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Patel A, Doernberg SB, Zack T, Butte AJ, Radtke KK. Predictive Modeling of Drug-Related Adverse Events with Real-World Data: A Case Study of Linezolid Hematologic Outcomes. Clin Pharmacol Ther 2024; 115:847-859. [PMID: 38345264 DOI: 10.1002/cpt.3201] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2023] [Accepted: 01/29/2024] [Indexed: 03/21/2024]
Abstract
Electronic health records (EHRs) provide meaningful knowledge of drug-related adverse events (AEs) that are not captured in standard drug development and postmarketing surveillance. Using variables obtained from EHR data in the University of California San Francisco de-identified Clinical Data Warehouse, we aimed to evaluate the potential of machine learning to predict two hematological AEs, thrombocytopenia and anemia, in a cohort of patients treated with linezolid for 3 or more days. Features for model input were extracted at linezolid initiation (index), and outcomes were characterized from index to 14 days post-treatment. Random forest classification (RFC) was used for AE prediction, and reduced feature models were evaluated using cumulative importance (cImp) for feature selection. Grade 3+ thrombocytopenia and anemia occurred in 31% of 2,171 and 56% of 2,170 evaluable patients, respectively. Of the total 53 features, as few as 7 contributed at least 50% cImp, resulting in prediction accuracies of 70% or higher and area under the receiver operating characteristic curves of 0.886 for grade 3+ thrombocytopenia and 0.759 for grade 3+ anemia. Sensitivity analyses in strictly defined patient subgroups revealed similarly high predictive performance in full and reduced feature models. A logistic regression model with the same 50% cImp features showed similar predictive performance as RFC and good concordance with RFC probability predictions after isotonic calibration, adding interpretability. Collectively, this work demonstrates potential for machine learning prediction of AE risk in real-world patients using few variables regularly available in EHRs, which may aid in clinical decision making and/or monitoring.
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Affiliation(s)
- Anu Patel
- Department of Bioengineering and Therapeutic Sciences, University of California San Francisco, San Francisco, California, USA
| | - Sarah B Doernberg
- Division of Infectious Diseases, Department of Medicine, University of California San Francisco, San Francisco, California, USA
| | - Travis Zack
- Bakar Computational Health Sciences Institute, University of California San Francisco, San Francisco, California, USA
- Helen Diller Family Comprehensive Cancer Center, University of California San Francisco, San Francisco, California, USA
| | - Atul J Butte
- Department of Bioengineering and Therapeutic Sciences, University of California San Francisco, San Francisco, California, USA
- Bakar Computational Health Sciences Institute, University of California San Francisco, San Francisco, California, USA
- University of California Health, University of California, Office of the President, Oakland, California, USA
| | - Kendra K Radtke
- Department of Bioengineering and Therapeutic Sciences, University of California San Francisco, San Francisco, California, USA
- Bakar Computational Health Sciences Institute, University of California San Francisco, San Francisco, California, USA
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Sankar J, Agarwal S, Goyal A, Kabra SK, Lodha R. Pediatric Sepsis Phenotypes and Outcome: 5-Year Retrospective Cohort Study in a Single Center in India (2017-2022). Pediatr Crit Care Med 2024; 25:e186-e192. [PMID: 38305702 DOI: 10.1097/pcc.0000000000003449] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2024]
Abstract
OBJECTIVES To describe mortality associated with different clinical phenotypes of sepsis in children. DESIGN Retrospective study. SETTING PICU of a tertiary care center in India from 2017 to 2022. PATIENTS Six hundred twelve children (from 2 mo to 17 yr old) with a retrospectively applied diagnosis of sepsis using 2020 guidance. METHODS The main outcome was mortality associated with sepsis subtypes. Other analyses included assessment of risk factors, requirement for organ support, and PICU resources used by sepsis phenotype. Clinical data were recorded on a predesigned proforma. INTERVENTIONS None. MEASUREMENTS AND RESULTS Of the 612 children identified, there were 382 (62%) with sepsis but no multiple organ failure (NoMOF), 48 (8%) with thrombocytopenia-associated MOF (TAMOF), 140 (23%) with MOF without thrombocytopenia, and 40 (6.5%) with sequential MOF (SMOF). Mortality was higher in the SMOF (20/40 [50%]), MOF (62/140 [44%]) and TAMOF (20/48 [42%]) groups, compared with NoMOF group (82/382 [21%] [ p < 0.001]). The requirement for organ support and PICU resources was higher in all phenotypes with MOF as compared with those without MOF. On multivariable analysis elevated lactate and having MOF were associated with greater odds of mortality. CONCLUSIONS In this single-center experience of sepsis in India, we found that sepsis phenotypes having MOF were associated with mortality and the requirement of PICU resources. Prospective studies in different regions of the world will help identify a classification of pediatric sepsis that is more widely applicable.
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Affiliation(s)
- Jhuma Sankar
- Department of Pediatrics, All India Institute of Medical Sciences, New Delhi, India
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Lee SG, Kim SC, Kim JH. Risk factors of rituximab-induced thrombocytopenia in patients with autoimmune bullous diseases. J Dermatol 2024; 51:597-601. [PMID: 37830427 DOI: 10.1111/1346-8138.17006] [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] [Received: 08/24/2023] [Revised: 09/20/2023] [Accepted: 09/29/2023] [Indexed: 10/14/2023]
Abstract
Rituximab has been the mainstay treatment for autoimmune bullous diseases (AIBDs). Among the side effects of rituximab, rituximab-induced thrombocytopenia (RIT) is a rare but critical complication. However, there have been no reports or identification of risk factors for RIT in patients with AIBD. In our retrospective study, we compared rituximab-treated AIBD in patients with and without thrombocytopenia to explore the risk factors. In addition, we compared two different rituximab protocols (rheumatoid arthritis [RA] and lymphoma) in terms of the incidence and severity of thrombocytopenia. A total of 222 patients were enrolled, and 46 patients (20.7%) developed RIT. Multivariate logistic regression analysis identified age and chronic kidney disease (CKD) as significant factors for RIT. We also found that patients treated with the lymphoma protocol demonstrated a significantly higher mean post-rituximab platelet count compared with those on the RA protocol. This was the first analysis, to our knowledge, of risk factors for RIT in patients with AIBD. Individuals aged 70 or older and those with multiple comorbidities, particularly CKD, should be closely monitored for thrombocytopenia. For patients with CKD, it may be safer to use the lymphoma protocol for rituximab administration as it results in a lesser reduction in post-rituximab platelet count.
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Affiliation(s)
- Sang Gyun Lee
- Department of Dermatology, Gangnam Severance Hospital, Cutaneous Biology Research Institute, Yonsei University College of Medicine, Seoul, Korea
| | - Soo-Chan Kim
- Department of Dermatology, Yongin Severance Hospital, Cutaneous Biology Research Institute, Yonsei University College of Medicine, Yongin, Korea
| | - Jong Hoon Kim
- Department of Dermatology, Gangnam Severance Hospital, Cutaneous Biology Research Institute, Yonsei University College of Medicine, Seoul, Korea
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Chen Y, Liu J, Shao S, Song Z, Ma Y, Tuo Y, Fang L, Xu Y, Xu B, Gu W, Cao X, Chen J, Yang Y, Wang P, Zhang J, Xu Y, Yu D, Hou P, Meng K, Li Z, Liu G, Qu X, Ji L, Yang R, Zhang L. Characteristics and outcomes of COVID-19 in Chinese immune thrombocytopenia patients: A prospective cohort study. Br J Haematol 2024; 204:1207-1218. [PMID: 37967471 DOI: 10.1111/bjh.19198] [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] [Received: 09/04/2023] [Revised: 10/09/2023] [Accepted: 10/30/2023] [Indexed: 11/17/2023]
Abstract
The coronavirus disease 2019 (COVID-19) pandemic has a significant impact on the immune system. This is the first and largest study on pre-existing immune thrombocytopenia (ITP) patients infected with COVID-19 in China. We prospectively collected ITP patients infected with COVID-19 enrolled in the National Longitudinal Cohort of Hematological Diseases (NICHE, NCT04645199) and followed up for at least 1 month after infection. One thousand and one hundred forty-eight pre-existing ITP patients were included. Two hundred and twelve (18.5%) patients showed a decrease in the platelet (PLT) count after infection. Forty-seven (4.1%) patients were diagnosed with pneumonia. Risk factors for a decrease in the PLT count included baseline PLT count <50 × 109/L (OR, 1.76; 95% CI, 1.25-2.46; p = 0.001), maintenance therapy including thrombopoietin receptor agonists (TPO-RAs) (OR, 2.27; 95% CI, 1.60-3.21; p < 0.001) and previous splenectomy (OR, 1.98; 95% CI, 1.09-3.61; p = 0.03). Risk factors for pneumonia included age ≥40 years (OR, 2.45; 95% CI, 1.12-5.33; p = 0.02), ≥2 comorbidities (OR, 3.47; 95% CI, 1.63-7.64; p = 0.001), maintenance therapy including TPO-RAs (OR, 2.14; 95% CI, 1.17-3.91; p = 0.01) and immunosuppressants (OR, 3.05; 95% CI, 1.17-7.91; p = 0.02). In this cohort study, we described the characteristics of pre-existing ITP patients infected with COVID-19 and identified several factors associated with poor outcomes.
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Affiliation(s)
- Yunfei Chen
- State Key Laboratory of Experimental Hematology, National Clinical Research Center for Blood Diseases, Haihe Laboratory of Cell Ecosystem, Institute of Hematology & Blood Diseases Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Tianjin Key Laboratory of Gene Therapy for Blood Diseases, CAMS Key Laboratory of Gene Therapy for Blood Diseases, Tianjin, China
- Tianjin Institutes of Health Science, Tianjin, China
| | - Jiaying Liu
- State Key Laboratory of Experimental Hematology, National Clinical Research Center for Blood Diseases, Haihe Laboratory of Cell Ecosystem, Institute of Hematology & Blood Diseases Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Tianjin Key Laboratory of Gene Therapy for Blood Diseases, CAMS Key Laboratory of Gene Therapy for Blood Diseases, Tianjin, China
- Tianjin Institutes of Health Science, Tianjin, China
| | - Shuai Shao
- State Key Laboratory of Experimental Hematology, National Clinical Research Center for Blood Diseases, Haihe Laboratory of Cell Ecosystem, Institute of Hematology & Blood Diseases Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Tianjin Key Laboratory of Gene Therapy for Blood Diseases, CAMS Key Laboratory of Gene Therapy for Blood Diseases, Tianjin, China
- Tianjin Institutes of Health Science, Tianjin, China
| | - Zhen Song
- State Key Laboratory of Experimental Hematology, National Clinical Research Center for Blood Diseases, Haihe Laboratory of Cell Ecosystem, Institute of Hematology & Blood Diseases Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Tianjin Key Laboratory of Gene Therapy for Blood Diseases, CAMS Key Laboratory of Gene Therapy for Blood Diseases, Tianjin, China
- Tianjin Institutes of Health Science, Tianjin, China
| | - Yueshen Ma
- State Key Laboratory of Experimental Hematology, National Clinical Research Center for Blood Diseases, Haihe Laboratory of Cell Ecosystem, Institute of Hematology & Blood Diseases Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Tianjin Key Laboratory of Gene Therapy for Blood Diseases, CAMS Key Laboratory of Gene Therapy for Blood Diseases, Tianjin, China
- Tianjin Institutes of Health Science, Tianjin, China
| | - Yuanyuan Tuo
- State Key Laboratory of Experimental Hematology, National Clinical Research Center for Blood Diseases, Haihe Laboratory of Cell Ecosystem, Institute of Hematology & Blood Diseases Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Tianjin Key Laboratory of Gene Therapy for Blood Diseases, CAMS Key Laboratory of Gene Therapy for Blood Diseases, Tianjin, China
- Tianjin Institutes of Health Science, Tianjin, China
- Department of Pediatric Hematology, Affiliated Hospital of Guizhou Medical University, Guiyang, China
| | - Lijun Fang
- State Key Laboratory of Experimental Hematology, National Clinical Research Center for Blood Diseases, Haihe Laboratory of Cell Ecosystem, Institute of Hematology & Blood Diseases Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Tianjin Key Laboratory of Gene Therapy for Blood Diseases, CAMS Key Laboratory of Gene Therapy for Blood Diseases, Tianjin, China
- Tianjin Institutes of Health Science, Tianjin, China
| | - Yanmei Xu
- State Key Laboratory of Experimental Hematology, National Clinical Research Center for Blood Diseases, Haihe Laboratory of Cell Ecosystem, Institute of Hematology & Blood Diseases Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Tianjin Key Laboratory of Gene Therapy for Blood Diseases, CAMS Key Laboratory of Gene Therapy for Blood Diseases, Tianjin, China
- Tianjin Institutes of Health Science, Tianjin, China
| | - Bingqi Xu
- State Key Laboratory of Experimental Hematology, National Clinical Research Center for Blood Diseases, Haihe Laboratory of Cell Ecosystem, Institute of Hematology & Blood Diseases Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Tianjin Key Laboratory of Gene Therapy for Blood Diseases, CAMS Key Laboratory of Gene Therapy for Blood Diseases, Tianjin, China
- Tianjin Institutes of Health Science, Tianjin, China
| | - Wenjing Gu
- State Key Laboratory of Experimental Hematology, National Clinical Research Center for Blood Diseases, Haihe Laboratory of Cell Ecosystem, Institute of Hematology & Blood Diseases Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Tianjin Key Laboratory of Gene Therapy for Blood Diseases, CAMS Key Laboratory of Gene Therapy for Blood Diseases, Tianjin, China
- Tianjin Institutes of Health Science, Tianjin, China
| | - Xuan Cao
- State Key Laboratory of Experimental Hematology, National Clinical Research Center for Blood Diseases, Haihe Laboratory of Cell Ecosystem, Institute of Hematology & Blood Diseases Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Tianjin Key Laboratory of Gene Therapy for Blood Diseases, CAMS Key Laboratory of Gene Therapy for Blood Diseases, Tianjin, China
- Tianjin Institutes of Health Science, Tianjin, China
| | - Jia Chen
- State Key Laboratory of Experimental Hematology, National Clinical Research Center for Blood Diseases, Haihe Laboratory of Cell Ecosystem, Institute of Hematology & Blood Diseases Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Tianjin Key Laboratory of Gene Therapy for Blood Diseases, CAMS Key Laboratory of Gene Therapy for Blood Diseases, Tianjin, China
- Tianjin Institutes of Health Science, Tianjin, China
| | - Yu Yang
- State Key Laboratory of Experimental Hematology, National Clinical Research Center for Blood Diseases, Haihe Laboratory of Cell Ecosystem, Institute of Hematology & Blood Diseases Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Tianjin Key Laboratory of Gene Therapy for Blood Diseases, CAMS Key Laboratory of Gene Therapy for Blood Diseases, Tianjin, China
- Tianjin Institutes of Health Science, Tianjin, China
| | - Panjing Wang
- State Key Laboratory of Experimental Hematology, National Clinical Research Center for Blood Diseases, Haihe Laboratory of Cell Ecosystem, Institute of Hematology & Blood Diseases Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Tianjin Key Laboratory of Gene Therapy for Blood Diseases, CAMS Key Laboratory of Gene Therapy for Blood Diseases, Tianjin, China
- Tianjin Institutes of Health Science, Tianjin, China
| | - Jing Zhang
- State Key Laboratory of Experimental Hematology, National Clinical Research Center for Blood Diseases, Haihe Laboratory of Cell Ecosystem, Institute of Hematology & Blood Diseases Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Tianjin Key Laboratory of Gene Therapy for Blood Diseases, CAMS Key Laboratory of Gene Therapy for Blood Diseases, Tianjin, China
- Tianjin Institutes of Health Science, Tianjin, China
| | - Yuan Xu
- State Key Laboratory of Experimental Hematology, National Clinical Research Center for Blood Diseases, Haihe Laboratory of Cell Ecosystem, Institute of Hematology & Blood Diseases Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Tianjin Key Laboratory of Gene Therapy for Blood Diseases, CAMS Key Laboratory of Gene Therapy for Blood Diseases, Tianjin, China
- Tianjin Institutes of Health Science, Tianjin, China
| | - Dandan Yu
