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Issitt RW, Cudworth E, Cortina-Borja M, Gupta A, Kallon D, Crook R, Shaw M, Robertson A, Tsang VT, Henwood S, Muthurangu V, Sebire NJ, Burch M, Fenton M. Rapid desensitization through immunoadsorption during cardiopulmonary bypass. A novel method to facilitate human leukocyte antigen incompatible heart transplantation. Perfusion 2024; 39:543-554. [PMID: 36625378 PMCID: PMC10943618 DOI: 10.1177/02676591221151035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
BACKGROUND Anti-human leukocyte antigen (HLA)-antibody production represents a major barrier to heart transplantation, limiting recipient compatibility with potential donors and increasing the risk of complications with poor waiting-list outcomes. Currently there is no consensus to when desensitization should take place, and through what mechanism, meaning that sensitized patients must wait for a compatible donor for many months, if not years. We aimed to determine if intraoperative immunoadsorption could provide a potential desensitization methodology. METHODS Anti-HLA antibody-containing whole blood was added to a Cardiopulmonary bypass (CPB) circuit set up to mimic a 20 kg patient undergoing heart transplantation. Plasma was separated and diverted to a standalone, secondary immunoadsorption system, with antibody-depleted plasma returned to the CPB circuit. Samples for anti-HLA antibody definition were taken at baseline, when combined with the CPB prime (on bypass), and then every 20 min for the duration of treatment (total 180 min). RESULTS A reduction in individual allele median fluorescence intensity (MFI) to below clinically relevant levels (<1000 MFI), and in the majority of cases below the lower positive detection limit (<500 MFI), even in alleles with a baseline MFI >4000 was demonstrated. Reduction occurred in all cases within 120 min, demonstrating efficacy in a time period usual for heart transplantation. Flowcytometric crossmatching of suitable pseudo-donor lymphocytes demonstrated a change from T cell and B cell positive channel shifts to negative, demonstrating a reduction in binding capacity. CONCLUSIONS Intraoperative immunoadsorption in an ex vivo setting demonstrates clinically relevant reductions in anti-HLA antibodies within the normal timeframe for heart transplantation. This method represents a potential desensitization technique that could enable sensitized children to accept a donor organ earlier, even in the presence of donor-specific anti-HLA antibodies.
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Affiliation(s)
- Richard W Issitt
- Perfusion Department, Great Ormond Street Hospital for Children, London, UK
- Institute of Cardiovascular Science, University College London, London, UK
- Digital Research, Informatics and Virtual Environment, NIHR Great Ormond Street Biomedical Research Centre, London, UK
| | - Eamonn Cudworth
- Clinical Transplantation Laboratory, Barts Health NHS Trust, London, UK
| | - Mario Cortina-Borja
- Population, Policy and Practice Research and Teaching Department, Great Ormond Street Institute of Child Health, University College London, London, UK
| | - Arun Gupta
- Clinical Transplantation Laboratory, Barts Health NHS Trust, London, UK
| | - Delordson Kallon
- Clinical Transplantation Laboratory, Barts Health NHS Trust, London, UK
| | - Richard Crook
- Perfusion Department, Great Ormond Street Hospital for Children, London, UK
| | - Michael Shaw
- Perfusion Department, Great Ormond Street Hospital for Children, London, UK
| | - Alex Robertson
- Perfusion Department, Great Ormond Street Hospital for Children, London, UK
| | - Victor T Tsang
- Institute of Cardiovascular Science, University College London, London, UK
- Department of Cardiothoracic Surgery, Great Ormond Street Hospital for Children, London, UK
| | - Sophie Henwood
- Department of Cardiothoracic Transplantation, Great Ormond Street Hospital for Children, London, UK
| | - Vivek Muthurangu
- Institute of Cardiovascular Science, University College London, London, UK
| | - Neil J Sebire
- Digital Research, Informatics and Virtual Environment, NIHR Great Ormond Street Biomedical Research Centre, London, UK
| | - Michael Burch
- Institute of Cardiovascular Science, University College London, London, UK
- Department of Cardiothoracic Transplantation, Great Ormond Street Hospital for Children, London, UK
- Department of Paediatric Cardiology, Institute of Child Health, University College London, London, UK
| | - Matthew Fenton
- Department of Cardiothoracic Transplantation, Great Ormond Street Hospital for Children, London, UK
- Department of Paediatric Cardiology, Institute of Child Health, University College London, London, UK
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Sperotto F, Gutiérrez-Sacristán A, Makwana S, Li X, Rofeberg VN, Cai T, Bourgeois FT, Omenn GS, Hanauer DA, Sáez C, Bonzel CL, Bucholz E, Dionne A, Elias MD, García-Barrio N, González TG, Issitt RW, Kernan KF, Laird-Gion J, Maidlow SE, Mandl KD, Ahooyi TM, Moraleda C, Morris M, Moshal KL, Pedrera-Jiménez M, Shah MA, South AM, Spiridou A, Taylor DM, Verdy G, Visweswaran S, Wang X, Xia Z, Zachariasse JM, Newburger JW, Avillach P. Clinical phenotypes and outcomes in children with multisystem inflammatory syndrome across SARS-CoV-2 variant eras: a multinational study from the 4CE consortium. EClinicalMedicine 2023; 64:102212. [PMID: 37745025 PMCID: PMC10511777 DOI: 10.1016/j.eclinm.2023.102212] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2023] [Revised: 08/22/2023] [Accepted: 08/29/2023] [Indexed: 09/26/2023] Open
Abstract
Background Multisystem inflammatory syndrome in children (MIS-C) is a severe complication of SARS-CoV-2 infection. It remains unclear how MIS-C phenotypes vary across SARS-CoV-2 variants. We aimed to investigate clinical characteristics and outcomes of MIS-C across SARS-CoV-2 eras. Methods We performed a multicentre observational retrospective study including seven paediatric hospitals in four countries (France, Spain, U.K., and U.S.). All consecutive confirmed patients with MIS-C hospitalised between February 1st, 2020, and May 31st, 2022, were included. Electronic Health Records (EHR) data were used to calculate pooled risk differences (RD) and effect sizes (ES) at site level, using Alpha as reference. Meta-analysis was used to pool data across sites. Findings Of 598 patients with MIS-C (61% male, 39% female; mean age 9.7 years [SD 4.5]), 383 (64%) were admitted in the Alpha era, 111 (19%) in the Delta era, and 104 (17%) in the Omicron era. Compared with patients admitted in the Alpha era, those admitted in the Delta era were younger (ES -1.18 years [95% CI -2.05, -0.32]), had fewer respiratory symptoms (RD -0.15 [95% CI -0.33, -0.04]), less frequent non-cardiogenic shock or systemic inflammatory response syndrome (SIRS) (RD -0.35 [95% CI -0.64, -0.07]), lower lymphocyte count (ES -0.16 × 109/uL [95% CI -0.30, -0.01]), lower C-reactive protein (ES -28.5 mg/L [95% CI -46.3, -10.7]), and lower troponin (ES -0.14 ng/mL [95% CI -0.26, -0.03]). Patients admitted in the Omicron versus Alpha eras were younger (ES -1.6 years [95% CI -2.5, -0.8]), had less frequent SIRS (RD -0.18 [95% CI -0.30, -0.05]), lower lymphocyte count (ES -0.39 × 109/uL [95% CI -0.52, -0.25]), lower troponin (ES -0.16 ng/mL [95% CI -0.30, -0.01]) and less frequently received anticoagulation therapy (RD -0.19 [95% CI -0.37, -0.04]). Length of hospitalization was shorter in the Delta versus Alpha eras (-1.3 days [95% CI -2.3, -0.4]). Interpretation Our study suggested that MIS-C clinical phenotypes varied across SARS-CoV-2 eras, with patients in Delta and Omicron eras being younger and less sick. EHR data can be effectively leveraged to identify rare complications of pandemic diseases and their variation over time. Funding None.
