highlights (identified by image capture; mean 8.5 per colonoscopy) and surrounding frames. Conclusions We report the successful merging of a large database of endoscopy videos stored with limited identifiers to rich patient-level data in a highly accurate manner. This technique facilitates the development of ML algorithms based upon relevant patient outcomes.

scholarly journals Predictors of insufficient peak amikacin concentration in critically ill patients on extracorporeal membrane oxygenation

Critical Care ◽  
2018 ◽  
Vol 22 (1) ◽  
Author(s):  
Cyril Touchard ◽  
Alexandra Aubry ◽  
Philippine Eloy ◽  
Nicolas Bréchot ◽  
Guillaume Lebreton ◽  
...  
Keyword(s):  
Extracorporeal Membrane Oxygenation ◽  
Critically Ill ◽  
Critically Ill Patients ◽  
Membrane Oxygenation
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