- State Key Laboratory of Experimental Hematology, National Clinical Research Center for Blood Diseases, Haihe Laboratory of Cell Ecosystem, Institute of Hematology & Blood Diseases Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Tianjin Key Laboratory of Gene Therapy for Blood Diseases, CAMS Key Laboratory of Gene Therapy for Blood Diseases, Tianjin, China
- Tianjin Institutes of Health Science, Tianjin, China
| | - Pengxiao Hou
- State Key Laboratory of Experimental Hematology, National Clinical Research Center for Blood Diseases, Haihe Laboratory of Cell Ecosystem, Institute of Hematology & Blood Diseases Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Tianjin Key Laboratory of Gene Therapy for Blood Diseases, CAMS Key Laboratory of Gene Therapy for Blood Diseases, Tianjin, China
- Tianjin Institutes of Health Science, Tianjin, China
| | - Ke Meng
- State Key Laboratory of Experimental Hematology, National Clinical Research Center for Blood Diseases, Haihe Laboratory of Cell Ecosystem, Institute of Hematology & Blood Diseases Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Tianjin Key Laboratory of Gene Therapy for Blood Diseases, CAMS Key Laboratory of Gene Therapy for Blood Diseases, Tianjin, China
- Tianjin Institutes of Health Science, Tianjin, China
| | - Zhirong Li
- State Key Laboratory of Experimental Hematology, National Clinical Research Center for Blood Diseases, Haihe Laboratory of Cell Ecosystem, Institute of Hematology & Blood Diseases Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Tianjin Key Laboratory of Gene Therapy for Blood Diseases, CAMS Key Laboratory of Gene Therapy for Blood Diseases, Tianjin, China
- Tianjin Institutes of Health Science, Tianjin, China
| | - Guanyu Liu
- State Key Laboratory of Experimental Hematology, National Clinical Research Center for Blood Diseases, Haihe Laboratory of Cell Ecosystem, Institute of Hematology & Blood Diseases Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Tianjin Key Laboratory of Gene Therapy for Blood Diseases, CAMS Key Laboratory of Gene Therapy for Blood Diseases, Tianjin, China
- Tianjin Institutes of Health Science, Tianjin, China
| | - Xinmiao Qu
- State Key Laboratory of Experimental Hematology, National Clinical Research Center for Blood Diseases, Haihe Laboratory of Cell Ecosystem, Institute of Hematology & Blood Diseases Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Tianjin Key Laboratory of Gene Therapy for Blood Diseases, CAMS Key Laboratory of Gene Therapy for Blood Diseases, Tianjin, China
- Tianjin Institutes of Health Science, Tianjin, China
| | - Lulu Ji
- State Key Laboratory of Experimental Hematology, National Clinical Research Center for Blood Diseases, Haihe Laboratory of Cell Ecosystem, Institute of Hematology & Blood Diseases Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Tianjin Key Laboratory of Gene Therapy for Blood Diseases, CAMS Key Laboratory of Gene Therapy for Blood Diseases, Tianjin, China
- Tianjin Institutes of Health Science, Tianjin, China
| | - Renchi Yang
- State Key Laboratory of Experimental Hematology, National Clinical Research Center for Blood Diseases, Haihe Laboratory of Cell Ecosystem, Institute of Hematology & Blood Diseases Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Tianjin Key Laboratory of Gene Therapy for Blood Diseases, CAMS Key Laboratory of Gene Therapy for Blood Diseases, Tianjin, China
- Tianjin Institutes of Health Science, Tianjin, China
| | - Lei Zhang
- State Key Laboratory of Experimental Hematology, National Clinical Research Center for Blood Diseases, Haihe Laboratory of Cell Ecosystem, Institute of Hematology & Blood Diseases Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Tianjin Key Laboratory of Gene Therapy for Blood Diseases, CAMS Key Laboratory of Gene Therapy for Blood Diseases, Tianjin, China
- Tianjin Institutes of Health Science, Tianjin, China
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Lloyd PC, Lufkin B, Moll K, Ogilvie RP, McMahill-Walraven CN, Beachler DC, Kelman JA, Shi X, Hobbi S, Amend KL, Djibo DA, Shangguan S, Shoaibi A, Sheng M, Secora A, Zhou CK, Kowarski L, Chillarige Y, Forshee RA, Anderson SA, Muthuri S, Seeger JD, Kline A, Reich C, MaCurdy T, Wong HL. Incidence rates of thrombosis with thrombocytopenia syndrome (TTS) among adults in United States commercial and Medicare claims databases, 2017-2020. Vaccine 2024; 42:2004-2010. [PMID: 38388240 DOI: 10.1016/j.vaccine.2024.02.017] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2023] [Revised: 01/25/2024] [Accepted: 02/05/2024] [Indexed: 02/24/2024]
Abstract
BACKGROUND Increased risk of thrombosis with thrombocytopenia syndrome (TTS) following adenovirus vector-based COVID-19 vaccinations has been identified in passive surveillance systems. TTS incidence rates (IRs) in the United States (U.S.) are needed to contextualize reports following COVID-19 vaccination. METHODS We estimated annual and monthly IRs of overall TTS, common site TTS, and unusual site TTS for adults aged 18-64 years in Carelon Research and MarketScan commercial claims (2017-Oct 2020), CVS Health and Optum commercial claims (2019-Oct 2020), and adults aged ≥ 65 years using CMS Medicare claims (2019-Oct 2020); IRs were stratified by age, sex, and race/ethnicity (CMS Medicare). RESULTS Across data sources, annual IRs for overall TTS were similar between Jan-Dec 2019 and Jan-Oct 2020. Rates were higher in Medicare (IRs: 370.72 and 365.63 per 100,000 person-years for 2019 and 2020, respectively) than commercial data sources (MarketScan IRs: 24.21 and 24.06 per 100,000 person-years; Optum IRs: 32.60 and 31.29 per 100,000 person-years; Carelon Research IRs: 24.46 and 26.16 per 100,000 person-years; CVS Health IRs: 30.31 and 30.25 per 100,000 person-years). Across years and databases, common site TTS IRs increased with age and were higher among males. Among adults aged ≥ 65 years, the common site TTS IR was highest among non-Hispanic black adults. Annual unusual site TTS IRs ranged between 2.02 and 3.04 (commercial) and 12.49 (Medicare) per 100,000 person-years for Jan-Dec 2019; IRs ranged between 1.53 and 2.67 (commercial) and 11.57 (Medicare) per 100,000 person-years for Jan-Oct 2020. Unusual site TTS IRs were higher in males and increased with age in commercial data sources; among adults aged ≥ 65 years, IRs decreased with age and were highest among non-Hispanic American Indian/Alaska native adults. CONCLUSION TTS IRs were generally similar across years, higher for males, and increased with age. These rates may contribute to surveillance of post-vaccination TTS.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - Cindy Ke Zhou
- US Food and Drug Administration, Silver Spring, MD, USA
| | | | | | | | | | | | | | | | | | - Thomas MaCurdy
- Acumen LLC, Burlingame, CA, USA; Department of Economics, Stanford University, Stanford, CA, USA
| | - Hui Lee Wong
- US Food and Drug Administration, Silver Spring, MD, USA
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Thi Phuong Thao L, Duc Trung N, Thi My L, Minh Hong L, Viet Hoan B, Quang Hung V, Dang Hai P. Association of clinical factors with thrombocytopenia in patients receiving linezolid treatment: a retrospective study. J Infect Dev Ctries 2024; 18:285-290. [PMID: 38484357 DOI: 10.3855/jidc.18488] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2023] [Accepted: 06/06/2023] [Indexed: 03/19/2024] Open
Abstract
INTRODUCTION Linezolid (LZD) plays an important role in the treatment of severe infections caused by Gram-positive bacteria. Thrombocytopenia is regarded as one of the most common side effects of linezolid, which results from the destruction of platelets or myelosuppression. The study aimed to identify the risk factors associated with the development of thrombocytopenia in Vietnamese patients. METHODOLOGY This retrospective, descriptive cross-sectional study was performed on adult patients who received parenteral LZD therapy (1,200 mg/day) in at least 3 days between January 2020 and June 2021 at a tertiary referral hospital in Vietnam. Thrombocytopenia was defined as either a final platelet count of less than 100 G/L or a 25% decrease in platelet count from baseline. Multivariate logistic regression analysis was applied to predict risk factors associated with LZD-induced thrombocytopenia. RESULTS In the 208 patients included in the study, the average age was 69 and males accounted for 73.1%. LZD-induced thrombocytopenia occurred in 37% of patients. LZD-induced thrombocytopenia was significantly associated with shock (HR = 8.26, 95% CI 3.82 - 17.84, p < 0.001), baseline creatinine clearance (HR = 1.02, 95% CI [1.01 - 1.03], p = 0.002), and duration of LZD treatment of at least 14 days (HR = 4.45, 95% CI [1.83 - 11.05], p = 0.001). CONCLUSIONS The results showed that thrombocytopenia was fairly common in patients using linezolid. Shock, renal failure, and duration of linezolid therapy of at least 14 days were significant risk factors for the incidence of linezolid-induced thrombocytopenia.
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Affiliation(s)
| | | | - Le Thi My
- Pharmacy Department, 108 Military Central Hospital, Vietnam
| | - Le Minh Hong
- Pharmacy Department, 108 Military Central Hospital, Vietnam
| | - Bui Viet Hoan
- Medical Intensive Care Unit, 108 Military Central Hospital, Vietnam
| | - Vu Quang Hung
- Medical Intensive Care Unit, 108 Military Central Hospital, Vietnam
| | - Pham Dang Hai
- Medical Intensive Care Unit, 108 Military Central Hospital, Vietnam
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Qin Y, Chen Z, Gao S, Shen Y, Ye Y. Development and validation of a risk prediction model for linezolid-induced thrombocytopenia in elderly patients. Eur J Hosp Pharm 2024; 31:94-100. [PMID: 35477677 PMCID: PMC10895188 DOI: 10.1136/ejhpharm-2022-003258] [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] [Received: 02/07/2022] [Accepted: 04/05/2022] [Indexed: 11/03/2022] Open
Abstract
OBJECTIVES Linezolid is the first oxazolidinone antimicrobial agent developed for treating multi-drug-resistant gram-positive bacterial infections. The study aimed to investigate the risk factors of linezolid (LI)-induced thrombocytopenia (LI-TP) and to develop and validate a risk prediction model to identify elderly patients at high risk of developing LI-TP during linezolid therapy. METHODS A retrospective cohort study was performed at Zhongshan Hospital, FuDan University, China. The study involved elderly Chinese patients aged ≥65 years administered with linezolid (600 mg) twice a day between January 2015 and April 2021. We collected the patients' clinical characteristics and demographic data from electronic medical records, and compared the differences between LI-TP patients and those who had not developed thrombocytopenia (NO-TP) after linezolid treatment. The risk prediction model was developed based on the regression coefficient generated from logistic regression model. RESULTS A total of 343 inpatients were enrolled from January 2015 to August 2020 and were used as the training set. Among them, 67 (19.5%) developed LI-TP. Multivariate logistic regression analysis revealed that baseline platelet counts <150×109·L-1 (odds ratio (OR)=3.576; p<0.001), age ≥75 years (OR=2.258; p=0.009), estimated glomerular filtration rate (eGFR <60 mL·(min·1.73 m2)-1 (OR=2.553; p=0.002), duration of linezolid therapy ≥10 d (OR=3.218; p<0.001), intensive care unit (ICU) admittance (OR=2.682; p=0.004), concomitant piperacillin-tazobactam (OR=3.863; p=0.006) were independent risk factors for LI-TP in elderly patients. The LI-TP risk prediction model was established using a scoring method based on the regression coefficient and exhibited a good discriminative power, with an area under the curve (AUC) of 0.795 (95% confidence interval (CI) 0.740 to 0.851) and 0.849 (95% CI 0.760 to 0.939) in the training set (n=343) and validation set (n=90) respectively. CONCLUSIONS These findings indicate that duration of linezolid therapy, age, eGFR, ICU admittance, baseline platelet counts, concomitant piperacillin-tazobactam were significantly associated with LI-TP in elderly patients. A risk prediction model based on these risk factors showed a good discriminative performance and may be useful for clinicians to identify patients at high risk of developing LI-TP.
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Affiliation(s)
- Yan Qin
- Department of Pharmacy, Zhongshan Hospital FuDan Univeristy, Shanghai, China
| | - Zhe Chen
- Department of Pharmacy, Zhongshan Hospital FuDan Univeristy, Shanghai, China
| | - Shuai Gao
- Shanghai University of Medicine & Health Sciences, Shanghai, China
| | - Yun Shen
- Department of Pharmacy, Zhongshan Hospital FuDan Univeristy, Shanghai, China
| | - Yanrong Ye
- Department of Pharmacy, Zhongshan Hospital FuDan Univeristy, Shanghai, China
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Hariri G, Belossi V, Perol L, Missri L, Gabarre P, Bonny V, Urbina T, Baudel JL, Guidet B, Joffre J, Maury E, Dumas G, Ait-Oufella H. Prospective evaluation of bleeding risk among thrombocytopenic patients admitted in intensive care unit. J Crit Care 2024; 79:154405. [PMID: 37659243 DOI: 10.1016/j.jcrc.2023.154405] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2023] [Revised: 06/30/2023] [Accepted: 08/25/2023] [Indexed: 09/04/2023]
Abstract
PURPOSE Bleeding risk evaluation of thrombocytopenic patients admitted in ICU has been poorly investigated. METHODS A prospective observational study conducted in an 18-bed medical ICU. Consecutive patients with thrombocytopenia (<150 Giga/L) and no bleeding at admission were included. RESULTS Over one year, 91 patients were included, mainly men (63%), with an age of 61 [46-68] years and a SOFA score of 6 [3-8]. Twenty-three patients (25%) had an hemorrhagic event during ICU stay, mainly digestive (n = 9; 39%) and urological (n = 6; 26%). The time between ICU admission and bleeding was 8 [2-19] days. Almost half of bleeding events required vasopressor infusion and a hemostatic procedure. At admission, two variables were significantly different between the Bleeding and No-Bleeding groups: plasma urea level was significantly higher in the Bleeding group (9 [5.1; 13] vs. 13 [8.9; 31] mmol/L; p < 0.001) and the presence of skin purpura was associated with a 3-fold higher risk for bleeding during ICU stay (HR: 3.4 [1.3-8.3]; p < 0.05). In contrast, admission platelet count was not significantly different between the 2 groups (90 [32; 128] vs 62 [36; 103] G/L; p = 0.26). CONCLUSION Plasma urea levels and the presence of skin purpura are helpful in identifying thrombocytopenic patients at high-risk of bleeding during ICU stay.
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Affiliation(s)
- Geoffroy Hariri
- Service de Médecine intensive-Réanimation, Assistance Publique-Hôpitaux de Paris, Hôpital Saint-Antoine, Paris, France; Sorbonne Université, Paris, France; Sorbonne Université, Inserm, Institut Pierre Louis d'Epidémiologie et de Santé Publique, F75013, Paris, France
| | - Vincent Belossi
- Service de Médecine intensive-Réanimation, Assistance Publique-Hôpitaux de Paris, Hôpital Saint-Antoine, Paris, France; Sorbonne Université, Paris, France
| | - Louis Perol
- Service de Médecine intensive-Réanimation, Assistance Publique-Hôpitaux de Paris, Hôpital Saint-Antoine, Paris, France
| | - Louai Missri
- Service de Médecine intensive-Réanimation, Assistance Publique-Hôpitaux de Paris, Hôpital Saint-Antoine, Paris, France
| | - Paul Gabarre
- Service de Médecine intensive-Réanimation, Assistance Publique-Hôpitaux de Paris, Hôpital Saint-Antoine, Paris, France; Sorbonne Université, Paris, France
| | - Vincent Bonny
- Service de Médecine intensive-Réanimation, Assistance Publique-Hôpitaux de Paris, Hôpital Saint-Antoine, Paris, France; Sorbonne Université, Paris, France
| | - Tomas Urbina
- Service de Médecine intensive-Réanimation, Assistance Publique-Hôpitaux de Paris, Hôpital Saint-Antoine, Paris, France
| | - Jean-Luc Baudel
- Service de Médecine intensive-Réanimation, Assistance Publique-Hôpitaux de Paris, Hôpital Saint-Antoine, Paris, France
| | - Bertrand Guidet
- Service de Médecine intensive-Réanimation, Assistance Publique-Hôpitaux de Paris, Hôpital Saint-Antoine, Paris, France; Sorbonne Université, Paris, France; Sorbonne Université, Inserm, Institut Pierre Louis d'Epidémiologie et de Santé Publique, F75013, Paris, France
| | - Jeremie Joffre
- Service de Médecine intensive-Réanimation, Assistance Publique-Hôpitaux de Paris, Hôpital Saint-Antoine, Paris, France; Sorbonne Université, Paris, France
| | - Eric Maury
- Service de Médecine intensive-Réanimation, Assistance Publique-Hôpitaux de Paris, Hôpital Saint-Antoine, Paris, France; Sorbonne Université, Paris, France
| | - Guillaume Dumas
- Service de Médecine intensive-Réanimation, Assistance Publique-Hôpitaux de Paris, Hôpital Saint-Antoine, Paris, France; Sorbonne Université, Paris, France
| | - Hafid Ait-Oufella
- Service de Médecine intensive-Réanimation, Assistance Publique-Hôpitaux de Paris, Hôpital Saint-Antoine, Paris, France; Sorbonne Université, Paris, France; Inserm U970, Paris Research Cardiovascular Center, Paris, France.