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Affiliation(s)
- Francesca Sperotto
- Department of Cardiology, Boston Children's Hospital, Harvard Medical School, 300 Longwood Ave, Boston, MA 02115, United States
| | - Alba Gutiérrez-Sacristán
- Department of Biomedical Informatics, Harvard Medical School, 10 Shattuck Street, Boston, MA 02115, United States
| | - Simran Makwana
- Department of Biomedical Informatics, Harvard Medical School, 10 Shattuck Street, Boston, MA 02115, United States
| | - Xiudi Li
- Department of Biostatistics, Harvard School of Public Health, 677 Huntington Ave, Boston, MA 02115, United States
| | - Valerie N. Rofeberg
- Department of Cardiology, Boston Children's Hospital, Harvard Medical School, 300 Longwood Ave, Boston, MA 02115, United States
| | - Tianxi Cai
- Department of Biomedical Informatics, Harvard Medical School, 10 Shattuck Street, Boston, MA 02115, United States
| | - Florence T. Bourgeois
- Department of Pediatrics, Harvard Medical School, 300 Longwood Ave, Boston, MA 02115, United States
| | - Gilbert S. Omenn
- Dept of Computational Medicine & Bioinformatics, Internal Medicine, Human Genetics, & Public Health, University of Michigan, 2017 Palmer Commons, Ann Arbor, MI 48109-2218, United States
| | - David A. Hanauer
- Department of Learning Health Sciences, University of Michigan Medical School, 100-107 NCRC, 2800 Plymouth Road, Ann Arbor, MI 48109, United States
| | - Carlos Sáez
- Biomedical Data Science Lab, Instituto Universitario de Tecnologías de la Información y Comunicaciones, Universitat Politécnica de Valéncia, Camino de Vera S/N, Valencia 46022, Spain
| | - Clara-Lea Bonzel
- Department of Biomedical Informatics, Harvard Medical School, 10 Shattuck Street, Boston, MA 02115, United States
| | - Emily Bucholz
- Department of Cardiology, Children's Hospital Colorado, University of Colorado Anschutz, 13123 E. 16th Ave, Aurora, CO 80045, United States
| | - Audrey Dionne
- Department of Cardiology, Boston Children's Hospital, Harvard Medical School, 300 Longwood Ave, Boston, MA 02115, United States
| | - Matthew D. Elias
- Division of Cardiology, The Children's Hospital of Philadelphia, 3401 Civic Center Boulevard, Philadelphia, PA 19104, United States
| | - Noelia García-Barrio
- Health Informatics, Hospital Universitario 12 de Octubre, Av. de Córdoba, s/n, Madrid 28041, Spain
| | - Tomás González González
- Health Informatics, Hospital Universitario 12 de Octubre, Av. de Córdoba, s/n, Madrid 28041, Spain
| | - Richard W. Issitt
- Digital Research, Informatics and Virtual Environments (DRIVE), Great Ormond Street Hospital for Children, Great Ormond Street, London WC1N 3JH, United Kingdom
| | - Kate F. Kernan
- Department of Critical Care Medicine, University of Pittsburgh, 3550 Terrace Street, Pittsburgh, PA 15213, United States
| | - Jessica Laird-Gion
- Department of Pediatrics, Boston Children's Hospital, Harvard Medical School, 300 Longwood Ave, Boston, MA 02115, United States
| | - Sarah E. Maidlow
- Michigan Institute for Clinical and Health Research (MICHR) Informatics, University of Michigan, NCRC Bldg 400, 2800 Plymouth Road, Ann Arbor, MI 48109, United States
| | - Kenneth D. Mandl
- Computational Health Informatics Program, Boston Children's Hospital, 300 Longwood Avenue, Boston, MA 02115, United States
| | - Taha Mohseni Ahooyi
- Department of Biomedical Health Informatics, The Children's Hospital of Philadelphia, Roberts Building, 734 Schuylkill Ave, Philadelphia, PA 19146, United States
| | - Cinta Moraleda
- Pediatric Infectious Disease Department, Hospital Universitario 12 de Octubre, Av. de Córdoba, s/n, Madrid 28041, Spain
| | - Michele Morris
- Department of Biomedical Informatics, University of Pittsburgh, 5607 Baum Blvd, Pittsburgh, PA 15206, United States
| | - Karyn L. Moshal
- Department of Infectious Diseases, Great Ormond Street Hospital for Children, Great Ormond Street, London WC1N 3JH, United Kingdom
| | - Miguel Pedrera-Jiménez
- Health Informatics, Hospital Universitario 12 de Octubre, Av. de Córdoba, s/n, Madrid 28041, Spain
| | - Mohsin A. Shah
- Digital Research, Informatics and Virtual Environments (DRIVE), Great Ormond Street Hospital for Children, DRIVE, 40 Bernard St, London WC1N 1LE, United Kingdom
| | - Andrew M. South
- Department of Pediatrics-Section of Nephrology, Brenner Children’s, Wake Forest University School of Medicine, Medical Center Boulevard, Winston Salem, NC 27157, United States
| | - Anastasia Spiridou
- Data Research, Innovation and Virtual Environments, Great Ormond Street Hospital for Children, DRIVE, 40 Bernard St, London WC1N 1LE, United Kingdom
| | - Deanne M. Taylor
- Department of Biomedical Health Informatics, The Children's Hospital of Philadelphia, United States
- The Department of Pediatrics, University of Pennsylvania Perelman Medical School, 3601 Civic Center Blvd, 6032 Colket, Philadelphia, PA 19104, United States
| | - Guillaume Verdy
- IAM Unit, Bordeaux University Hospital, Place amélie rabat Léon, Bordeaux 33076, France
| | - Shyam Visweswaran
- Department of Biomedical Informatics, University of Pittsburgh, 5607 Baum Blvd, Pittsburgh, PA 15206, United States
| | - Xuan Wang
- Department of Biomedical Informatics, Harvard Medical School, 10 Shattuck Street, Boston, MA 02115, United States
| | - Zongqi Xia
- Department of Neurology, University of Pittsburgh, 3501 5th Avenue, BST-3 Suite 7014, Pittsburgh, PA 15260, United States
| | - Joany M. Zachariasse
- Department of Biomedical Informatics, Harvard Medical School, 10 Shattuck Street, Boston, MA 02115, United States
| | - Jane W. Newburger
- Department of Cardiology, Boston Children's Hospital, Harvard Medical School, 300 Longwood Ave, Boston, MA 02115, United States
| | - Paul Avillach
- Department of Biomedical Informatics, Harvard Medical School, 10 Shattuck Street, Boston, MA 02115, United States
- Computational Health Informatics Program, Boston Children's Hospital, 300 Longwood Avenue, Boston, MA 02115, United States