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9
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Wang J, Wang X, Xu X, Xie L, Yang P. The investigation of thrombocytopenia after transcatheter occlusion of patent ductus arteriosus. BMC Cardiovasc Disord 2024; 24:59. [PMID: 38238685 PMCID: PMC10795349 DOI: 10.1186/s12872-024-03718-0] [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] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2023] [Accepted: 01/06/2024] [Indexed: 01/22/2024] Open
Abstract
OBJECTIVE To investigate the risk factors for thrombocytopenia after transcatheter occlusion operation of patent ductus arteriosus (PDA). METHOD Retrospective analyses were conducted using clinical data from 106 patients with PDA who underwent transcatheter closure operations at Henan Provincial Chest Hospital, Zhengzhou University, from January 2018 to June 2022. The study compared the changes in platelet counts before and after the operation, and investigated the risk factors for thrombocytopenia following PDA closure in different groups and layers. RESULTS The platelet count of patients with PDA significantly decreased after undergoing transcatheter PDA occlusion. Logistic regression analysis revealed that factors such as PDA diameter, occluder diameter, pressure difference on the two sides of the occluder, and residual shunt were associated with an increased risk of thrombocytopenia following PDA occlusion. Specifically, the size of the occluder and the pressure difference between the two sides of the occluder were found to have a negative correlation with the postoperative platelet count. Further subgroup analysis demonstrated that the incidence of total thrombocytopenia was significantly higher in the large PDA group compared to the small-medium PDA groups. CONCLUSION Our findings suggest that occluder diameter, the pressure difference between the two sides of the occluder, and the residual shunt are major risk factors correlated with the incidence of postoperative thrombocytopenia. However, a multicenter and long-term prospective study is required to further evaluate the prognosis of PDA patients with thrombocytopenia after transcatheter occlusion.
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Affiliation(s)
- Jipei Wang
- Department of Cardiovascular Medicine, Henan Provincial Chest Hospital, Zhengzhou University, No. 1, Weiwu Road, Zhengzhou, Henan, 450000, China.
| | - Xiaoming Wang
- Department of Cardiovascular Medicine, Henan Provincial Chest Hospital, Zhengzhou University, No. 1, Weiwu Road, Zhengzhou, Henan, 450000, China
| | - Xuefei Xu
- Department of Cardiovascular Medicine, Henan Provincial Chest Hospital, Zhengzhou University, No. 1, Weiwu Road, Zhengzhou, Henan, 450000, China
| | - Limin Xie
- Department of Cardiovascular Medicine, Henan Provincial Chest Hospital, Zhengzhou University, No. 1, Weiwu Road, Zhengzhou, Henan, 450000, China
| | - Pengwei Yang
- Department of Cardiovascular Medicine, Henan Provincial Chest Hospital, Zhengzhou University, No. 1, Weiwu Road, Zhengzhou, Henan, 450000, China
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Arkew M, Asmerom H, Sileshi B, Walle M, Adane A, Ayele F, Tebeje F, Bete T, Ersino T, Gemechu K. Thrombocytopenia and associated factors among pregnant women attending antenatal care at Hiwot Fana Comprehensive Specialized Hospital, Eastern Ethiopia: A cross-sectional study. Medicine (Baltimore) 2024; 103:e36866. [PMID: 38215109 PMCID: PMC10783285 DOI: 10.1097/md.0000000000036866] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/13/2023] [Accepted: 12/14/2023] [Indexed: 01/14/2024] Open
Abstract
Thrombocytopenia (TCP) is the second most common hematological change during pregnancy and is considered as a major source of maternal and neonatal morbidity and mortality. Despite its effects to morbidity and mortality, it is frequently ignored or disregarded, particularly in resource-limited nations. Thus, the purpose of this study was to determine the prevalence of thrombocytopenia and associated factors among pregnant women attending antenatal care at Hiwot Fana Comprehensive Specialized University Hospital, Eastern Ethiopia from June 20 to August 30, 2022. A hospital-based cross-sectional study was conducted among 199 pregnant women selected through a systematic sampling technique. Ethical approval was obtained from the Ethics Review Committee of Haramaya University. Data related to sociodemographic and reproductive variables were collected using structured questionnaires. Four milliliters of venous blood were collected from each study participant and a complete blood cell count was determined using UniCel DxH 800 hematology analyzer. Logistic regression analysis was done to assess the association between TCP and independent variables and P < .05 was considered statistically significant. In this study, the prevalence of TCP was 14.1% (95% CI: 9.6-19.7). Of them, 10 (35.7%), 12 (42.9%), and 4 (21.4%) had mild, moderate, and severe TCP, respectively. Having more than 3 children (adjusted odds ratio, AOR = 7.90, 95% CI: 2.60, 24.3), no antenatal care follow-up (AOR = 7.90, 95% CI: 2.40-26.2), being in the second and third trimester (AOR = 6.90, 95% CI: 1.70, 28.9 and AOR = 5.04, 95% CI: 1.12, 22.7, respectively), and history of heavy menstrual bleeding (AOR = 4.03, 95% CI: 1.25, 13.1) were significantly associated with TCP. TCP is a public health problem among pregnant women in the study area. Having more than 3 children, lack of antenatal care follow-up, being in the second and third trimesters, and having history of heavy menstrual bleeding was significantly associated with TCP. As a result, regular platelet count monitoring and appropriate intervention approaches based on identified predictors should be explored to mitigate adverse outcomes in pregnant women.
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Affiliation(s)
- Mesay Arkew
- School of Medical Laboratory Sciences, College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
| | - Haftu Asmerom
- School of Medical Laboratory Sciences, College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
| | - Beza Sileshi
- School of Medical Laboratory Sciences, College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
| | - Muluken Walle
- Department of Medical Laboratory Sciences, College of Medicine and Health Sciences, Jigjiga University, Jigjiga, Ethiopia
| | - Amlak Adane
- Department of Obstetrics and Gynecology, Hiwot Fana Comprehensive Specialized University Hospital, Haramaya University, Harar, Ethiopia
| | - Firayad Ayele
- School of Medical Laboratory Sciences, College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
| | - Fikru Tebeje
- School of Medical Laboratory Sciences, College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
| | - Tilahun Bete
- Department of Psychiatry, College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
| | - Tamirat Ersino
- School of Medical Laboratory Sciences, College of Health Sciences and Medicine, Wolaita Sodo University, Wolaita Sodo, Ethiopia
| | - Kabtamu Gemechu
- School of Medical Laboratory Sciences, College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
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11
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Huang XX, Du SS, Li AQ, Li C, Tian TT, Liu TZ, Wang Q, Liang MF, Wang SW, Li JD, Li DX. [Epidemiological characteristics of severe fever with thrombocytopenia syndrome in China, 2018-2021]. Zhonghua Liu Xing Bing Xue Za Zhi 2024; 45:112-116. [PMID: 38228532 DOI: 10.3760/cma.j.cn112338-20230504-00274] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Subscribe] [Scholar Register] [Indexed: 01/18/2024]
Abstract
Objective: To understand the epidemiological characteristics and incidence trend of severe fever with thrombocytopenia syndrome (SFTS) in China. Methods: The incidence data of SFTS in China from 2018 to 2021 were collected from Chinese Disease Prevention and Control Information System for a statistical and descriptive epidemiological analysis by using software such as Excel 2016, Joinpoint 5.0.2, SPSS 26.0, and GraphPad Prism 8.0, especially, the SFTS cases reported monthly by key provinces were analyzed. Results: From 2018 to 2021, a total of 8 835 SFTS cases were reported in 25 provinces and the annual incidence showed an upward trend. The distribution of SFTS cases showed clustering, but the cases were mainly sporadic ones. The cases began to increase in March, mainly occurred during April to October (96.79%,8 551/8 835), and peaked during May to July. The cases were mainly distributed in middle-aged and old farmers, and slight more cases were women. The average case fatality rate was 5.38%, which varied greatly with areas. The case fatality rate tended to increase with age. Conclusion: From 2018 to 2021, the epidemiological characteristics of SFTS in China remained stable, but the number of reported cases gradually increased and the distribution showed an expanding trend, to which close attention should be paid.
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Affiliation(s)
- X X Huang
- National Health Commision Key Laboratory of Medical Virology and Viral Diseases/National Institute for Viral Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing 102206, China
| | - S S Du
- National Health Commision Key Laboratory of Medical Virology and Viral Diseases/National Institute for Viral Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing 102206, China
| | - A Q Li
- National Health Commision Key Laboratory of Medical Virology and Viral Diseases/National Institute for Viral Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing 102206, China
| | - C Li
- National Health Commision Key Laboratory of Medical Virology and Viral Diseases/National Institute for Viral Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing 102206, China
| | - T T Tian
- National Health Commision Key Laboratory of Medical Virology and Viral Diseases/National Institute for Viral Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing 102206, China
| | - T Z Liu
- National Health Commision Key Laboratory of Medical Virology and Viral Diseases/National Institute for Viral Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing 102206, China
| | - Q Wang
- National Health Commision Key Laboratory of Medical Virology and Viral Diseases/National Institute for Viral Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing 102206, China
| | - M F Liang
- National Health Commision Key Laboratory of Medical Virology and Viral Diseases/National Institute for Viral Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing 102206, China
| | - S W Wang
- National Health Commision Key Laboratory of Medical Virology and Viral Diseases/National Institute for Viral Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing 102206, China
| | - J D Li
- National Health Commision Key Laboratory of Medical Virology and Viral Diseases/National Institute for Viral Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing 102206, China
| | - D X Li
- National Health Commision Key Laboratory of Medical Virology and Viral Diseases/National Institute for Viral Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing 102206, China
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12
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Mohamed SS, Gamal SM, Mokbel A, Alkamary AK, Siam I, Soliman A, Elgengehy FT. Thrombocytopenia and disease outcomes in a cohort of patients with systemic lupus erythematosus. A post hoc analysis of the COMOSLE-EGYPT study. Int J Rheum Dis 2024; 27:e15016. [PMID: 38200649 DOI: 10.1111/1756-185x.15016] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2023] [Revised: 11/09/2023] [Accepted: 12/12/2023] [Indexed: 01/12/2024]
Abstract
BACKGROUND Thrombocytopenia ranges from 20% to 40% in patients with systemic lupus erythematosus (SLE). It is usually associated with severe disease manifestations and worse disease outcomes. AIM OF THE STUDY To identify the frequency of thrombocytopenia in a cohort of Egyptian patients with SLE and to examine the relationship of thrombocytopenia with various disease manifestations and disease outcomes. METHODS Data on 902 SLE patients were collected, including demographics, clinical, laboratory, immunological findings, and medications. SLE Disease Activity Index (SLEDAI) at baseline, last visit, and Systemic Lupus International Collaborating Clinics/ACR Damage Index (SLICC) were calculated. A comparison was done between patients with thrombocytopenia (group I) and patients without (group II) regarding different disease parameters. Regression analysis was done to examine if thrombocytopenia is a predictor of worse disease outcomes. RESULTS Thrombocytopenia was found in 33% of our cohort. Longer disease duration was observed in group I compared to group II (p value = .01). As regards clinical manifestations, significantly higher frequencies of constitutional manifestations, anemia, arterial thrombosis, pulmonary hypertension, cardiac manifestations, neurological manifestations, gastrointestinal tract (GIT), and hepatic manifestations were detected in group I compared to group II. The disease damage index was detected to be significantly higher in group I as compared to group II (p value < .001). Mortality was higher in group I (p value < .001). Although it was found that antiphospholipid antibodies (APL) were associated with thrombocytopenia and their presence resulted in higher damage (p value: .001), the presence of thrombocytopenia even in patients with negative APL antibodies was associated with higher damage and mortality. Apart from thrombocytopenia, the male gender was also found to be an independent risk factor for mortality. CONCLUSION Thrombocytopenia was associated with more organ damage and higher mortality in SLE patients with or without APL antibodies. SLE patients with thrombocytopenia have a 3.4 times higher risk of mortality than patients without thrombocytopenia. Apart from thrombocytopenia, the male gender was also found to be an independent risk factor for mortality.
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Affiliation(s)
| | | | - Abir Mokbel
- Rheumatology Department, Cairo University, Cairo, Egypt
| | | | - Ibrahem Siam
- Internal Medicine Department, National Research Center, Giza, Egypt
| | - Ahmed Soliman
- Dermatology Department, National Research Center, Giza, Egypt
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13
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Ding W, Gong C, Meng T, Xiang X, Hong B, Shen S, Ding S. Cardiac injury in hospitalized patients with severe fever and thrombocytopenia syndrome. J Med Virol 2024; 96:e29375. [PMID: 38258285 DOI: 10.1002/jmv.29375] [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] [Received: 04/25/2023] [Revised: 10/24/2023] [Accepted: 12/25/2023] [Indexed: 01/24/2024]
Abstract
Severe fever with thrombocytopenia syndrome (SFTS), an emerging infectious disease with a high fatality rate. Cardiac injury in SFTS patients is a major concern. This study aimed to evaluate the prevalence of cardiac injury and its association with mortality in hospitalized patients infected with novel Bunyavirus. Cardiac injury was defined as the presence of any of the following abnormalities: (1) blood levels of cardiac biomarkers (creatine kinase-MB, troponin-I, B-type natriuretic peptide or N-terminal pro-B-type natriuretic peptide); (2) new abnormalities in electrocardiography. The 203 SFTS patients were included in the final analysis. The proportion of SFTS patients developing cardiac injury during hospitalization was 71.4% (145/203). Compared with the uninjured group, the cardiac injury group had the severity of cardiac injury was underscored by higher median hospital costs (31420 vs. 12911, p < 0.001), higher proportion of intensive care units admissions (13.1% vs. 3.4%, p = 0.041), and higher hospital mortality rate (33.8% vs. 6.9%, p < 0.001). Multivariable-adjusted Cox proportional hazards regression analysis showed that cardiac injury was associated with higher mortality during hospitalization (hazards ratio, 7.349; 95% CI: 2.352-22.960). Cardiac injury is common among hospitalized SFTS patients, and it is associated with higher risk of mortality.
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Affiliation(s)
- Wenqian Ding
- Department of Pediatrics, The First Affiliated Hospital of Anhui Medical University, Hefei, China
| | - Chen Gong
- Department of Pediatrics, The First Affiliated Hospital of Anhui Medical University, Hefei, China
| | - Tao Meng
- Department of Clinical Laboratory, The First Affiliated Hospital of Anhui Medical University, Hefei, China
| | - Xinjian Xiang
- Department of Plastic Surgery, The Second Affiliated Hospital of Anhui Medical University, Hefei, China
| | - Baoyu Hong
- Department of Pediatrics, The Second Affiliated Hospital of Anhui Medical University, Hefei, China
| | - Shichun Shen
- Division of Life Sciences and Medicine, The First Affiliated Hospital of USTC, University of Science and Technology of China, Hefei, China
| | - Shenggang Ding
- Department of Pediatrics, The First Affiliated Hospital of Anhui Medical University, Hefei, China
- China National Clinical Research Center of Respiratory Diseases, Beijing Children's Hospital, Capital Medical University, Beijing, China
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14
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Yesantharao LV, Etchill EW, Canner J, Alejo D, Choi CW, Lawton JS, Sussman M, Schena S. Heparin-Induced Thrombocytopenia After Cardiac Surgery-A Statewide Review of Health Care Utilization. Ann Thorac Surg 2024; 117:221-228. [PMID: 35988740 DOI: 10.1016/j.athoracsur.2022.07.049] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2021] [Revised: 05/20/2022] [Accepted: 07/19/2022] [Indexed: 11/15/2022]
Abstract
BACKGROUND Despite its severe consequences, clinical and economic impacts of heparin-induced thrombocytopenia (HIT) after cardiac operations have not been well characterized. This study assessed statewide incidence, outcomes, and resource consumption associated with HIT after cardiac operations. METHODS This was a retrospective investigation of cardiac surgery patients using the Maryland Health Services Cost Review Commission's database from 2012 to 2020. Health care costs, utilization, and outcomes for those who experienced postoperative HIT were compared with propensity score-matched controls. RESULTS Of 33 583 cardiac surgery patients, 184 (0.55%) were diagnosed with postoperative HIT. Compared with non-HIT patients, HIT patients were significantly more likely to be in the oldest age group (>80 years; P < .001) and to have greater severity of illness at admission (P < .001). HIT was associated with a longer hospitalization (21 vs 7 days; P < .001), greater mortality (13.6% vs 2.3%; P < .001), and greater hospital charges ($123 160 vs $45 303; P < .001), even after propensity score matching. Readmission rates were not significantly different, however, and readmission hospital charges did not significantly differ between HIT and non-HIT patients. CONCLUSIONS In addition to worse outcomes, HIT was associated with higher costs during index admissions but not during readmissions of cardiac surgery patients. Strategies to minimize HIT could yield better outcomes and reduced costs, particularly relevant for health care systems seeking improved value-based care while reducing unnecessary hospitalizations.
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Affiliation(s)
- Lekha V Yesantharao
- Division of Cardiac Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Eric W Etchill
- Division of Cardiac Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Joseph Canner
- Division of Cardiac Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Diane Alejo
- Division of Cardiac Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Chun W Choi
- Division of Cardiac Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Jennifer S Lawton
- Division of Cardiac Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Marc Sussman
- Division of Cardiac Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Stefano Schena
- Division of Cardiac Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland.
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Wang J, Huang S, Hou J, Feng K, Wu H, Liu Q, Zhou Z, Li H, Luo L, Shang L, Chen G, Wu Z. Impact of heart failure and preoperative platelet count on the postoperative short-term outcome in infective endocarditis patients. Clin Cardiol 2024; 47:e24171. [PMID: 37814957 PMCID: PMC10766123 DOI: 10.1002/clc.24171] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [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: 08/28/2023] [Revised: 09/16/2023] [Accepted: 09/29/2023] [Indexed: 10/11/2023] Open
Abstract
BACKGROUND Heart failure (HF) and platelet count are often considered risk factors for mortality in patients with infective endocarditis (IE); however, their effects on various complications have not been elucidated. HYPOTHESIS We speculated that HF and platelet count have significant impact on the short-term outcomes of IE. METHODS This single-center retrospective study analyzed data from 320 IE patients who underwent surgery. A multivariate Cox proportional hazards model was used to identify the risk factors for adverse outcomes. The effect of the platelet count on the prognosis of patients with HF was determined by subgroup analysis and Kaplan-Meier analysis. RESULTS The study population was divided into the HF group (n = 102) and the non-HF group (n = 218). The median age of the total population was 44.5 years (31-56 years), of which 227 (70.94%) patients were male. The incidence rates of 1-year all-cause mortality, cardiac outcomes, and composite outcomes were respectively almost sixfold, fourfold, and threefold higher in the HF group than in the non-HF group (all p < 0.001). In multivariate Cox regression analysis, HF was an independent risk factor for 1-year all-cause mortality, cardiac outcomes, cerebral outcomes, and composite outcomes. The Kaplan-Meier survival curves revealed that the patients with both HF and thrombocytopenia demonstrated the worst composite outcomes than the patients of the other groups (log-rank p < 0.001). In the HF group, the platelet count was significantly associated with mortality and composite outcomes. CONCLUSIONS HF and preoperative platelet count are significantly associated with 1-year all-cause mortality and adverse outcomes postoperatively in IE patients. Patients with HF and thrombocytopenia have the worst short-term prognosis.
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Affiliation(s)
- Junjie Wang
- Department of Cardiac SurgeryFirst Affiliated Hospital of Sun Yat‐sen UniversityGuangzhouChina
| | - Suiqing Huang
- Department of Cardiac SurgeryFirst Affiliated Hospital of Sun Yat‐sen UniversityGuangzhouChina
| | - Jian Hou
- Department of Cardiac SurgeryFirst Affiliated Hospital of Sun Yat‐sen UniversityGuangzhouChina
| | - Kangni Feng
- Department of Cardiac SurgeryFirst Affiliated Hospital of Sun Yat‐sen UniversityGuangzhouChina
| | - Huawei Wu
- Department of Epidemiology, Mailman School of Public HealthColumbia UniversityNew YorkNew YorkUSA
| | - Quan Liu
- Department of Cardiac SurgeryFirst Affiliated Hospital of Sun Yat‐sen UniversityGuangzhouChina
| | - Zhuoming Zhou
- Department of Cardiac SurgeryFirst Affiliated Hospital of Sun Yat‐sen UniversityGuangzhouChina
| | - Huayang Li
- Department of Cardiac SurgeryFirst Affiliated Hospital of Sun Yat‐sen UniversityGuangzhouChina
| | - Li Luo
- Department of Cardiac SurgeryFirst Affiliated Hospital of xi'an jiaotong universityXi'anShaanxiChina
| | - Liqun Shang
- Department of Cardiac SurgeryFirst Affiliated Hospital of Sun Yat‐sen UniversityGuangzhouChina
| | - Guangxian Chen
- Department of Cardiac SurgeryFirst Affiliated Hospital of Sun Yat‐sen UniversityGuangzhouChina
- Department of Cardiothoracic Surgery ICU, First Affiliated HospitalSun Yat‐sen UniversityGuangzhouChina
| | - Zhongkai Wu
- Department of Cardiac SurgeryFirst Affiliated Hospital of Sun Yat‐sen UniversityGuangzhouChina
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16
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Gao Y, Wang X, Li X, Fang Y, Lv C, Chen D. Association between platelet counts and clinical outcomes in acute fatty liver of pregnancy: A retrospective cohort study. Int J Gynaecol Obstet 2024; 164:173-183. [PMID: 37427679 DOI: 10.1002/ijgo.14955] [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] [Received: 12/18/2022] [Revised: 05/15/2023] [Accepted: 06/05/2023] [Indexed: 07/11/2023]
Abstract
OBJECTIVES To investigate whether platelet counts are associated with clinical outcomes in patients with acute fatty liver of pregnancy (AFLP). METHODS We retrospectively analyzed 140 patients with AFLP admitted to the Third Affiliated Hospital of Guangzhou Medical University between January 2010 and August 2022. In this cohort study, we used smooth curve fitting, Kaplan-Meier analysis, and multivariable logistic regression analysis to examine the independent relationship between platelet counts and 42-day postpartum mortality in AFLP. RESULTS There were 140 patients with AFLP, of which 15 died and 53 (37.86%) had thrombocytopenia. The overall 42-day postpartum maternal mortality was 10.7%. We observed a U-shaped relationship between the platelet counts and 42-day postpartum mortality. Two different slopes were observed below and above the inflection point at approximately 220 × 109 /L. After adjusting for some confounders, patients with thrombocytopenia (<100 × 109 /L) were found to have increased 42-day postpartum mortality compared with middle-tertile and highest-tertile patients. Patients with thrombocytopenia had a higher 42-day postpartum mortality, and higher proportions of intensive care unit admissions, postpartum hemorrhage, and multiple organ failure (P < 0.05). CONCLUSIONS A U-shaped association between platelet counts and 42-day postpartum mortality was observed in patients with AFLP. Thrombocytopenia is associated with poorer adverse clinical outcomes in women with AFLP.
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Affiliation(s)
- Yuanmei Gao
- Pulmonary and Critical Care Medicine, Key Laboratory for Major Obstetric Diseases of Guangdong Province, The Third Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Xiaoli Wang
- Maternal and Child Office, The Third Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Xiangbin Li
- The Third Clinical College, Guangzhou Medical University, Guangzhou, China
| | - Yuxin Fang
- The Third Clinical College, Guangzhou Medical University, Guangzhou, China
| | - Chengtian Lv
- Pulmonary and Critical Care Medicine, Key Laboratory for Major Obstetric Diseases of Guangdong Province, The Third Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Dunjin Chen
- Department of Obstetrics and Gynecology, Key Laboratory for Major Obstetric Diseases of Guangdong Province, The Third Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
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Maiorano BA, De Giorgi U, Verzoni E, Maiello E, Procopio G, Conteduca V, Di Maio M. Hematological Toxicity of PARP Inhibitors in Metastatic Prostate Cancer Patients with Mutations of BRCA or HRR Genes: A Systematic Review and Safety Meta-analysis. Target Oncol 2024; 19:1-11. [PMID: 37993604 PMCID: PMC10830661 DOI: 10.1007/s11523-023-01016-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/01/2023] [Indexed: 11/24/2023]
Abstract
BACKGROUND PARP inhibitors (PARPis) are effective treatment options for patients with metastatic castration-resistant prostate cancer (mCRPC) as single agents or in combination with androgen receptor-targeted agents (ARTA). However, a clinically relevant adverse effect of these agents is hematological toxicity, a typical class adverse event (AE), which can lead to treatment modifications and discontinuations. OBJECTIVE We aimed to analyze the risk of hematological AEs, including anemia, neutropenia, and thrombocytopenia secondary to PARPi treatments in mCRPC. PATIENTS AND METHODS This systematic review and meta-analysis followed the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) statement. We systematically searched the PubMed, EMBASE, and Cochrane databases, the American Society of Clinical Oncology (ASCO), and the European Society of Medical Oncology (ESMO) meeting abstracts for clinical trials concerning the use of PARPis, both as single agents and in combination, in patients with mCRPC. The search deadline was 30 June, 2023. We analyzed the pooled incidence of all grades of and ≥ G3 anemia, neutropenia, and thrombocytopenia. We subsequently calculated risk ratios (RRs) for all grades of and ≥ G3 AEs of PARPis versus non-PARPis from randomized clinical trials (RCTs). RESULTS Eleven phase 2/3 trials with olaparib, niraparib, rucaparib, and talazoparib administered as single agents or combined with ARTA were selected. Anemia was the most common all grades (38.6%) and ≥ G3 AE (24.9%). In the analysis of relative risk, six RCTs were included. The administration of PARPis significantly increased the risk of developing all grades of anemia (RR = 2.44), neutropenia (RR = 3.15), and thrombocytopenia (RR = 4.66) compared with non-PARPis. Similarly, a significant increase in the risk of ≥ G3 anemia (RR = 5.73) and thrombocytopenia (RR = 5.44), and a not significant increased risk of neutropenia (RR = 3.41), were detected. CONCLUSIONS In mCRPC, PARPis increase the risk of hematological toxicity compared with other treatments, both as single agents or combined with ARTA (high-quality evidence). Clinicians should be aware of this risk and the correct management, especially with the expected increased PARPis use in mCRPC.
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Affiliation(s)
| | - Ugo De Giorgi
- Department of Medical Oncology, IRCCS Istituto Romagnolo Per Lo Studio Dei Tumori (IRST) "Dino Amadori", Meldola, Italy
| | - Elena Verzoni
- Department of Medical Oncology, Fondazione IRCCS Istituto Nazionale Tumori, Milan, Italy
| | - Evaristo Maiello
- Oncology Unit, IRCCS Casa Sollievo della Sofferenza, San Giovanni Rotondo, Italy
| | - Giuseppe Procopio
- Department of Medical Oncology, Fondazione IRCCS Istituto Nazionale Tumori, Milan, Italy
| | - Vincenza Conteduca
- Unit of Medical Oncology and Biomolecular Therapy, Department of Medical and Surgical Sciences, University of Foggia, Policlinico Riuniti, Foggia, Italy
| | - Massimo Di Maio
- Division of Medical Oncology, Department of Oncology, University of Turin, Turin, Italy
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Duan Q, Tian X, Pang B, Zhang Y, Xiao C, Yao M, Ding S, Zhang X, Jiang X, Kou Z. Spatiotemporal distribution and environmental influences of severe fever with thrombocytopenia syndrome in Shandong Province, China. BMC Infect Dis 2023; 23:891. [PMID: 38124061 PMCID: PMC10731860 DOI: 10.1186/s12879-023-08899-1] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2023] [Accepted: 12/12/2023] [Indexed: 12/23/2023] Open
Abstract
BACKGROUND Severe fever with thrombocytopenia syndrome (SFTS) is an emerging infectious disease discovered in China in 2009. The purpose of this study was to describe the spatiotemporal distribution of SFTS and to identify its environmental influencing factors and potential high-risk areas in Shandong Province, China. METHODS Data on the SFTS incidence from 2010 to 2021 were collected. Spatiotemporal scan statistics were used to identify the time and area of SFTS clustering. The maximum entropy (MaxEnt) model was used to analyse environmental influences and predict high-risk areas. RESULTS From 2010 to 2021, a total of 5705 cases of SFTS were reported in Shandong. The number of SFTS cases increased yearly, with a peak incidence from April to October each year. Spatiotemporal scan statistics showed the existence of one most likely cluster and two secondary likely clusters in Shandong. The most likely cluster was in the eastern region, from May to October 2021. The first secondary cluster was in the central region, from May to October 2021. The second secondary cluster was in the southeastern region, from May to September 2020. The MaxEnt model showed that the mean annual wind speed, NDVI, cattle density and annual cumulative precipitation were the key factors influencing the occurrence of SFTS. The predicted risk map showed that the area of high prevalence was 28,120 km2, accounting for 18.05% of the total area of the province. CONCLUSIONS The spatiotemporal distribution of SFTS was heterogeneous and influenced by multidimensional environmental factors. This should be considered as a basis for delineating SFTS risk areas and developing SFTS prevention and control measures.
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Affiliation(s)
- Qing Duan
- Infectious Disease Prevention and Control Section, Shandong Center for Disease Control and Prevention, Jinan, 250014, China
- Chinese Field Epidemiology Training Program, Chinese Center for Disease Control and Prevention, Beijing, 100050, China
| | - Xueying Tian
- Infectious Disease Prevention and Control Section, Shandong Center for Disease Control and Prevention, Jinan, 250014, China
| | - Bo Pang
- Infectious Disease Prevention and Control Section, Shandong Center for Disease Control and Prevention, Jinan, 250014, China
| | - Yuwei Zhang
- Infectious Disease Prevention and Control Section, Shandong Center for Disease Control and Prevention, Jinan, 250014, China
| | - Chuanhao Xiao
- Infectious Disease Prevention and Control Section, Shandong Center for Disease Control and Prevention, Jinan, 250014, China
| | - Mingxiao Yao
- Infectious Disease Prevention and Control Section, Shandong Center for Disease Control and Prevention, Jinan, 250014, China
| | - Shujun Ding
- Infectious Disease Prevention and Control Section, Shandong Center for Disease Control and Prevention, Jinan, 250014, China
| | - Xiaomei Zhang
- Infectious Disease Prevention and Control Section, Shandong Center for Disease Control and Prevention, Jinan, 250014, China.
| | - Xiaolin Jiang
- Infectious Disease Prevention and Control Section, Shandong Center for Disease Control and Prevention, Jinan, 250014, China.
| | - Zengqiang Kou
- Infectious Disease Prevention and Control Section, Shandong Center for Disease Control and Prevention, Jinan, 250014, China.