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Hayward A, Robertson A, Thiruchelvam T, Broadhead M, Tsang VT, Sebire NJ, Issitt RW. Oxygen delivery in pediatric cardiac surgery and its association with acute kidney injury using machine learning. J Thorac Cardiovasc Surg 2023; 165:1505-1516. [PMID: 35840430 DOI: 10.1016/j.jtcvs.2022.05.039] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/14/2021] [Revised: 05/05/2022] [Accepted: 05/30/2022] [Indexed: 10/18/2022]
Abstract
OBJECTIVE Acute kidney injury (AKI) after pediatric cardiac surgery with cardiopulmonary bypass (CPB) is a frequently reported complication. In this study we aimed to determine the oxygen delivery indexed to body surface area (Do2i) threshold associated with postoperative AKI in pediatric patients during CPB, and whether it remains clinically important in the context of other known independent risk factors. METHODS A single-institution, retrospective study, encompassing 396 pediatric patients, who underwent heart surgery between April 2019 and April 2021 was undertaken. Time spent below Do2i thresholds were compared to determine the critical value for all stages of AKI occurring within 48 hours of surgery. Do2i threshold was then included in a classification analysis with known risk factors including nephrotoxic drug usage, surgical complexity, intraoperative data, comorbidities and ventricular function data, and vasoactive inotrope requirement to determine Do2i predictive importance. RESULTS Logistic regression models showed cumulative time spent below a Do2i value of 350 mL/min/m2 was associated with AKI. Random forest models, incorporating established risk factors, showed Do2i threshold still maintained predictive importance. Patients who developed post-CPB AKI were younger, had longer CPB and ischemic times, and required higher inotrope support postsurgery. CONCLUSIONS The present data support previous findings that Do2i during CPB is an independent risk factor for AKI development in pediatric patients. Furthermore, the data support previous suggestions of a higher threshold value in children compared with that in adults and indicate that adjustments in Do2i management might reduce incidence of postoperative AKI in the pediatric cardiac surgery population.
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Affiliation(s)
- Alice Hayward
- Department of Perfusion, Great Ormond Street Hospital, London, United Kingdom
| | - Alex Robertson
- Department of Perfusion, Great Ormond Street Hospital, London, United Kingdom
| | - Timothy Thiruchelvam
- Department of Intensive Care, Great Ormond Street Hospital, London, United Kingdom; Institute of Cardiovascular Science, University College London, London, United Kingdom
| | - Michael Broadhead
- Department of Anesthetics, Great Ormond Street Hospital, London, United Kingdom
| | - Victor T Tsang
- Institute of Cardiovascular Science, University College London, London, United Kingdom; Department of Cardiothoracic Surgery, Great Ormond Street Hospital, London, United Kingdom
| | - Neil J Sebire
- Digital Research, Informatics and Virtual Environment, NIHR Great Ormond Street Hospital BRC, London, United Kingdom
| | - Richard W Issitt
- Department of Perfusion, Great Ormond Street Hospital, London, United Kingdom; Institute of Cardiovascular Science, University College London, London, United Kingdom; Digital Research, Informatics and Virtual Environment, NIHR Great Ormond Street Hospital BRC, London, United Kingdom.
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4
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Weber GM, Hong C, Xia Z, Palmer NP, Avillach P, L'Yi S, Keller MS, Murphy SN, Gutiérrez-Sacristán A, Bonzel CL, Serret-Larmande A, Neuraz A, Omenn GS, Visweswaran S, Klann JG, South AM, Loh NHW, Cannataro M, Beaulieu-Jones BK, Bellazzi R, Agapito G, Alessiani M, Aronow BJ, Bell DS, Benoit V, Bourgeois FT, Chiovato L, Cho K, Dagliati A, DuVall SL, Barrio NG, Hanauer DA, Ho YL, Holmes JH, Issitt RW, Liu M, Luo Y, Lynch KE, Maidlow SE, Malovini A, Mandl KD, Mao C, Matheny ME, Moore JH, Morris JS, Morris M, Mowery DL, Ngiam KY, Patel LP, Pedrera-Jimenez M, Ramoni RB, Schriver ER, Schubert P, Balazote PS, Spiridou A, Tan ALM, Tan BWL, Tibollo V, Torti C, Trecarichi EM, Wang X, Kohane IS, Cai T, Brat GA. International comparisons of laboratory values from the 4CE collaborative to predict COVID-19 mortality. NPJ Digit Med 2022; 5:74. [PMID: 35697747 PMCID: PMC9192605 DOI: 10.1038/s41746-022-00601-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2021] [Accepted: 03/11/2022] [Indexed: 01/08/2023] Open
Abstract
Given the growing number of prediction algorithms developed to predict COVID-19 mortality, we evaluated the transportability of a mortality prediction algorithm using a multi-national network of healthcare systems. We predicted COVID-19 mortality using baseline commonly measured laboratory values and standard demographic and clinical covariates across healthcare systems, countries, and continents. Specifically, we trained a Cox regression model with nine measured laboratory test values, standard demographics at admission, and comorbidity burden pre-admission. These models were compared at site, country, and continent level. Of the 39,969 hospitalized patients with COVID-19 (68.6% male), 5717 (14.3%) died. In the Cox model, age, albumin, AST, creatine, CRP, and white blood cell count are most predictive of mortality. The baseline covariates are more predictive of mortality during the early days of COVID-19 hospitalization. Models trained at healthcare systems with larger cohort size largely retain good transportability performance when porting to different sites. The combination of routine laboratory test values at admission along with basic demographic features can predict mortality in patients hospitalized with COVID-19. Importantly, this potentially deployable model differs from prior work by demonstrating not only consistent performance but also reliable transportability across healthcare systems in the US and Europe, highlighting the generalizability of this model and the overall approach.
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Affiliation(s)
- Griffin M Weber
- Department of Biomedical Informatics, Harvard Medical School, Boston, USA
| | - Chuan Hong
- Department of Biomedical Informatics, Harvard Medical School, Boston, USA
- Department of Biostatistics and Bioinformatics, Duke University, Durham, USA
| | - Zongqi Xia
- Department of Neurology, University of Pittsburgh, Pittsburgh, USA
| | - Nathan P Palmer
- Department of Biomedical Informatics, Harvard Medical School, Boston, USA
| | - Paul Avillach
- Department of Biomedical Informatics, Harvard Medical School, Boston, USA
| | - Sehi L'Yi
- Department of Biomedical Informatics, Harvard Medical School, Boston, USA
| | - Mark S Keller
- Department of Biomedical Informatics, Harvard Medical School, Boston, USA
| | - Shawn N Murphy
- Department of Neurology, Massachusetts General Hospital, Boston, USA
| | | | - Clara-Lea Bonzel
- Department of Biomedical Informatics, Harvard Medical School, Boston, USA
| | - Arnaud Serret-Larmande
- Department of biomedical informatics, Hôpital Européen Georges Pompidou, Assistance Publique - Hôpitaux de Paris, Paris, France
| | - Antoine Neuraz
- Department of biomedical informatics, Hôpital Necker-Enfants Malade, Assistance Publique Hôpitaux de Paris (APHP), University of Paris, Paris, France
| | - Gilbert S Omenn
- Department of Computational Medicine & Bioinformatics, Internal Medicine, Human Genetics, and School of Public Health, University of Michigan, Ann Arbor, USA
| | - Shyam Visweswaran
- Department of Biomedical Informatics, University of Pittsburgh, Pittsburgh, USA
| | - Jeffrey G Klann
- Department of Medicine, Massachusetts General Hospital, Boston, USA
| | - Andrew M South
- Department of Pediatrics-Section of Nephrology, Brenner Children's Hospital, Wake Forest School of Medicine, Winston Salem, USA
| | - Ne Hooi Will Loh
- Department of Anaesthesia, National University Health System, Singapore, Singapore, Singapore
| | - Mario Cannataro
- Department of Medical and Surgical Sciences, Data Analytics Research Center, University Magna Graecia of Catanzaro, Italy, Catanzaro, Italy
| | | | - Riccardo Bellazzi
- Department of Electrical, Computer and Biomedical Engineering, University of Pavia, Italy, Pavia, Italy
| | - Giuseppe Agapito
- Department of Legal, Economic and Social Sciences, University Magna Graecia of Catanzaro, Italy, Catanzaro, Italy
| | - Mario Alessiani
- Department of Surgery, ASST Pavia, Lombardia Region Health System, Pavia, Italy
| | - Bruce J Aronow
- Departments of Biomedical Informatics, Pediatrics, Cincinnati Children's Hospital Medical Center, University of Cincinnati, Cincinnati, USA
| | - Douglas S Bell
- Department of Medicine, David Geffen School of Medicine at UCLA, Los Angeles, USA
| | - Vincent Benoit
- IT department, Innovation & Data, APHP Greater Paris University Hospital, Paris, France
| | | | - Luca Chiovato
- Unit of Internal Medicine and Endocrinology, Istituti Clinici Scientifici Maugeri SpA SB IRCCS, Pavia, Italy
| | - Kelly Cho
- Massachusetts Veterans Epidemiology Research and Information Center (MAVERIC), VA Boston Healthcare System, Boston, USA
| | - Arianna Dagliati
- Department of Electrical Computer and Biomedical Engineering, University of Pavia, Italy, Pavia, Italy
| | - Scott L DuVall
- VA Informatics and Computing Infrastructure, VA Salt Lake City Health Care System, Salt Lake City, USA
| | | | - David A Hanauer
- Department of Learning Health Sciences, University of Michigan, Ann Arbor, USA
| | - Yuk-Lam Ho
- Massachusetts Veterans Epidemiology Research and Information Center (MAVERIC), VA Boston Healthcare System, Boston, USA
| | - John H Holmes
- Department of Biostatistics, Epidemiology, and Informatics, University of Pennsylvania Perelman School of Medicine, Philadelphia, USA
- Institute for Biomedical Informatics, University of Pennsylvania Perelman School of Medicine, Philadelphia, USA
| | - Richard W Issitt
- Digital Research, Informatics and Virtual Environments (DRIVE), Great Ormond Street Hospital for Children, UK, London, UK
| | - Molei Liu
- Department of Biostatistics, Harvard School of Public Health, Boston, USA
| | - Yuan Luo
- Department of Preventive Medicine, Northwestern University, Chicago, USA
| | - Kristine E Lynch
- VA Informatics and Computing Infrastructure, VA Salt Lake City Health Care System, Salt Lake City, USA
| | - Sarah E Maidlow
- Michigan Institute for Clinical and Health Research, University of Michigan, Ann Arbor, USA
| | - Alberto Malovini
- Laboratory of Informatics and Systems Engineering for Clinical Research, Istituti Clinici Scientifici Maugeri SpA SB IRCCS, Pavia, Italy
| | - Kenneth D Mandl
- Computational Health Informatics Program, Boston Children's Hospital, Boston, USA
| | - Chengsheng Mao
- Department of Preventive Medicine, Northwestern University, Chicago, USA
| | - Michael E Matheny
- VA Informatics and Computing Infrastructure, Tennessee Valley Healthcare System Veterans Affairs Medical Center, Nashville, USA
| | - Jason H Moore
- Institute for Biomedical Informatics, University of Pennsylvania Perelman School of Medicine, Philadelphia, USA
| | - Jeffrey S Morris
- Department of Biostatistics, Epidemiology, and Biostatistics, University of Pennysylvania Perelman School of Medicine, Philadelphia, USA
| | - Michele Morris
- Department of Biomedical Informatics, University of Pittsburgh, Pittsburgh, USA
| | - Danielle L Mowery
- Department of Biostatistics, Epidemiology, and Informatics, University of Pennsylvania Perelman School of Medicine, Philadelphia, USA
| | - Kee Yuan Ngiam
- Department of Biomedical informatics, WiSDM, National University Health Systems Singapore, Singapore, Singapore
| | - Lav P Patel
- Department of Internal Medicine, Division of Medical Informatics, University of Kansas Medical Center, Kansas City, USA
| | | | - Rachel B Ramoni
- Office of Research and Development, Department of Veterans Affairs, Washington, DC, USA
| | - Emily R Schriver
- Data Analytics Center, University of Pennsylvania Health System, Philadelphia, USA
| | - Petra Schubert
- Massachusetts Veterans Epidemiology Research and Information Center (MAVERIC), VA Boston Healthcare System, Boston, USA
| | | | - Anastasia Spiridou
- Digital Research, Informatics and Virtual Environments (DRIVE), Great Ormond Street Hospital for Children, UK, London, UK
| | - Amelia L M Tan
- Department of Biomedical Informatics, Harvard Medical School, Boston, USA
| | - Byorn W L Tan
- Department of Medicine, National University Hospital, Singapore, Singapore, Singapore
| | - Valentina Tibollo
- Laboratory of Informatics and Systems Engineering for Clinical Research, Istituti Clinici Scientifici Maugeri SpA SB IRCCS, Pavia, Italy
| | - Carlo Torti
- Department of Medical and Surgical Sciences, Infectious and Tropical Disease Unit, University Magna Graecia of Catanzaro, Italy, Catanzaro, Italy
| | - Enrico M Trecarichi
- Department of Medical and Surgical Sciences, Infectious and Tropical Disease Unit, University Magna Graecia of Catanzaro, Italy, Catanzaro, Italy
| | - Xuan Wang
- Department of Biomedical Informatics, Harvard Medical School, Boston, USA
| | - Isaac S Kohane
- Department of Biomedical Informatics, Harvard Medical School, Boston, USA
| | - Tianxi Cai
- Department of Biomedical Informatics, Harvard Medical School, Boston, USA.