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19
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Jiang D, Rosenlind K, Baxter S, Gernsheimer T, Gulsuner S, Allenspach EJ, Keel SB. Evaluating the prevalence of inborn errors of immunity in adults with chronic immune thrombocytopenia or Evans syndrome. Blood Adv 2023; 7:7202-7208. [PMID: 37792884 PMCID: PMC10702780 DOI: 10.1182/bloodadvances.2023011042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2023] [Revised: 08/15/2023] [Accepted: 08/15/2023] [Indexed: 10/06/2023] Open
Abstract
Inborn errors of immunity (IEIs) are monogenic disorders that predispose patients to immune dysregulation, autoimmunity, and infection. Autoimmune cytopenias, such as immune thrombocytopenia (ITP) and Evans syndrome (a combination of ITP and autoimmune hemolytic anemia), are increasingly recognized phenotypes of IEI. Although recent findings suggest that IEIs may commonly underlie pediatric ITP and Evans syndrome, its prevalence in adult patients with these disorders remains undefined. This study sought to estimate the prevalence of underlying IEIs among adults with persistent or chronic ITP or Evans syndrome using a next-generation sequencing panel encompassing >370 genes implicated in IEIs. Forty-four subjects were enrolled from an outpatient adult hematology clinic at a tertiary referral center in the United States, with a median age of 49 years (range, 20-83). Fourteen subjects (31.8%) had secondary ITP, including 8 (18.2%) with Evans syndrome. No cases of IEI were identified despite a high representation of subjects with a personal history of autoimmunity (45.5%) and early onset of disease (median age at diagnosis of 40 years [range, 2-77]), including 20.5% who were initially diagnosed as children. Eight subjects (18.2%) were found to be carriers of pathogenic IEI variants, which, in their heterozygous state, are not disease-causing. One case of TUBB1-related congenital thrombocytopenia was identified. Although systematic screening for IEI has been proposed for pediatric patients with Evans syndrome, findings from this real-world study suggest that inclusion of genetic testing for IEI in the routine work-up of adults with ITP and Evans syndrome has a low diagnostic yield.
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MESH Headings
- Humans
- Adult
- Child
- Young Adult
- Middle Aged
- Aged
- Aged, 80 and over
- Child, Preschool
- Adolescent
- Anemia, Hemolytic, Autoimmune/epidemiology
- Anemia, Hemolytic, Autoimmune/genetics
- Anemia, Hemolytic, Autoimmune/complications
- Purpura, Thrombocytopenic, Idiopathic/epidemiology
- Purpura, Thrombocytopenic, Idiopathic/genetics
- Purpura, Thrombocytopenic, Idiopathic/complications
- Autoimmunity
- Prevalence
- Thrombocytopenia/epidemiology
- Thrombocytopenia/genetics
- Thrombocytopenia/complications
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Affiliation(s)
- Debbie Jiang
- Division of Hematology, University of Washington, Seattle, WA
- Fred Hutchinson Cancer Center, Seattle, WA
- Division of Hematology, Massachusetts General Hospital, Boston, MA
| | | | - Sarah Baxter
- Division of Rheumatology, Seattle Children’s Hospital, Seattle, WA
| | - Terry Gernsheimer
- Division of Hematology, University of Washington, Seattle, WA
- Fred Hutchinson Cancer Center, Seattle, WA
| | | | | | - Siobán B. Keel
- Division of Hematology, University of Washington, Seattle, WA
- Fred Hutchinson Cancer Center, Seattle, WA
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20
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Abbas FF, Kouser S. Assessment of clinical spectrum of thrombocytopenia and its association with different disease states reported in Dow Diagnostic Reference and Research Lab (DDRRL). J PAK MED ASSOC 2023; 73:2375-2378. [PMID: 38083915 DOI: 10.47391/jpma.7634] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2023]
Abstract
Objectives To evaluate the relevance of thrombocytopenia to other disease states in patients reporting at a haematology laboratory. METHODS The cross-sectional, retrospective study was conducted at the Dow Diagnostic Research and Reference Laboratory of the Dr Ishrat ul Ebad Khan Institute of Blood Diseases, Dow University of Health Sciences, Karachi, and comprised data from the blood bank and haematology laboratory related to patients who visited during October 2021to August 2022. Data was analysed using SPSS 26. RESULTS Of the 1,249 patients with mean age 38.5±19.7 years (range: 0-89 years), 79(6.3%) were aged <12 years, 592(47.4%) were aged 12-40 years and 578(46.3%) were aged >40. Most of the patients were males 793 (63.5%), and 604(48.4%) had Grade 1 thrombocytopenia. Among the females, Grade 1 thrombocytopenia was found in 246(53.9%) and Grade 2 in 140(30.7%) patients compared to 358(45.1%) and 222(28%) in males, respectively (p<0.05). Association between thrombocytopenia and diagnoses was not significant (p>0.05). CONCLUSIONS Thrombocytopenia was found to be strongly associated with gender.
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Affiliation(s)
- Farah Fatima Abbas
- Department of Pathology, Dow International Medical College, Dow University of Health Sciences, Karachi, Pakistan
| | - Shaheen Kouser
- Department of Pathology, Dr. Ishrat ul Ebad Khan Institute of Blood Diseases, Dow University of Health Science, Karachi, Pakistan
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21
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Gao Z, Qi N, Qin X, Li Z, Li G, Wang Z, Wang J, Wen R, Li H. The addition of tislelizumab to gemcitabine and cisplatin chemotherapy increases thrombocytopenia in patients with urothelial carcinoma: A single-center study based on propensity score matching. Cancer Med 2023; 12:22071-22080. [PMID: 38093592 PMCID: PMC10757149 DOI: 10.1002/cam4.6807] [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] [Received: 07/27/2023] [Revised: 11/16/2023] [Accepted: 11/27/2023] [Indexed: 12/31/2023] Open
Abstract
PURPOSE Whether the addition of tislelizumab to gemcitabine and cisplatin (GC) chemotherapy increases the incidence of myelosuppression has not been well established. This study identified the risk factors for the development of myelosuppression in patients with urothelial carcinoma (UC) after receiving GC chemotherapy with or without tislelizumab. MATERIALS AND METHODS We enrolled 192 UC patients who received GC with or without tislelizumab at the Affiliated Hospital of Xuzhou Medical University between July 2014 and November 2022. Patient baseline characteristics were included in the statistical analyses after adjusting for previously reported risk factors affecting survival using propensity score matching (1:1). Binary logistic regression analysis was used to identify the risk factors associated with posttreatment myelosuppression. RESULTS A total of 192 patients were enrolled, of whom 96 were treated with tislelizumab plus gemcitabine and cisplatin (T + GC) and 96 with GC alone. The incidence of leukopenia, anemia, and thrombocytopenia of any grade was 50.0%, 70.8%, and 42.7%, respectively, in the T + GC group and 41.7%, 72.9%, and 20.8%, respectively, in the GC group. In multivariate analysis, patients aged over 70 years (OR = 2.486, 95% CI: 1.067-5.792, p = 0.035) and those who received T + GC (OR = 3.119, 95% CI: 1.576-6.173, p = 0.001) were more likely to develop thrombocytopenia. Patients aged over 70 years (OR = 3.213, 95% CI: 1.254-8.237, p = 0.015) were more likely to develop anemia, and patients with renal insufficiency (OR = 2.105, 95% CI: 1.035-4.280, p = 0.040) were more likely to develop leukopenia. Eventually, 99 (51.6%) patients with UC successfully completed all the treatment cycles. CONCLUSIONS This study demonstrates that the addition of tislelizumab to GC chemotherapy led to a considerable increase in the occurrence of thrombocytopenia, whereas no significant changes were observed regarding anemia or leukopenia. It is crucial to fully inform patients at increased risk for myelosuppression of potential risks and closely monitor changes in their blood routines.
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Affiliation(s)
- Zhimin Gao
- Department of UrologyThe Affiliated Hospital of Xuzhou Medical UniversityXuzhouChina
- Graduate School of Xuzhou Medical UniversityXuzhouChina
| | - Nienie Qi
- Department of UrologyThe Affiliated Hospital of Xuzhou Medical UniversityXuzhouChina
| | - Xu Qin
- Department of UrologyThe Affiliated Hospital of Xuzhou Medical UniversityXuzhouChina
- Graduate School of Xuzhou Medical UniversityXuzhouChina
| | - Zhen Li
- Department of UrologyThe Affiliated Hospital of Xuzhou Medical UniversityXuzhouChina
- Graduate School of Xuzhou Medical UniversityXuzhouChina
| | - Gang Li
- Department of UrologyThe Affiliated Hospital of Xuzhou Medical UniversityXuzhouChina
- Graduate School of Xuzhou Medical UniversityXuzhouChina
| | - Zewei Wang
- Department of UrologyThe Affiliated Hospital of Xuzhou Medical UniversityXuzhouChina
- Graduate School of Xuzhou Medical UniversityXuzhouChina
| | - Junqi Wang
- Department of UrologyThe Affiliated Hospital of Xuzhou Medical UniversityXuzhouChina
| | - Rumin Wen
- Department of UrologyThe Affiliated Hospital of Xuzhou Medical UniversityXuzhouChina
| | - Hailong Li
- Department of UrologyThe Affiliated Hospital of Xuzhou Medical UniversityXuzhouChina
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22
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Ab Rahman N, Lim MT, Lee FY, Wo WK, Yeoh HS, Peariasamy KM, Sivasampu S. Thrombocytopenia and venous thromboembolic events after BNT162b2, CoronaVac, ChAdOx1 vaccines and SARS-CoV-2 infection: a self-controlled case series study. Sci Rep 2023; 13:20471. [PMID: 37993548 PMCID: PMC10665324 DOI: 10.1038/s41598-023-47486-x] [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] [Received: 10/18/2022] [Accepted: 11/14/2023] [Indexed: 11/24/2023] Open
Abstract
This study assessed the association between COVID-19 vaccines, SARS-CoV-2 infection and the risk of thrombocytopenia and venous thromboembolism (VTE). This self-controlled case series study used hospital records between 1st February 2021 and 28th February 2022 linked to the national immunisation registry and COVID-19 surveillance data in Malaysia. Conditional Poisson regression was used to estimate incidence rate ratios (IRR) of events in the risk period (day 1-21 post-exposure) relative to control period with the corresponding 95% confidence interval (CI) adjusted for calendar period. We found no significant increased risk of thrombocytopenia in 1-21 days following BNT162b2, CoronaVac and ChAdOx1 vaccines while the risk was increased following SARS-CoV-2 infection (IRR 15.52, 95% CI 13.38-18.00). Similarly, vaccination with BNT162b2, CoronaVac, or ChAdOx1 was not associated with an increased risk of VTE during the 1-21 days risk period. SARS-CoV-2 infection was associated with increased risk of VTE (IRR 39.84, 95% CI 27.45-32.44). Our findings showed low event rates of thrombocytopenia and VTE following booster vaccination with comparable safety profiles between those who received homologous and heterologous booster combinations. Our findings showed the risk of thrombocytopenia and VTE was not increased after COVID-19 vaccination while the risks were substantially higher after SARS-CoV-2 infection.
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Affiliation(s)
- Norazida Ab Rahman
- Institute for Clinical Research, National Institutes of Health, Block B4, No 1, Jalan Setia Murni U13/52, 40170, Shah Alam, Selangor, Malaysia.
| | - Ming Tsuey Lim
- Institute for Clinical Research, National Institutes of Health, Block B4, No 1, Jalan Setia Murni U13/52, 40170, Shah Alam, Selangor, Malaysia
| | - Fei Yee Lee
- Clinical Research Centre, Selayang Hospital, Ministry of Health, Kepong, Selangor, Malaysia
| | - Wee Kee Wo
- National Pharmaceutical Regulatory Agency, Ministry of Health, Shah Alam, Selangor, Malaysia
| | - Hee Sheong Yeoh
- National Pharmaceutical Regulatory Agency, Ministry of Health, Shah Alam, Selangor, Malaysia
| | - Kalaiarasu M Peariasamy
- Institute for Clinical Research, National Institutes of Health, Block B4, No 1, Jalan Setia Murni U13/52, 40170, Shah Alam, Selangor, Malaysia
| | - Sheamini Sivasampu
- Institute for Clinical Research, National Institutes of Health, Block B4, No 1, Jalan Setia Murni U13/52, 40170, Shah Alam, Selangor, Malaysia
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Mossayebi MH, Iyer NS, McLaren RA, Moussa HN, Sibai BM, Al-Kouatly HB. HELLP syndrome at <23 weeks' gestation: a systematic literature review. Am J Obstet Gynecol 2023; 229:502-515.e10. [PMID: 37150281 DOI: 10.1016/j.ajog.2023.04.046] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2023] [Revised: 04/23/2023] [Accepted: 04/26/2023] [Indexed: 05/09/2023]
Abstract
OBJECTIVE We performed a systematic review to evaluate the clinical presentation and maternal and fetal outcomes in pregnancies with early-onset HELLP (hemolysis, elevated liver enzymes, and low platelets) syndrome. DATA SOURCES PubMed, Ovid MEDLINE, Scopus, CINAHL, Cochrane Library, and ClinicalTrials.gov were queried from inception through January 1, 2023 with the following terms: "HELLP syndrome," "HELLP," "hemolysis, elevated liver enzymes, low platelets," "hemolysis, elevated liver enzymes, low platelets syndrome," "pre-viable," "peri-viable," "previable," "periviable," "first trimester," "second trimester," "before 23 weeks," "<23 weeks," "<23 week gestation," and "before 23 weeks gestation." We also included an additional case from our institution. STUDY ELIGIBILITY CRITERIA Abstracts, unpublished studies, and review articles were excluded, yielding 46 studies that met our inclusion criteria. METHODS Two reviewers (N.S.I. and M.H.M.) performed the study selection and subsequent data extraction independently, after which the results were reviewed together. PRISMA guidelines were followed, and our study was registered at PROSPERO (CRD42021292692). RESULTS A total of 55 patients had 58 pregnancies complicated by early-onset HELLP syndrome, including 3 with recurrent HELLP. The most common presenting signs/symptoms were abdominal pain (35/45; 78%), hypertension (32/49; 65%), nausea/vomiting (16/45; 36%), headache (13/45; 29%), and edema (8/45; 18%). Lactate dehydrogenase ≥600 IU/L was observed in 21 of 31 (68%) cases, whereas liver enzyme abnormalities and thrombocytopenia were reported in 48 of 51 (94%) and 50 of 54 (93%) cases, respectively. Maternal complications were encountered in 25 of 56 (45%) cases. The most common complications were hepatic (13/56; 23%), central nervous system-related (11/56; 20%), and respiratory (11/56; 20%). In 36 of 57 (63%) cases, pregnancy was terminated. Of the 21 continued pregnancies, early fetal death (at <20 weeks' gestation) was reported in 10 (48%), stillbirth in 6 (28%), and neonatal demise in 2 (10%). Living neonates were reported in 3 of 21 (14%) cases, all delivered at 23 weeks. The perinatal mortality rate was 73% (8/11). One case (2%) reported maternal death. Antiphospholipid syndrome was diagnosed in 14 of 29 (48%) cases. CONCLUSION Early-onset HELLP syndrome presents with symptoms similar to those observed in later gestation. Maternal complications are life-threatening, with the most common complications being hepatic, central nervous system-related, and respiratory. Fetal outcomes are poor.
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Affiliation(s)
- Matthew H Mossayebi
- Department of Obstetrics and Gynecology, Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA.
| | - Neel S Iyer
- Department of Obstetrics and Gynecology, Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA
| | - Rodney A McLaren
- Department of Obstetrics and Gynecology, Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA
| | - Hind N Moussa
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, University of Toledo, ProMedica Health System, Toledo, OH
| | - Baha M Sibai
- Department of Obstetrics, Gynecology and Reproductive Sciences, The University of Texas Health Science Center at Houston, Houston, TX
| | - Huda B Al-Kouatly
- Department of Obstetrics and Gynecology, Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA
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24
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Dungu KHS, Lund S, Malchau Carlsen EL, Hartling UB, Matthesen AT, Franck KT, Thomsen MK, Justesen US, Nielsen HL, Nielsen ACY, Henriksen TB, Nygaard U. Herpes simplex virus infection among neonates suspected of invasive bacterial infection: a population-based cohort study. Arch Dis Child Fetal Neonatal Ed 2023; 108:655-660. [PMID: 37225392 DOI: 10.1136/archdischild-2023-325583] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2023] [Accepted: 05/16/2023] [Indexed: 05/26/2023]
Abstract
OBJECTIVE To estimate the incidence of neonatal herpes simplex virus (HSV) infection and the number of neonates with suspected invasive bacterial infection (IBI) needed to treat (NNT) with acyclovir to ensure prompt treatment of invasive HSV infections. DESIGN A nationwide population-based cohort study. SETTING All neonatal and paediatric emergency departments in Denmark from 1 January 2010 to 31 December 2019. PATIENTS Neonates aged 0-28 days with HSV infection. MAIN OUTCOME MEASURES The main outcome measures were incidence and NNT. The NNT was calculated based on neonates with invasive HSV infection whose onset symptoms resembled IBI and the estimated number of Danish neonates who received antibiotics for suspected IBI. RESULTS Fifty-four neonates with HSV infection were identified, that is, an incidence of 9 per 100 000 live births. Twenty presented with symptoms resembling IBI, all within the first 14 days of life. Of 18 (78%) neonates, 14 had elevated C reactive protein, 14 of 19 (74%) had elevated alanine aminotransferase and 11 of 17 (65%) had thrombocytopaenia. The estimated NNTs with empiric acyclovir at postnatal ages 0-3, 4-7 and 8-14 days were 1139 (95% CI 523 to 3103), 168 (95% CI 101 to 726) and 117 (95% CI 48 to 198), respectively. CONCLUSIONS The incidence of neonatal HSV infection was higher than in previous decades; however, the estimated NNT with empiric acyclovir was high. Therefore, we propose not to treat all neonates suspected of IBI with empiric acyclovir, as current European guidelines suggest. However, HSV should be considered in neonates with signs of infection, especially after the third postnatal day and in neonates with high alanine aminotransferases and thrombocytopaenia.