| | - Gabriel A Brat
- Department of Biomedical Informatics, Harvard Medical School, Boston, USA.
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5
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Issitt RW, Cortina-Borja M, Bryant W, Bowyer S, Taylor AM, Sebire N. Classification Performance of Neural Networks Versus Logistic Regression Models: Evidence From Healthcare Practice. Cureus 2022; 14:e22443. [PMID: 35345728 PMCID: PMC8942139 DOI: 10.7759/cureus.22443] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/20/2022] [Indexed: 12/19/2022] Open
Abstract
Machine learning encompasses statistical approaches such as logistic regression (LR) through to more computationally complex models such as neural networks (NN). The aim of this study is to review current published evidence for performance from studies directly comparing logistic regression, and neural network classification approaches in medicine. A literature review was carried out to identify primary research studies which provided information regarding comparative area under the curve (AUC) values for the overall performance of both LR and NN for a defined clinical healthcare-related problem. Following an initial search, articles were reviewed to remove those that did not meet the criteria and performance metrics were extracted from the included articles. Teh initial search revealed 114 articles; 21 studies were included in the study. In 13/21 (62%) of cases, NN had a greater AUC compared to LR, but in most the difference was small and unlikely to be of clinical significance; (unweighted mean difference in AUC 0.03 (95% CI 0-0.06) in favour of NN versus LR. In the majority of cases examined across a range of clinical settings, LR models provide reasonable performance that is only marginally improved using more complex methods such as NN. In many circumstances, the use of a relatively simple LR model is likely to be adequate for real-world needs but in specific circumstances in which large amounts of data are available, and where even small increases in performance would provide significant management value, the application of advanced analytic tools such as NNs may be indicated.
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Affiliation(s)
- Richard W Issitt
- Clinical Informatics, Great Ormond Street Hospital, National Institute for Health Research (NIHR) Biomedical Research Centre (BRC) University College London (UCL), London, GBR
| | - Mario Cortina-Borja
- Statistics, Great Ormond Street Institute of Child Health, University College London (UCL), London, GBR
| | - William Bryant
- Clinical Informatics, Great Ormond Street Hospital, National Institute for Health Research (NIHR) Biomedical Research Centre (BRC) University College London (UCL), London, GBR
| | - Stuart Bowyer
- Clinical Informatics, Great Ormond Street Hospital, National Institute for Health Research (NIHR) Biomedical Research Centre (BRC) University College London (UCL), London, GBR
| | - Andrew M Taylor
- Clinical Informatics, Great Ormond Street Hospital, National Institute for Health Research (NIHR) Biomedical Research Centre (BRC) University College London (UCL), London, GBR
| | - Neil Sebire
- Clinical Informatics, Great Ormond Street Hospital, National Institute for Health Research (NIHR) Biomedical Research Centre (BRC) University College London (UCL), London, GBR
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Bourgeois FT, Gutiérrez-Sacristán A, Keller MS, Liu M, Hong C, Bonzel CL, Tan ALM, Aronow BJ, Boeker M, Booth J, Cruz Rojo J, Devkota B, García Barrio N, Gehlenborg N, Geva A, Hanauer DA, Hutch MR, Issitt RW, Klann JG, Luo Y, Mandl KD, Mao C, Moal B, Moshal KL, Murphy SN, Neuraz A, Ngiam KY, Omenn GS, Patel LP, Jiménez MP, Sebire NJ, Balazote PS, Serret-Larmande A, South AM, Spiridou A, Taylor DM, Tippmann P, Visweswaran S, Weber GM, Kohane IS, Cai T, Avillach P. International Analysis of Electronic Health Records of Children and Youth Hospitalized With COVID-19 Infection in 6 Countries. JAMA Netw Open 2021; 4:e2112596. [PMID: 34115127 PMCID: PMC8196345 DOI: 10.1001/jamanetworkopen.2021.12596] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
IMPORTANCE Additional sources of pediatric epidemiological and clinical data are needed to efficiently study COVID-19 in children and youth and inform infection prevention and clinical treatment of pediatric patients. OBJECTIVE To describe international hospitalization trends and key epidemiological and clinical features of children and youth with COVID-19. DESIGN, SETTING, AND PARTICIPANTS This retrospective cohort study included pediatric patients hospitalized between February 2 and October 10, 2020. Patient-level electronic health record (EHR) data were collected across 27 hospitals in France, Germany, Spain, Singapore, the UK, and the US. Patients younger than 21 years who tested positive for COVID-19 and were hospitalized at an institution participating in the Consortium for Clinical Characterization of COVID-19 by EHR were included in the study. MAIN OUTCOMES AND MEASURES Patient characteristics, clinical features, and medication use. RESULTS There were 347 males (52%; 95% CI, 48.5-55.3) and 324 females (48%; 95% CI, 44.4-51.3) in this study's cohort. There was a bimodal age distribution, with the greatest proportion of patients in the 0- to 2-year (199 patients [30%]) and 12- to 17-year (170 patients [25%]) age range. Trends in hospitalizations for 671 children and youth found discrete surges with variable timing across 6 countries. Data from this cohort mirrored national-level pediatric hospitalization trends for most countries with available data, with peaks in hospitalizations during the initial spring surge occurring within 23 days in the national-level and 4CE data. A total of 27 364 laboratory values for 16 laboratory tests were analyzed, with mean values indicating elevations in markers of inflammation (C-reactive protein, 83 mg/L; 95% CI, 53-112 mg/L; ferritin, 417 ng/mL; 95% CI, 228-607 ng/mL; and procalcitonin, 1.45 ng/mL; 95% CI, 0.13-2.77 ng/mL). Abnormalities in coagulation were also evident (D-dimer, 0.78 ug/mL; 95% CI, 0.35-1.21 ug/mL; and fibrinogen, 477 mg/dL; 95% CI, 385-569 mg/dL). Cardiac troponin, when checked (n = 59), was elevated (0.032 ng/mL; 95% CI, 0.000-0.080 ng/mL). Common complications included cardiac arrhythmias (15.0%; 95% CI, 8.1%-21.7%), viral pneumonia (13.3%; 95% CI, 6.5%-20.1%), and respiratory failure (10.5%; 95% CI, 5.8%-15.3%). Few children were treated with COVID-19-directed medications. CONCLUSIONS AND RELEVANCE This study of EHRs of children and youth hospitalized for COVID-19 in 6 countries demonstrated variability in hospitalization trends across countries and identified common complications and laboratory abnormalities in children and youth with COVID-19 infection. Large-scale informatics-based approaches to integrate and analyze data across health care systems complement methods of disease surveillance and advance understanding of epidemiological and clinical features associated with COVID-19 in children and youth.
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Affiliation(s)
- Florence T. Bourgeois
- Department of Pediatrics, Harvard Medical School, Boston, Massachusetts
- Computational Health Informatics Program, Boston Children’s Hospital, Boston, Massachusetts
| | | | - Mark S. Keller
- Department of Biomedical Informatics, Harvard Medical School, Boston, Massachusetts
| | - Molei Liu
- Department of Biostatistics, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
| | - Chuan Hong
- Department of Biomedical Informatics, Harvard Medical School, Boston, Massachusetts
| | - Clara-Lea Bonzel
- Department of Biomedical Informatics, Harvard Medical School, Boston, Massachusetts
| | - Amelia L. M. Tan
- Department of Biomedical Informatics, Harvard Medical School, Boston, Massachusetts
| | - Bruce J. Aronow
- Departments of Biomedical Informatics, Pediatrics, Cincinnati Children's Hospital Medical Center, University of Cincinnati, Ohio
| | - Martin Boeker
- Institute of Medical Biometry and Statistics, Faculty of Medicine and Medical Center, University of Freiburg, Germany
| | - John Booth
- Digital Research, Informatics and Virtual Environments (DRIVE), Great Ormond Street Hospital for Children, London, United Kingdom
| | - Jaime Cruz Rojo
- Department of Health Informatics, Hospital Universitario 12 de Octubre, Madrid, Spain
| | - Batsal Devkota
- Department of Biomedical Health Informatics and the Department of Pediatrics, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Noelia García Barrio
- Department of Health Informatics, Hospital Universitario 12 de Octubre, Madrid, Spain
| | - Nils Gehlenborg
- Department of Biomedical Informatics, Harvard Medical School, Boston, Massachusetts
| | - Alon Geva
- Computational Health Informatics Program, Boston Children’s Hospital, Boston, Massachusetts
- Department of Anesthesiology, Critical Care, and Pain Medicine, Boston Children’s Hospital, Boston, Massachusetts
| | - David A. Hanauer
- Department of Learning Health Sciences, University of Michigan, Ann Arbor
| | - Meghan R. Hutch
- Department of Preventive Medicine, Northwestern University, Evanston, Illinois
| | - Richard W. Issitt
- Digital Research, Informatics and Virtual Environments (DRIVE), Great Ormond Street Hospital for Children, London, United Kingdom
| | | | - Yuan Luo
- Department of Preventive Medicine, Northwestern University, Evanston, Illinois
| | - Kenneth D. Mandl
- Computational Health Informatics Program, Boston Children’s Hospital, Boston, Massachusetts
| | - Chengsheng Mao
- Department of Preventive Medicine, Northwestern University, Evanston, Illinois
| | - Bertrand Moal
- IAM Unit, Bordeaux University Hospital, Bordeaux, France
| | - Karyn L. Moshal
- Department of Infectious Diseases, Great Ormond Street Hospital for Children, London, United Kingdom
| | - Shawn N. Murphy
- Department of Neurology, Massachusetts General Hospital, Boston, Massachusetts
| | - Antoine Neuraz
- Department of Biomedical Informatics, Hôpital Necker-Enfants Malade, Assistance Publique Hôpitaux de Paris, University of Paris, Paris, France
| | - Kee Yuan Ngiam
- Department of Biomedical informatics, WiSDM, National University Health Systems Singapore, Singapore
| | - Gilbert S Omenn
- Department of Computational Medicine & Bioinformatics, Internal Medicine, Human Genetics, & School of Public Health, University of Michigan, Ann Arbor
| | - Lav P. Patel
- Department of Internal Medicine, Division of Medical Informatics, University of Kansas Medical Center, Kansas City
| | | | - Neil J. Sebire
- Digital Research, Informatics and Virtual Environments (DRIVE), Great Ormond Street Hospital for Children, London, United Kingdom
| | | | | | - Andrew M. South
- Department of Pediatrics-Section of Nephrology, Brenner Children's Hospital, Wake Forest School of Medicine, Winston Salem, North Carolina
| | - Anastasia Spiridou
- Digital Research, Informatics and Virtual Environments (DRIVE), Great Ormond Street Hospital for Children, London, United Kingdom
| | - Deanne M. Taylor
- Department of Biomedical Health Informatics and the Department of Pediatrics, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
- Department of Pediatrics, Perelman Medical School at the University of Pennsylvania, Philadelphia
| | - Patric Tippmann
- Institute of Medical Biometry and Statistics, Faculty of Medicine and Medical Center, University of Freiburg, Germany
| | - Shyam Visweswaran
- Department of Biomedical Informatics, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Griffin M. Weber
- Department of Biomedical Informatics, Harvard Medical School, Boston, Massachusetts
| | - Isaac S. Kohane
- Department of Biomedical Informatics, Harvard Medical School, Boston, Massachusetts
| | - Tianxi Cai
- Department of Biomedical Informatics, Harvard Medical School, Boston, Massachusetts
| | - Paul Avillach
- Computational Health Informatics Program, Boston Children’s Hospital, Boston, Massachusetts
- Department of Biomedical Informatics, Harvard Medical School, Boston, Massachusetts
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Weber GM, Hong C, Palmer NP, Avillach P, Murphy SN, Gutiérrez-Sacristán A, Xia Z, Serret-Larmande A, Neuraz A, Omenn GS, Visweswaran S, Klann JG, South AM, Loh NHW, Cannataro M, Beaulieu-Jones BK, Bellazzi R, Agapito G, Alessiani M, Aronow BJ, Bell DS, Bellasi A, Benoit V, Beraghi M, Boeker M, Booth J, Bosari S, Bourgeois FT, Brown NW, Bucalo M, Chiovato L, Chiudinelli L, Dagliati A, Devkota B, DuVall SL, Follett RW, Ganslandt T, García Barrio N, Gradinger T, Griffier R, Hanauer DA, Holmes JH, Horki P, Huling KM, Issitt RW, Jouhet V, Keller MS, Kraska D, Liu M, Luo Y, Lynch KE, Malovini A, Mandl KD, Mao C, Maram A, Matheny ME, Maulhardt T, Mazzitelli M, Milano M, Moore JH, Morris JS, Morris M, Mowery DL, Naughton TP, Ngiam KY, Norman JB, Patel LP, Pedrera Jimenez M, Ramoni RB, Schriver ER, Scudeller L, Sebire NJ, Serrano Balazote P, Spiridou A, Tan AL, Tan BW, Tibollo V, Torti C, Trecarichi EM, Vitacca M, Zambelli A, Zucco C, Kohane IS, Cai T, Brat GA. International Comparisons of Harmonized Laboratory Value Trajectories to Predict Severe COVID-19: Leveraging the 4CE Collaborative Across 342 Hospitals and 6 Countries: A Retrospective Cohort Study. medRxiv 2021:2020.12.16.20247684. [PMID: 33564777 PMCID: PMC7872369 DOI: 10.1101/2020.12.16.20247684] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Objectives