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Affiliation(s)
- Kia Hee Schultz Dungu
- Department of Paediatrics and Adolescent Medicine, Copenhagen University Hospital, Copenhagen, Denmark
| | - Stine Lund
- Department of Neonatology, Copenhagen University Hospital, Copenhagen, Denmark
| | | | - Ulla Birgitte Hartling
- Department of Paediatrics and Adolescent Medicine, Odense University Hospital, Odense, Denmark
| | - Astrid Thaarup Matthesen
- Department of Paediatrics and Adolescent Medicine, Aalborg University Hospital, Aalborg, Denmark
| | - Kristina Træholt Franck
- Department of Virus and Microbiological Special Diagnostics, Statens Serum Institut, Copenhagen, Denmark
| | | | - Ulrik Stenz Justesen
- Department of Clinical Microbiology, Odense University Hospital, Odense, Denmark
| | - Hans Linde Nielsen
- Department of Clinical Microbiology, Aalborg University Hospital, Aalborg, Denmark
| | | | - Tine Brink Henriksen
- Department of Paediatrics and Adolescent Medicine, Aarhus University Hospital, Aarhus, Denmark
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Ulrikka Nygaard
- Department of Paediatrics and Adolescent Medicine, Copenhagen University Hospital, Copenhagen, Denmark
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25
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Anthon CT, Pène F, Perner A, Azoulay E, Puxty K, Van De Louw A, Barratt-Due A, Chawla S, Castro P, Póvoa P, Coelho L, Metaxa V, Kochanek M, Liebregts T, Kander T, Hästbacka J, Andreasen JB, Péju E, Nielsen LB, Hvas CL, Dufranc E, Canet E, Lundqvist L, Wright CJ, Schmidt J, Uhel F, Ait-Oufella H, Krag M, Cos Badia E, Díaz-Lagares C, Menat S, Voiriot G, Clausen NE, Lorentzen K, Kvåle R, Hildebrandt T, Holten AR, Strand K, Tzalavras A, Bestle MH, Klepstad P, Fernandez S, Vimpere D, Paulino C, Graça C, Lueck C, Juhl CS, Costa C, Bådstøløkken PM, Miranda T, Lêdo LSA, Sousa Torres JC, Granholm A, Møller MH, Russell L. Thrombocytopenia and platelet transfusions in ICU patients: an international inception cohort study (PLOT-ICU). Intensive Care Med 2023; 49:1327-1338. [PMID: 37812225 PMCID: PMC10622358 DOI: 10.1007/s00134-023-07225-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [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] [Received: 06/19/2023] [Accepted: 09/05/2023] [Indexed: 10/10/2023]
Abstract
PURPOSE Thrombocytopenia (platelet count < 150 × 109/L) is common in intensive care unit (ICU) patients and is likely associated with worse outcomes. In this study we present international contemporary data on thrombocytopenia in ICU patients. METHODS We conducted a prospective cohort study in adult ICU patients in 52 ICUs across 10 countries. We assessed frequencies of thrombocytopenia, use of platelet transfusions and clinical outcomes including mortality. We evaluated pre-selected potential risk factors for the development of thrombocytopenia during ICU stay and associations between thrombocytopenia at ICU admission and 90-day mortality using pre-specified logistic regression analyses. RESULTS We analysed 1166 ICU patients; the median age was 63 years and 39.5% were female. Overall, 43.2% (95% confidence interval (CI) 40.4-46.1) had thrombocytopenia; 23.4% (20-26) had thrombocytopenia at ICU admission, and 19.8% (17.6-22.2) developed thrombocytopenia during their ICU stay. Absence of acquired immune deficiency syndrome (AIDS), non-cancer-related immune deficiency, liver failure, male sex, septic shock, and bleeding at ICU admission were associated with the development of thrombocytopenia during ICU stay. Among patients with thrombocytopenia, 22.6% received platelet transfusion(s), and 64.3% of in-ICU transfusions were prophylactic. Patients with thrombocytopenia had higher occurrences of bleeding and death, fewer days alive without the use of life-support, and fewer days alive and out of hospital. Thrombocytopenia at ICU admission was associated with 90-day mortality (adjusted odds ratio 1.7; 95% CI 1.19-2.42). CONCLUSION Thrombocytopenia occurred in 43% of critically ill patients and was associated with worse outcomes including increased mortality. Platelet transfusions were given to 23% of patients with thrombocytopenia and most were prophylactic.
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Affiliation(s)
- Carl Thomas Anthon
- Department of Intensive Care, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark
| | - Frédéric Pène
- Médecine Intensive and Réanimation, Hôpital Cochin, Assistance Publique-Hôpitaux de Paris, Institut Cochin, INSERM U1016, CNRS UMR8104, Université Paris Cité, Paris, France
| | - Anders Perner
- Department of Intensive Care, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
- Médecine Intensive and Réanimation, Hôpital Saint-Louis, Assistance Publique-Hôpitaux de Paris, Université Paris Cité, Paris, France
| | - Elie Azoulay
- Médecine Intensive and Réanimation, Hôpital Saint-Louis, Assistance Publique-Hôpitaux de Paris, Université Paris Cité, Paris, France
| | - Kathryn Puxty
- Department of Intensive Care, Glasgow Royal Infirmary, Glasgow, UK
| | - Andry Van De Louw
- Division of Pulmonary and Critical Care, Penn State University College of Medicine, Hershey, PA, USA
| | - Andreas Barratt-Due
- Department of Anaesthesia and Intensive Care Medicine, Division of Emergencies and Critical Care, Oslo University Hospital, Rikshospitalet, Oslo, Norway
| | - Sanjay Chawla
- Critical Care Medicine Service, Department of Anesthesiology and Critical Care Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
- Department of Anesthesiology, Weill Cornell Medical College, New York, NY, USA
| | - Pedro Castro
- Medical Intensive Care Unit, Hospital Clinic of Barcelona, IDIBAPS, University of Barcelona, Barcelona, Spain
| | - Pedro Póvoa
- Department of Intensive Care, Sao Francisco Xavier Hospital, CHLO, Lisbon, Portugal
- Nova Medical School, CHRC, New University of Lisbon, Lisbon, Portugal
- Center for Clinical Epidemiology and Research Unit of Clinical Epidemiology, Odense University Hospital, Odense, Denmark
| | - Luis Coelho
- Department of Intensive Care, Sao Francisco Xavier Hospital, CHLO, Lisbon, Portugal
- Nova Medical School, CHRC, New University of Lisbon, Lisbon, Portugal
| | - Victoria Metaxa
- Department of Critical Care, King's College Hospital NHS Foundation Trust, London, UK
| | - Matthias Kochanek
- Department I of Internal Medicine, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Tobias Liebregts
- Department of Hematology and Stem Cell Transplantation, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
| | - Thomas Kander
- Department of Intensive and Perioperative Care, Skåne University Hospital, Lund, Sweden
- Department of Clinical Sciences, Lund University, Lund, Sweden
| | - Johanna Hästbacka
- Department of Perioperative and Intensive Care Medicine, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
- Department of Anaesthesiology and Intensive Care, Tampere University Hospital and Tampere University, Tampere, Finland
| | - Jo Bønding Andreasen
- Department of Anaesthesia and Intensive Care, Aalborg University Hospital, Aalborg, Denmark
| | - Edwige Péju
- Médecine Intensive and Réanimation, Hôpital Cochin, Assistance Publique-Hôpitaux de Paris, Institut Cochin, INSERM U1016, CNRS UMR8104, Université Paris Cité, Paris, France
| | | | - Christine Lodberg Hvas
- Department of Anaesthesiology and Intensive Care, Aarhus University Hospital, Aarhus, Denmark
| | - Etienne Dufranc
- Service de Médecine Intensive Réanimation, Hôpitaux Universitaires Henri-Mondor, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Emmanuel Canet
- Médecine Intensive Réanimation, CHU de Nantes, Université de Nantes, Nantes, France
| | - Linda Lundqvist
- Department of Intensive and Perioperative Care, Skåne University Hospital, Lund, Sweden
| | | | - Julien Schmidt
- Service de Réanimation Médico-Chirurgicale, Hôpital Avicenne, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Fabrice Uhel
- Médecine Intensive Réanimation, Hôpital Louis Mourier, Assistance Publique-Hôpitaux de Paris, DMU ESPRIT, Paris, France
- Institut Necker-Enfants Malades, Université Paris Cité, INSERMUMR-S1151, CNRSUMR-S8253, Paris, France
| | - Hafid Ait-Oufella
- Service de Médecine Intensive-Réanimation, Hôpital Saint-Antoine, Assistance Publique-Hôpitaux de Paris, Sorbonne Université, Paris, France
| | - Mette Krag
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
- Department of Intensive Care, Holbaek Hospital, Holbaek, Denmark
| | - Elisabet Cos Badia
- Department of Intensive Care, Hospital General Granollers, Barcelona, Spain
| | - Cándido Díaz-Lagares
- Intensive Care Department, Vall d'Hebron Hospital Universitari, Barcelona, Spain
- SODIR Research Group, Vall d'Hebron Institut de Recerca (VHIR), Vall d'Hebron Barcelona Hospital Campus, Barcelona, Spain
| | - Sophie Menat
- Service de Médecine Intensive-Réanimation, Hôpital Pitié-Salpêtrière, Assistance Publique-Hôpitaux de Paris, Sorbonne Université, Paris, France
| | - Guillaume Voiriot
- Service de Médecine Intensive Réanimation, Hôpital Tenon, Assistance Publique-Hôpitaux de Paris, Sorbonne Université, Centre de Recherche Saint-Antoine UMRS_938 INSERM, Paris, France
| | - Niels Erikstrup Clausen
- Department of Anaesthesia and Intensive Care, Copenhagen University Hospital - Bispebjerg and Frederiksberg, Copenhagen, Denmark
| | - Kristian Lorentzen
- Department of Intensive Care, Copenhagen University Hospital - Herlev and Gentofte, Herlev, Denmark
| | - Reidar Kvåle
- Department of Anaesthesia and Intensive Care, Haukeland University Hospital, Bergen, Norway
- Faculty of Medicine, University of Bergen, Bergen, Norway
| | - Thomas Hildebrandt
- Department of Intensive Care, Zealand University Hospital - Roskilde, Roskilde, Denmark
| | - Aleksander Rygh Holten
- Department of Acute Medicine, Oslo University Hospital, Oslo, Norway
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Kristian Strand
- Department of Intensive Care, Stavanger University Hospital, Stavanger, Norway
| | - Asterios Tzalavras
- Department of Hematology and Stem Cell Transplantation, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
| | - Morten Heiberg Bestle
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
- Department of Anaesthesiology and Intensive Care, Copenhagen University Hospital - North Zealand, Hilleroed, Denmark
| | - Pål Klepstad
- Department of Intensive Care Medicine, St. Olav's University Hospital, Trondheim, Norway
- Department Circulation and Medical Imaging, Norwegian University of Technology and Science, Trondheim, Norway
| | - Sara Fernandez
- Medical Intensive Care Unit, Hospital Clinic of Barcelona, University of Barcelona, Barcelona, Spain
| | - Damien Vimpere
- Médecine Intensive and Réanimation, Hôpital Necker, Assistance Publique-Hôpitaux de Paris, Université Paris Cité, Paris, France
| | - Carolina Paulino
- Nova Medical School, CHRC, New University of Lisbon, Lisbon, Portugal
- Department of Intensive Care, Hospital da Luz Lisboa, Lisbon, Portugal
| | - Carina Graça
- Department of Intensive Care, Hospital Central do Funchal, Funchal, Portugal
| | - Catherina Lueck
- Department of Hematology, Hemostasis, Oncology and Stem Cell Transplantation, Hannover Medical School, Hannover, Germany
| | - Christian Svendsen Juhl
- Department of Anaesthesiology, Copenhagen University Hospital - Amager and Hvidovre, Hvidovre, Denmark
| | - Carolina Costa
- Intensive Care Unit, Hospital Professor Doutor Fernando Fonseca, EPE, Amadora, Portugal
| | | | - Teresa Miranda
- Department of Intensive Care, Sao Francisco Xavier Hospital, CHLO, Lisbon, Portugal
| | - Lia Susana Aires Lêdo
- Department of Intensive Care Medicine-Unit 2, Hospital Egas Moniz-CHLO, EPE, Lisbon, Portugal
| | | | - Anders Granholm
- Department of Intensive Care, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark
| | - Morten Hylander Møller
- Department of Intensive Care, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Lene Russell
- Department of Intensive Care, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark.
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark.
- Médecine Intensive and Réanimation, Hôpital Saint-Louis, Assistance Publique-Hôpitaux de Paris, Université Paris Cité, Paris, France.
- Department of Intensive Care, Copenhagen University Hospital - Gentofte, Hellerup, Denmark.
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Shittu O, Oniya MO, Olusi TA. Circulating platelets and malaria severity: two sides of the same coin among inhabitants of a tropical savannah region, Nigeria. Parasitol Res 2023; 122:2503-2511. [PMID: 37658925 DOI: 10.1007/s00436-023-07949-6] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2023] [Accepted: 08/18/2023] [Indexed: 09/05/2023]
Abstract
Changes in circulating platelets during different grades of malaria are of major concerns, and its etiology is poorly understood. We appraised and evaluated the role of circulating platelets in the determination of the severity of malaria among a cohort of outpatients living in Ilorin, Nigeria. A hospital-based case-control study of outpatients visiting public health facilities within the locality voluntarily enrolled for this study. Blood samples from 1162 malaise patients were screened using routine microscopy for Plasmodium parasite species identification, and their respective circulating platelet levels were determined. Seven hundred and seventy-five individuals (775, 66.7%, p<0.001) were malaria-positive. Samples from 387 (33.3%) uninfected healthy individuals were used as controls. Individuals with uncomplicated malaria (UCM) and complicated malaria (CM) across age group were notable (p<0.05). Children ≤5 years had the highest number of individuals with CM (103, 45.2%) with a relative risk ratio of 4.005 (95% CI: 2.964-5.413). UCM (471, 40.5%) occurred more than CM (304, 26.2%) (p>0.05) across the groups. The geometric mean, 95% CI, median, and IQR of populations with malaria thrombocytopenia were higher (181, 110.94±2.207, 106.59-115.30, 118.00, and 39.00) than thrombocytosis (78, 624.64±13.131, 598.49-650.79, 623.00, and 208). Seemingly, health controls recorded insignificant morbidity with respect to platelet counts. High P. falciparum parasitemia is inversely correlated with platelet count, and its' morbidity is associated with the manifestation of several malaria pathogenesis. Thrombocytopenia is a silent pathophysiological attribute that can trigger other cofactors during severe malaria disease. Although further studies are pertinent in order to specifically clarify its relevance to clinical disease spectrum.
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Affiliation(s)
- Olalere Shittu
- Parasitology and Public Health Unit, Department of Biology, Federal University of Technology, Akure, Nigeria.