To perform an international comparison of the trajectory of laboratory values among hospitalized patients with COVID-19 who develop severe disease and identify optimal timing of laboratory value collection to predict severity across hospitals and regions. Design Retrospective cohort study. Setting The Consortium for Clinical Characterization of COVID-19 by EHR (4CE), an international multi-site data-sharing collaborative of 342 hospitals in the US and in Europe. Participants Patients hospitalized with COVID-19, admitted before or after PCR-confirmed result for SARS-CoV-2. Primary and secondary outcome measures Patients were categorized as "ever-severe" or "never-severe" using the validated 4CE severity criteria. Eighteen laboratory tests associated with poor COVID-19-related outcomes were evaluated for predictive accuracy by area under the curve (AUC), compared between the severity categories. Subgroup analysis was performed to validate a subset of laboratory values as predictive of severity against a published algorithm. A subset of laboratory values (CRP, albumin, LDH, neutrophil count, D-dimer, and procalcitonin) was compared between North American and European sites for severity prediction. Results Of 36,447 patients with COVID-19, 19,953 (43.7%) were categorized as ever-severe. Most patients (78.7%) were 50 years of age or older and male (60.5%). Longitudinal trajectories of CRP, albumin, LDH, neutrophil count, D-dimer, and procalcitonin showed association with disease severity. Significant differences of laboratory values at admission were found between the two groups. With the exception of D-dimer, predictive discrimination of laboratory values did not improve after admission. Sub-group analysis using age, D-dimer, CRP, and lymphocyte count as predictive of severity at admission showed similar discrimination to a published algorithm (AUC=0.88 and 0.91, respectively). Both models deteriorated in predictive accuracy as the disease progressed. On average, no difference in severity prediction was found between North American and European sites. Conclusions Laboratory test values at admission can be used to predict severity in patients with COVID-19. Prediction models show consistency across international sites highlighting the potential generalizability of these models.
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Affiliation(s)
- Griffin M Weber
- Harvard Medical School, Department of Biomedical Informatics
| | - Chuan Hong
- Harvard Medical School, Department of Biomedical Informatics
| | - Nathan P Palmer
- Harvard Medical School, Department of Biomedical Informatics
| | - Paul Avillach
- Harvard Medical School, Department of Biomedical Informatics
| | | | | | | | - Arnaud Serret-Larmande
- Ho pital Européen Georges Pompidou, Assistance Publique - Ho pitaux de Paris, Department of biomedical informatics
| | | | - Gilbert S Omenn
- University of Michigan, Dept of Computational Medicine & Bioinformatics, Internal Medicine, Human Genetics, and School of Public Health
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - John Booth
- Great Ormond Street Hospital for Children
| | - Silvano Bosari
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico
| | | | | | - Mauro Bucalo
- BIOMERIS (BIOMedical Research Informatics Solutions)
| | | | | | | | | | | | | | - Thomas Ganslandt
- Ruprecht Karls University Heidelberg Faculty of Medicine Mannheim
| | | | - Tobias Gradinger
- Ruprecht Karls University Heidelberg Faculty of Medicine Mannheim
| | | | - David A Hanauer
- University of Michigan Institute for Healthcare Policy & Innovation
| | - John H Holmes
- University of Pennsylvania Perelman School of Medicine
| | | | | | | | | | - Mark S Keller
- Harvard Medical School, Department of Biomedical Informatics
| | | | - Molei Liu
- Harvard University T H Chan School of Public Health
| | | | | | | | - Kenneth D Mandl
- Boston Children's Hospital, Computational Health Informatics Program
| | | | | | | | | | | | | | - Jason H Moore
- University of Pennsylvania Perelman School of Medicine
| | | | | | | | | | | | - James B Norman
- Harvard Medical School, Department of Biomedical Informatics
| | | | | | | | | | | | | | | | | | - Amelia Lm Tan
- Harvard Medical School, Department of Biomedical Informatics
| | | | | | | | | | | | | | | | - Isaac S Kohane
- Harvard Medical School, Department of Biomedical Informatics
| | - Tianxi Cai
- Harvard Medical School, Department of Biomedical Informatics
| | - Gabriel A Brat
- Beth Israel Deaconess Medical Center, Surgery
- Harvard Medical School, Department of Biomedical Informatics
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Issitt RW, Booth J, Bryant WA, Spiridou A, Taylor AM, du Pré P, Ramnarayan P, Hartley J, Cortina-Borja M, Moshal K, Dunn H, Hemingway H, Sebire NJ. Children with COVID-19 at a specialist centre: initial experience and outcome. Lancet Child Adolesc Health 2020; 4:e30-e31. [PMID: 32585186 PMCID: PMC7308787 DOI: 10.1016/s2352-4642(20)30204-2] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 05/28/2020] [Revised: 06/12/2020] [Accepted: 06/18/2020] [Indexed: 01/26/2023]
Affiliation(s)
- Richard W Issitt
- Digital Research and Informatics Unit, Great Ormond Street Hospital and Great Ormond Street Institute of Child Health and NIHR GOSH Biomedical Research Centre, London WC1N 3JH, UK,Institute of Cardiovascular Science, University College London, United Kingdom
| | - John Booth
- Digital Research and Informatics Unit, Great Ormond Street Hospital and Great Ormond Street Institute of Child Health and NIHR GOSH Biomedical Research Centre, London WC1N 3JH, UK
| | - William A Bryant
- Digital Research and Informatics Unit, Great Ormond Street Hospital and Great Ormond Street Institute of Child Health and NIHR GOSH Biomedical Research Centre, London WC1N 3JH, UK
| | - Anastasia Spiridou
- Digital Research and Informatics Unit, Great Ormond Street Hospital and Great Ormond Street Institute of Child Health and NIHR GOSH Biomedical Research Centre, London WC1N 3JH, UK
| | - Andrew M Taylor
- Institute of Cardiovascular Science, University College London, United Kingdom
| | - Pascale du Pré
- Digital Research and Informatics Unit, Great Ormond Street Hospital and Great Ormond Street Institute of Child Health and NIHR GOSH Biomedical Research Centre, London WC1N 3JH, UK
| | - Pad Ramnarayan
- Digital Research and Informatics Unit, Great Ormond Street Hospital and Great Ormond Street Institute of Child Health and NIHR GOSH Biomedical Research Centre, London WC1N 3JH, UK
| | - John Hartley
- Digital Research and Informatics Unit, Great Ormond Street Hospital and Great Ormond Street Institute of Child Health and NIHR GOSH Biomedical Research Centre, London WC1N 3JH, UK
| | - Maria Cortina-Borja
- Faculty of Population Health Sciences, University College London, United Kingdom
| | - Karyn Moshal
- Digital Research and Informatics Unit, Great Ormond Street Hospital and Great Ormond Street Institute of Child Health and NIHR GOSH Biomedical Research Centre, London WC1N 3JH, UK
| | - Helen Dunn
- Digital Research and Informatics Unit, Great Ormond Street Hospital and Great Ormond Street Institute of Child Health and NIHR GOSH Biomedical Research Centre, London WC1N 3JH, UK
| | - Harry Hemingway
- Institute of Health Informatics UCL and NIHR UCLH Biomedical Research Centre, London UK
| | - Neil J Sebire
- Digital Research and Informatics Unit, Great Ormond Street Hospital and Great Ormond Street Institute of Child Health and NIHR GOSH Biomedical Research Centre, London WC1N 3JH, UK
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Issitt RW, Harvey I, Walsh B, Voegeli D. Quantification of Lipid Filtration and the Effects on Cerebral Injury During Cardiopulmonary Bypass. Ann Thorac Surg 2017; 104:884-890. [DOI: 10.1016/j.athoracsur.2017.02.022] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2016] [Revised: 02/03/2017] [Accepted: 02/06/2017] [Indexed: 11/24/2022]
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Issitt RW. Invited Commentary on: Effect of cardiopulmonary bypass on platelet mitochondrial respiration and correlation with aggregation and bleeding: a pilot study. Perfusion 2016; 31:516-7. [PMID: 27353803 DOI: 10.1177/0267659116657167] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- Richard W Issitt
- Department of Clinical Perfusion Science, Great Ormond Street Children's Hospital, London, UK
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Issitt RW, Robertson DA, Crook RM, Cross NT, Shaw M, Tsang VT. Tetralogy of Fallot with pulmonary atresia and major aortopulmonary collateral vessels. Perfusion 2014; 29:567-70. [PMID: 24947458 DOI: 10.1177/0267659114540019] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Major aortopulmonary collateral arteries (MAPCAs) provide significant issues during cardiopulmonary bypass, including flooding of the surgical field which requires significant blood volumes to be returned to the extracorporeal circuit via handheld suckers. This has been shown to be the major source of gaseous microemboli and is associated with adverse neurological outcome. Use of pH-stat has been previously shown to decrease the shunt through MAPCAs via an unknown mechanism. Here, we report the associated benefits of pH-stat in decreasing sucker usage and gaseous microemboli in a patient with known MAPCAs presenting for repair of tetralogy of Fallot and pulmonary atresia.
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Affiliation(s)
- R W Issitt
- Department of Clinical Perfusion, Great Ormond Street Hospital, London, UK Institute of Cardiovascular Science, University College London, UK
| | - D A Robertson
- Department of Clinical Perfusion, Great Ormond Street Hospital, London, UK
| | - R M Crook
- Department of Clinical Perfusion, Great Ormond Street Hospital, London, UK
| | - N T Cross
- Department of Clinical Perfusion, Great Ormond Street Hospital, London, UK
| | - M Shaw
- Department of Clinical Perfusion, Great Ormond Street Hospital, London, UK
| | - V T Tsang
- Institute of Cardiovascular Science, University College London, UK Department of Cardiothoracic Surgery, Great Ormond Street Hospital, London, UK
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12
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Issitt RW, Crook RM, Cross NT, Shaw M, Robertson A, Burch M, Hsia TY, Tsang VT. Incompatible ABO-plasma exchange and its impact on patient selection in paediatric cardiac transplantation. Perfusion 2012; 27:480-5. [PMID: 22773392 DOI: 10.1177/0267659112453076] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVES A decade ago, the first series of ABO-incompatible heart transplants was published, with surprising and extremely promising results; drastically reduced waiting list mortalities of infants listed for heart transplantation. Essential to the procedure was the process of plasma exchange transfusion, required to reduce isohaemagglutinin titres and facilitate the crossing of ABO blood group boundaries. Since then, Great Ormond Street Hospital, London has offered ABO-incompatible heart transplants to infants who potentially would die waiting for a suitable organ. We report the results of a decade of evolving plasma exchange experience and its impact upon patient selection. METHODS A retrospective analysis was undertaken of all elective ABO-incompatible heart transplants at Great Ormond Street Children's Hospital from January 2001 until January 2011. Data were sought on underlying conditions and demographics of the patients, the isohaemagglutinin titre before and after plasma exchange and survival figures to date. RESULTS Twenty-one patients underwent ABO-incompatible heart transplantation, ranging from 3 to 44 months, with preoperative isohaemagglutinin titres ranging from 0 to 1:32. All patients underwent a "3 times" plasma exchange before transplantation, requiring exchange volumes of up to 3209 mL. Postoperative isohaemagglutinin titres ranged from 0 to 1:16. One patient died of causes unrelated to organ rejection. CONCLUSIONS Our data showed that eight patients (38.1%) were older than the previously suggested 12-month cut-off age. Using a combination of adult reservoir/paediatric oxygenator and extracorporeal circuit, ABO-incompatible plasma exchange transfusions can be undertaken safely using a simplified '3 times' method, reducing the circulating levels of isohaemagglutinins whilst providing minimal circuit size. This allows ABO-incompatible heart transplantation in a broader patient population than previously reported.
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Affiliation(s)
- R W Issitt
- Department of Clinical Perfusion Science, Great Ormond Street Children's Hospital, London, UK.
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