- Parasitology Unit, Department of Zoology, University of Ilorin, Ilorin, Nigeria.
| | - Mobolanle Oladipo Oniya
- Parasitology and Public Health Unit, Department of Biology, Federal University of Technology, Akure, Nigeria
| | - Titus Adeniyi Olusi
- Parasitology and Public Health Unit, Department of Biology, Federal University of Technology, Akure, Nigeria
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27
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Iijima R, Tokue M, Nakamura M, Yasuda S, Kaikita K, Akao M, Ako J, Matoba T, Miyauchi K, Hagiwara N, Kimura K, Hirayama A, Matsui K, Ogawa H. Thrombocytopenia as a Bleeding Risk Factor in Atrial Fibrillation and Coronary Artery Disease: Insights From the AFIRE Study. J Am Heart Assoc 2023; 12:e031096. [PMID: 37815031 PMCID: PMC10757527 DOI: 10.1161/jaha.123.031096] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/20/2023] [Accepted: 09/08/2023] [Indexed: 10/11/2023]
Abstract
Background Thrombocytopenia poses a risk of bleeding in patients with chronic coronary syndrome after coronary intervention. However, whether thrombocytopenia also increases the bleeding risk in patients with atrial fibrillation and chronic coronary syndrome remains unclear. Methods and Results This study evaluated the AFIRE (Atrial Fibrillation and Ischemic Events With Rivaroxaban in Patients With Stable Coronary Artery Disease) trial. Thrombocytopenia was defined as platelet count <100 000/mm3 level at enrollment. Primary end points included incidence of major bleeding based on the International Society on Thrombosis and Hemostasis criterion and major adverse cardiovascular ischemic events (cardiac death, myocardial infarction, and stroke). A total of 2133 patients were classified into the thrombocytopenia (n=70) and nonthrombocytopenia (n=2063) groups. Major bleeding was significantly higher in the thrombocytopenia group than in the nonthrombocytopenia group (10.0% versus 4.1%, P=0.027). The thrombocytopenia group tended to have a higher risk of major adverse cardiovascular ischemic events (11.4% versus 6.2%, P=0.08). The bleeding incidence was significantly higher in patients with thrombocytopenia receiving combination therapy with rivaroxaban and a single antiplatelet drug (thrombocytopenia group, 14.3%, versus nonthrombocytopenia group, 5.0%; hazard ratio, 3.18 [95% CI, 1.27-7.97], P=0.014). Thrombocytopenia was an independent predictor of major bleeding (hazard ratio, 2.57 [95% CI, 1.19-5.56], P=0.017). Conclusions Among patients with atrial fibrillation and chronic coronary syndrome, thrombocytopenia was significantly associated with increased risk of major bleeding. Selecting drugs for patients with thrombocytopenia continuing antithrombotic therapy should be given special consideration. Registration URL: https://www.clinicaltrials.gov; Unique identifier: NCT02642419. https://www.umin.ac.jp/ctr/; Unique identifier: UMIN000016612.
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Affiliation(s)
- Raisuke Iijima
- Division of Cardiovascular MedicineToho University Ohashi Medical CenterTokyoJapan
| | - Masahide Tokue
- Kawasaki Miyamaedaira Tokue Internal‐Cardiovascular Medical ClinicKawasakiJapan
| | - Masato Nakamura
- Division of Cardiovascular MedicineToho University Ohashi Medical CenterTokyoJapan
| | - Satoshi Yasuda
- Department of Cardiovascular MedicineTohoku University Graduate School of MedicineSendaiJapan
| | - Koichi Kaikita
- Division of Cardiovascular Medicine and Nephrology, Department of Internal Medicine, Faculty of MedicineUniversity of MiyazakiMiyazakiJapan
| | - Masaharu Akao
- Department of CardiologyNational Hospital Organization Kyoto Medical CenterKyotoJapan
| | - Junya Ako
- Department of Cardiovascular MedicineKitasato University School of MedicineSagamiharaJapan
| | - Tetsuya Matoba
- Department of Cardiovascular Medicine, Faculty of Medical SciencesKyushu UniversityFukuokaJapan
| | - Katsumi Miyauchi
- Department of Cardiovascular MedicineJuntendo Tokyo Koto Geriatric Medical CenterTokyoJapan
| | | | - Kazuo Kimura
- Department of CardiologyYokosuka City HospitalYokosukaJapan
| | | | - Kunihiko Matsui
- Department of General MedicineKumamoto University HospitalKumamotoJapan
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28
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Li Y, Wang XY, Li YF, Li DX, Hu X, Zhu L, You AG, Wang HF, Ye Y, Guo WS, Huang XY. [The epidemiology and pathogeny investigation of two clusters of severe fever with thrombocytopenia syndrome disease outbreaking in Henan Province, 2022]. Zhonghua Yu Fang Yi Xue Za Zhi 2023; 57:1719-1724. [PMID: 37859394 DOI: 10.3760/cma.j.cn112150-20221130-01162] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Subscribe] [Scholar Register] [Indexed: 10/21/2023]
Abstract
To investigate two clusters of severe fever with thrombocytopenia syndrome virus (SFTSV) in Xinyang City, Henan Province, in 2022, and analyze their causes, transmission route, risk factors, and the characteristics of virus genetic variation. Case search and case investigation were carried out according to the case definition. Blood samples from cases, family members and neighbors and samples of biological vectors were collected for RT-PCR to detect SFTSV. The whole genome sequencing and bioinformatics analysis were performed on the collected positive samples. A total of two clustered outbreaks occurred, involving two initial cases and ten secondary cases, all of which were family recurrent cases. Among them, nine secondary cases had close contact with the blood of the initial case, and it was determined that close contact with blood was the main risk factor for the two clustered outbreaks. After genome sequencing analysis, we found that the SFTSV genotype in two cases was type A, which was closely related to previous endemic strains in Xinyang. The nucleotide sequence of the SFTSV in the case was highly homologous, with a total of nine amino acid mutation sites in the coding region. It was not ruled out that its mutation sites might have an impact on the outbreak of the epidemic.
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Affiliation(s)
- Y Li
- Henan Key Laboratory of Infectious Disease Microbiology/Infectious Disease Control and Prevention Institute, Henan Provincial Center for Disease Control and Prevention, Zhengzhou 450016, China
| | - X Y Wang
- Henan Key Laboratory of Infectious Disease Microbiology/Infectious Disease Control and Prevention Institute, Henan Provincial Center for Disease Control and Prevention, Zhengzhou 450016, China College of Public Health, Zhengzhou University, Zhengzhou 450001, China
| | - Y F Li
- Henan Key Laboratory of Infectious Disease Microbiology/Infectious Disease Control and Prevention Institute, Henan Provincial Center for Disease Control and Prevention, Zhengzhou 450016, China
| | - D X Li
- Henan Key Laboratory of Infectious Disease Microbiology/Infectious Disease Control and Prevention Institute, Henan Provincial Center for Disease Control and Prevention, Zhengzhou 450016, China
| | - X Hu
- Henan Key Laboratory of Infectious Disease Microbiology/Infectious Disease Control and Prevention Institute, Henan Provincial Center for Disease Control and Prevention, Zhengzhou 450016, China
| | - L Zhu
- Henan Key Laboratory of Infectious Disease Microbiology/Infectious Disease Control and Prevention Institute, Henan Provincial Center for Disease Control and Prevention, Zhengzhou 450016, China
| | - A G You
- Henan Key Laboratory of Infectious Disease Microbiology/Infectious Disease Control and Prevention Institute, Henan Provincial Center for Disease Control and Prevention, Zhengzhou 450016, China
| | - H F Wang
- Henan Key Laboratory of Infectious Disease Microbiology/Infectious Disease Control and Prevention Institute, Henan Provincial Center for Disease Control and Prevention, Zhengzhou 450016, China
| | - Y Ye
- Henan Key Laboratory of Infectious Disease Microbiology/Infectious Disease Control and Prevention Institute, Henan Provincial Center for Disease Control and Prevention, Zhengzhou 450016, China
| | - W S Guo
- Henan Key Laboratory of Infectious Disease Microbiology/Infectious Disease Control and Prevention Institute, Henan Provincial Center for Disease Control and Prevention, Zhengzhou 450016, China
| | - X Y Huang
- Henan Key Laboratory of Infectious Disease Microbiology/Infectious Disease Control and Prevention Institute, Henan Provincial Center for Disease Control and Prevention, Zhengzhou 450016, China
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Regev-Sadeh S, Borovitz Y, Steinberg-Shemer O, Gilad O, Shoham S, Yacobovich J. Cytopenias in pediatric kidney transplant recipients: preceding factors and clinical consequences. Pediatr Nephrol 2023; 38:3445-3454. [PMID: 37079102 DOI: 10.1007/s00467-023-05905-1] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/15/2022] [Revised: 01/30/2023] [Accepted: 02/01/2023] [Indexed: 04/21/2023]
Abstract
BACKGROUND Kidney trans plantation is associated with secondary complications, including the risk of developing posttransplant cytopenias. This study aimed to evaluate the characteristics, identify predictors, and assess the management and consequences of cytopenias in the pediatric kidney transplant population. METHODS This is a single-center retrospective analysis of 89 pediatric kidney transplant recipients. Possible factors preceding cytopenias were compared with the goal of recognizing predictors for posttransplant cytopenias. Posttransplant neutropenias were analyzed for the total study period and separately for the period beyond 6 months posttransplant (late neutropenias), to rule out confounding influences of induction and initial intensive therapy. RESULTS Sixty patients (67%) developed at least one episode of posttransplant cytopenia. All episodes of posttransplant thrombocytopenias were mild or moderate. Posttransplant infections and graft rejection were found to be significant predictors for thrombocytopenia (HR 6.06, 95% CI 1.6-22.9, and HR 5.82, 95% CI 1.27-26.6, respectively). A total of 30% of posttransplant neutropenias were severe (ANC ≤ 500). Pretransplant dialysis and posttransplant infections were significant predictors for late neutropenias (HR 11.2, 95% CI 1.45-86.4, and HR 3.32, 95% CI 1.46-7.57, respectively). Graft rejection occurred in 10% of patients with cytopenia, all following neutropenia, within 3 months from cytopenia appearance. In all such cases, mycophenolate mofetil dosing had been held or reduced prior to rejection. CONCLUSIONS Posttransplant infections are substantial contributors to developing posttransplant cytopenias. Preemptive transplantation appears to reduce risk of late neutropenia, the accompanying reduction in immunosuppressive therapy, and the ensuing risk of graft rejection. An alternative response to neutropenia, possibly using granulocyte colony stimulating factor, may diminish graft rejection. A higher resolution version of the Graphical abstract is available as Supplementary information.
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Affiliation(s)
| | - Yael Borovitz
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel.
- Nephrology Institute, Schneider Children's Medical Center, Petach Tikva, Israel.
| | - Orna Steinberg-Shemer
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
- Department of Pediatric Hematology and Oncology, Schneider Children's Medical Center, Petach Tikva, Israel
| | - Oded Gilad
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
- Department of Pediatric Hematology and Oncology, Schneider Children's Medical Center, Petach Tikva, Israel
| | - Shoval Shoham
- Research Authority, Schneider Children's Medical Center, Petach Tikva, Israel
| | - Joanne Yacobovich
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
- Department of Pediatric Hematology and Oncology, Schneider Children's Medical Center, Petach Tikva, Israel
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30
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van de Munckhof A, Borhani-Haghighi A, Aaron S, Krzywicka K, van Kammen MS, Cordonnier C, Kleinig TJ, Field TS, Poli S, Lemmens R, Scutelnic A, Lindgren E, Duan J, Arslan Y, van Gorp ECM, Kremer Hovinga JA, Günther A, Jood K, Tatlisumak T, Putaala J, Heldner MR, Arnold M, de Sousa DA, Wasay M, Arauz A, Conforto AB, Ferro JM, Coutinho JM. Cerebral venous sinus thrombosis due to vaccine-induced immune thrombotic thrombocytopenia in middle-income countries. Int J Stroke 2023; 18:1112-1120. [PMID: 37277922 PMCID: PMC10614174 DOI: 10.1177/17474930231182901] [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] [Received: 02/24/2023] [Accepted: 05/26/2023] [Indexed: 06/07/2023]
Abstract
BACKGROUND Adenovirus-based COVID-19 vaccines are extensively used in low- and middle-income countries (LMICs). Remarkably, cases of cerebral venous sinus thrombosis due to vaccine-induced immune thrombotic thrombocytopenia (CVST-VITT) have rarely been reported from LMICs. AIMS We studied the frequency, manifestations, treatment, and outcomes of CVST-VITT in LMICs. METHODS We report data from an international registry on CVST after COVID-19 vaccination. VITT was classified according to the Pavord criteria. We compared CVST-VITT cases from LMICs to cases from high-income countries (HICs). RESULTS Until August 2022, 228 CVST cases were reported, of which 63 were from LMICs (all middle-income countries [MICs]: Brazil, China, India, Iran, Mexico, Pakistan, Turkey). Of these 63, 32 (51%) met the VITT criteria, compared to 103 of 165 (62%) from HICs. Only 5 of the 32 (16%) CVST-VITT cases from MICs had definite VITT, mostly because anti-platelet factor 4 antibodies were often not tested. The median age was 26 (interquartile range [IQR] 20-37) versus 47 (IQR 32-58) years, and the proportion of women was 25 of 32 (78%) versus 77 of 103 (75%) in MICs versus HICs, respectively. Patients from MICs were diagnosed later than patients from HICs (1/32 [3%] vs. 65/103 [63%] diagnosed before May 2021). Clinical manifestations, including intracranial hemorrhage, were largely similar as was intravenous immunoglobulin use. In-hospital mortality was lower in MICs (7/31 [23%, 95% confidence interval (CI) 11-40]) than in HICs (44/102 [43%, 95% CI 34-53], p = 0.039). CONCLUSIONS The number of CVST-VITT cases reported from LMICs was small despite the widespread use of adenoviral vaccines. Clinical manifestations and treatment of CVST-VITT cases were largely similar in MICs and HICs, while mortality was lower in patients from MICs.
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Affiliation(s)
- Anita van de Munckhof
- Amsterdam University Medical Centers, location University of Amsterdam, Amsterdam, The Netherlands
| | | | | | - Katarzyna Krzywicka
- Amsterdam University Medical Centers, location University of Amsterdam, Amsterdam, The Netherlands
| | - Mayte Sánchez van Kammen
- Amsterdam University Medical Centers, location University of Amsterdam, Amsterdam, The Netherlands
| | - Charlotte Cordonnier
- Univ. Lille, Inserm, CHU Lille, U1172—LilNCog—Lille Neuroscience & Cognition, Lille, France
| | | | | | - Sven Poli
- University Hospital Tuebingen, Eberhard-Karls University, Tuebingen, Germany
| | | | - Adrian Scutelnic
- Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Erik Lindgren
- Sahlgrenska University Hospital, Gothenburg, Sweden
- Institute of Neuroscience and Physiology, Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden
| | - Jiangang Duan
- Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Yıldız Arslan
- Medicana İzmir International Hospital, Izmir, Turkey
| | | | | | | | - Katarina Jood
- Sahlgrenska University Hospital, Gothenburg, Sweden
- Institute of Neuroscience and Physiology, Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden
| | - Turgut Tatlisumak
- Sahlgrenska University Hospital, Gothenburg, Sweden
- Institute of Neuroscience and Physiology, Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden
| | - Jukka Putaala
- Helsinki University Hospital and University of Helsinki, Helsinki, Finland
| | - Mirjam R Heldner
- Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Marcel Arnold
- Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | | | | | - Antonio Arauz
- National Institute of Neurology and Neurosurgery, Mexico City, Mexico
| | | | - José M Ferro
- Instituto de Medicina Molecular João Lobo Antunes, Faculdade de Medicina, Universidade de Lisboa, Lisboa, Portugal
| | - Jonathan M Coutinho
- Amsterdam University Medical Centers, location University of Amsterdam, Amsterdam, The Netherlands
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31
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Cosmi B, Legnani C, Cini M, Borgese L, Sartori M, Palareti G. Incidence and clinical outcomes of heparin-induced thrombocytopenia: 11 year experience in a tertiary care university hospital. Intern Emerg Med 2023; 18:1971-1980. [PMID: 37568069 DOI: 10.1007/s11739-023-03379-5] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2023] [Accepted: 07/12/2023] [Indexed: 08/13/2023]
Abstract
Heparin-induced thrombocytopenia (HIT) is a rare immuno-mediated adverse reaction with high thrombotic and mortality risk. To evaluate incidence and outcomes of HIT cases diagnosed at a tertiary care hospital from 2007 to 2018. A retrospective study was conducted. Patients with suspected HIT underwent 4Ts score assessment and anti-heparin PF4 IgG antibodies ELISA screening test. If the latter was positive, platelet aggregation test (PAT) was performed. If the latter was positive, any form of heparin was stopped, alternative anticoagulants were started and then overlapped with warfarin. HIT incidence was calculated by dividing HIT cases by the mean yearly number of admitted patients over 11 years. Follow-up was 90 days. Among 2125 screening tests, 96 (4.5%) were positive with confirmatory PAT in 82/90 (3.8% for missing data in 6). Median age was 75; 39 patients were surgical and 51 medical. The median 4Ts score was 5. Unfractionated heparin was employed in 34 (37%). HIT incidence was 0.16/1000/patient/years (95% CI: 0.12-0.23) in surgical and 0.15/1000/patient/years (95%: 0.12-0.20) in medical patients. HIT with thrombosis (HIT-T) was observed in 31 patients (0.05/1000/patient/years 95% CI: 0.04-0.1), with venous thromboses in 25 (80%). HIT without thrombosis was observed in 59 patients (0.1/1000 patient/years; 95% CI: 0.08-0.13, twofold vs HIT-T). All cause mortality was 25.5% (95% CI: 17.6-35.4), major bleeding 7.7% (95% CI:3.2-15.3), and thromboembolic complications 3.3% (95% CI:1.1-9.3). HIT is a rare event with high mortality, despite the use of non heparin anticoagulants.
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Affiliation(s)
- Benilde Cosmi
- Angiology and Blood Coagulation Unit , IRCCS, Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy.
- Angiology and Blood Coagulation Unit, Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy.
| | | | | | - Laura Borgese
- Angiology and Blood Coagulation Unit , IRCCS, Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
- Angiology and Blood Coagulation Unit, Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy
| | - Michelangelo Sartori
- Angiology and Blood Coagulation Unit , IRCCS, Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
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32
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Zhang D, Xu Y, Wang X, Hou L, Xing M, Xu S, Guo R, Luo Y. Risk factors for thrombocytopenia in patients receiving linezolid therapy: a systematic review and meta-analysis. Eur J Clin Pharmacol 2023; 79:1303-1314. [PMID: 37578552 DOI: 10.1007/s00228-023-03542-z] [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] [Received: 05/30/2023] [Accepted: 07/18/2023] [Indexed: 08/15/2023]
Abstract
PURPOSE The incidence of linezolid-induced thrombocytopenia (LIT) has been reported to vary widely across studies. We performed a meta-analysis to identify the risk factors for thrombocytopenia among patients who received linezolid treatment. METHODS The PubMed, Embase and Cochrane Library databases were searched from inception to November 2022 to identify eligible studies. Data on the potential predictors of incidence in LIT were pooled using a random effects model. Sensitivity analyses were performed to determine the robustness of the results when significant heterogeneity was observed. RESULTS Forty observational studies involving 6454 patients treated with linezolid were included in the analysis. LIT was estimated to occur in 37% of patients. The following important factors were associated with the incidence of LIT: advanced age, body mass index, concurrent renal impairment or liver disease, abnormal laboratory parameters (including white blood cell count, serum creatinine, baseline platelet count, albumin, creatinine clearance rate, and estimated glomerular filtration rate), treatment duration and renal replacement therapy. CONCLUSIONS A variety of risk factors related to the occurrence of LIT were revealed in our analysis. Early identification of these factors could help patients improve clinical outcomes.
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Affiliation(s)
- Dan Zhang
- Department of Pharmacy, Affiliated Hangzhou First People's Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Yasi Xu
- Translational Medicine Research Center, Key Laboratory of Clinical Cancer Pharmacology and Toxicology Research of Zhejiang Province, Affiliated Hangzhou First People's Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Xiang Wang
- Department of Pharmacy, Affiliated Hangzhou First People's Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Leping Hou
- Department of Pharmacy, Affiliated Hangzhou First People's Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Mengyu Xing
- Department of Pharmacy, Affiliated Hangzhou First People's Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Shuang Xu
- Department of Pharmacy, Affiliated Hangzhou First People's Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Rui Guo
- Department of Pharmacy, Affiliated Hangzhou First People's Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Ying Luo
- Department of Pharmacy, Affiliated Hangzhou First People's Hospital, Zhejiang University School of Medicine, Hangzhou, China.
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Sánchez-Sanz B, Caro-Teller JM, González-Barrios I, Rodríguez-Quesada PP, Hernández-Ramos JA, Ferrari-Piquero JM. [Translated article] Influence of augmented renal clearance in the lower incidence of linezolid-related haematological toxicity. Farm Hosp 2023; 47:T190-T195. [PMID: 37679220 DOI: 10.1016/j.farma.2023.08.003] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2022] [Accepted: 04/26/2023] [Indexed: 09/09/2023] Open
Abstract
OBJECTIVES Linezolid is an oxazolidin commonly related to the development of haematological toxicity, being renal clearance the major factor involved in the drug clearance. The aim of this study is to evaluate the influence of increased filtration rates in the incidence of linezolid-induced haematological toxicity by comparing augmented renal clearance (ARC) patients versus normal renal function patients. MATERIAL AND METHODS A retrospective, observational study was conducted on hospitalized patients treated with linezolid for 5 days or more during 2014-2019 period. Patients with a filtration rate of ≥130 mL/min versus reference patients (60-90 mL/min) were compared. Haematological toxicity was defined as a decrease of 25% in platelets, of 25% in haemoglobin, and/or 50% in neutrophils from baseline. Toxicity relevance was classified according to Common Terminology Criteria for Adverse Events v5. Incidence of haematological toxicity between groups was studied by chi-square and Fisher test. Furthermore, percentage diminution of all 3 parameters was calculated and compared by Mann-Whitney test and treatment interruption and transfusion requirements were registered. RESULTS 30 ARC patients and 38 reference patients were included. Haematological toxicity was observed in 16.66% of ARC patients vs 44.74% of reference patients (P=.014); thrombocytopenia in 13.33% vs 36.84% (P=.051), anaemia in 3.3% vs 10.52% (P=.374) and neutropenia in 10% vs 23.68% (P=.204). Median percentage of platelets decrease in ARC patients was -10.36 (-193.33-62.03) vs 2.68 (-163.16-82.71) in reference patients (P=.333), while haemoglobin decrease was 2.50 (-12.12-25.93) vs 9.09 (-17.72-30.63) (P=.047) and neutrophils decrease was 9.14 (-73.91-76.47) vs 27.33 (-86.66-90.90) (P=.093). 10.5% of normal renal function patients reported at least 1 adverse event grade 3 or superior while 2.6% of them interrupted treatment and 5.2% had transfusion requirements. No major events or interruptions were reported in ARC patients. CONCLUSION Our findings suggest a lower incidence and clinical relevance of haematological toxicity in augmented renal clearance patients. Thrombocytopenia was the major event in both populations. This might be related to a lower exposure to the drug due to the higher clearance and likely lower therapeutic efficiency. These results suggest a potential benefit of therapeutic drug monitoring on high risk patients.
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Struyf F, Hardt K, Van Rampelbergh R, Shukarev G, Inamdar A, Ruiz-Guiñazú J, van Paassen V, Anaya-Velarde L, Diba C, Ceuppens M, Cardenas V, Soff GA, Pragalos A, Sadoff J, Douoguih M. Thrombosis with thrombocytopenia syndrome: A database review of clinical trial and post-marketing experience with Ad26.COV2.S. Vaccine 2023; 41:5351-5359. [PMID: 37517912 DOI: 10.1016/j.vaccine.2023.07.013] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2023] [Revised: 07/06/2023] [Accepted: 07/07/2023] [Indexed: 08/01/2023]
Abstract
BACKGROUND Thrombosis with thrombocytopenia syndrome (TTS) is a very rare disorder described after vaccination with adenoviral vector-based COVID-19 vaccines. Co-occurring thrombosis with thrombocytopenia reported after vaccination can be a proxy for identification of TTS. METHODS Descriptive database review of all cases of co-occurring (within 42 days) thrombosis with thrombocytopenia in participants in Ad26.COV2.S clinical trials or recipients of Ad26.COV2.S in real-world clinical practice. Cases were retrieved from Janssens' clinical trial and Global Medical Safety databases. RESULTS There were 34 cases of co-occurring thrombosis with thrombocytopenia in Ad26.COV2.S recipients (46 per 100,000 person-years) and 15 after placebo (75 per 100,000 person-years) in clinical trials. Among Ad26.COV2.S recipients, mean age at the time of the event was 63 years (range 25-85), 82 % were male, mean time-to-onset 112 days (range 8-339) post-last Ad26.COV2.S dose, 26 events occurred post-dose-1, and 7 within a 28-day risk window post-vaccination. Diagnostic certainty was evaluated using Brighton Collaboration, US Centers for Disease Control and Prevention, and European Medicines Agency Pharmacovigilance Risk Assessment Committee case definitions. One case met the highest level of diagnostic certainty for all 3 definitions. There were 355 spontaneous reports of co-occurring thrombosis with thrombocytopenia in the Global Medical Safety database, 47 % males, 85 % within 28-days after vaccination. Twenty-seven cases met the highest level of diagnostic certainty for all definitions, 21 female, 19 with cerebral venous sinus thrombosis, age-range 18-68 years. Time-to-onset was 7-14 days post-vaccination in 20 cases. There were 8 fatalities. CONCLUSION TTS induced by Ad26.COV2.S is very rare. Most co-occurring thrombosis with thrombocytopenia does not constitute TTS.
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Affiliation(s)
- Frank Struyf
- Janssen Research and Development, Beerse, Belgium.
| | - Karin Hardt
- Janssen Research and Development, Beerse, Belgium
| | | | | | | | | | | | | | | | | | - Vicky Cardenas
- Janssen Research and Development, Spring House, PA, United States
| | - Gerald A Soff
- University of Miami Health System/Sylvester Comprehensive Cancer Center, Soffer Clinical Research Building, Miami, FL 33136, United States
| | | | - Jerald Sadoff
- Janssen Vaccines and Prevention, Leiden, the Netherlands
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35
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Shaw RJ, Doyle AJ, Millen EA, Stowe J, Tessier E, Andrews N, Miller E. Re-evaluation of the risk of venous thromboembolism after COVID-19 vaccination using haematological criteria. Vaccine 2023; 41:5330-5337. [PMID: 37495490 PMCID: PMC10247139 DOI: 10.1016/j.vaccine.2023.06.006] [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] [Received: 06/27/2022] [Revised: 05/31/2023] [Accepted: 06/01/2023] [Indexed: 07/28/2023]
Abstract
An elevated risk of venous thromboembolism (VTE) following a first dose of the ChAdOx1 adenovirus-vectored vaccine was found in a national epidemiological study in England using routine discharge diagnosis codes. Separately, the syndrome of vaccine-induced immune thrombotic thrombocytopenia (VITT) was identified using haematological criteria based on presence of thrombocytopenia, significantly elevated D-dimers and development of anti-PF4 antibodies. To re-evaluate risk estimates using haematological criteria, we obtained the haematology results for hospital admitted patients aged 18-64 years in 43 National Health Service trusts in England who were included in the national epidemiological study. Diagnoses were confirmed and haematological parameters obtained from local records without knowledge of vaccination status. The haematological parameters in patients admitted for a confirmed VTE following ChAdOx1 or BNT162b2 mRNA vaccination were then compared with those in a randomly selected 40% sample of unvaccinated patients with VTE. Overall, 12 (14%) of the 84 vaccinated cases had a diagnosis compatible with VITT, 11 after a first dose of ChAdOx1 and one after a first dose of BNT162b2. Thrombocytopenia (platelet count <150 × 109/L) occurred in 17 vaccinated (20%) and 4 (4%) of 108 unvaccinated patients, with all 6 cases of severe thrombocytopenia (<50 × 109/L) occurring within 42 days of a first dose of ChAdOx1. The attributable risk estimates for a cerebral venous thrombosis (CVT) or other VTE with thrombocytopenia after a first dose of ChAdOx1 vaccine were 2.82 and 9.62 per million doses respectively. However, elevated risks were also found after a first dose of ChAdOx1 for VTE without thrombocytopenia with relative incidences for CVT and other VTE of 2.67 (1.77-3.77) and 1.93 (1.57-2.35) respectively. While we identified a distinct population with features of VITT within 42 days of receiving ChAdOx1 vaccination, confirming current diagnostic criteria, we also found evidence of an increased risk of a VTE without thrombocytopenia after ChAdOx1 vaccine.
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Affiliation(s)
- Rebecca J Shaw
- Department of Clinical Infection, Microbiology and Immunology, University of Liverpool, United Kingdom; Roald Dahl Centre for Haemostasis and Thrombosis, Liverpool University Hospitals NHS Foundation Trust, Liverpool, United Kingdom.
| | - Andrew J Doyle
- Centre for Haemostasis and Thrombosis, Guy's & St Thomas' Hospitals NHS Foundation Trust, London, United Kingdom
| | - Emily A Millen
- Department of Haematology, Nottingham University Hospitals NHS Trust, United Kingdom
| | - Julia Stowe
- UK Health Security Agency, London, United Kingdom
| | | | - Nick Andrews
- UK Health Security Agency, London, United Kingdom
| | - Elizabeth Miller
- Department of Infectious Disease Epidemiology, Faculty of Epidemiology & Population Health, London School of Hygiene & Tropical Medicine, London, United Kingdom
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36
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Kouchit Y, Canac B, Levraut J, Martis N. Prevalence of hypothermia and its associated clinical and biological features (such as thrombocytopenia) in emergency department patients: a case series. Intern Emerg Med 2023; 18:1595-1598. [PMID: 37395981 DOI: 10.1007/s11739-023-03345-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2023] [Accepted: 06/12/2023] [Indexed: 07/04/2023]
Affiliation(s)
- Yanis Kouchit
- Internal Medicine Department, University Hospital of Nice, Archet 1 Hospital, 151 Route de Saint-Antoine de Ginestière, 06200, Nice, France
- Côte d'Azur University, Nice, France
| | - Benoit Canac
- Côte d'Azur University, Nice, France
- Emergency Medicine Department, University Hospital of Nice, Nice, France
| | - Jacques Levraut
- Côte d'Azur University, Nice, France
- Emergency Medicine Department, University Hospital of Nice, Nice, France
| | - Nihal Martis
- Internal Medicine Department, University Hospital of Nice, Archet 1 Hospital, 151 Route de Saint-Antoine de Ginestière, 06200, Nice, France.
- Côte d'Azur University, Nice, France.
- INSERM U1065, Mediterranean Centre for Molecular Medicine, Team: Control of Gene Expression, Nice, France.
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37
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Shah NB, Sharedalal P, Shafi I, Tang A, Zhao H, Lakhter V, Kolluri R, Rao AK, Bashir R. Prevalence and outcomes of heparin-induced thrombocytopenia in hospitalized patients with venous thromboembolic disease: Insight from national inpatient sample. J Vasc Surg Venous Lymphat Disord 2023; 11:723-730. [PMID: 36893884 DOI: 10.1016/j.jvsv.2023.02.001] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2022] [Revised: 02/01/2023] [Accepted: 02/01/2023] [Indexed: 03/09/2023]
Abstract
OBJECTIVE The mainstay of therapy for patients with venous thromboembolic disease (VTE) is anticoagulation. In the inpatient setting, majority of these patients are treated with heparin or low molecular weight heparin. The prevalence and outcomes of heparin-induced thrombocytopenia (HIT) in hospitalized patients with venous thromboembolic disease (VTE) is unknown. METHODS This nationwide study identified patients with VTE from the National Inpatient Sample database between January 2009 and December 2013. Among these patients, we compared in-hospital outcomes of patients with and without HIT using a propensity score-matching algorithm. The primary outcome was in-hospital mortality. Secondary outcomes included rates of blood transfusions, intracranial hemorrhage, gastrointestinal bleed, length of hospital stay, and total hospital charges. RESULTS Among 791,932 hospitalized patients with VTE, 4948 patients (0.6%) were noted to have HIT (mean age, 62.9 ±16.2 years; 50.1% female). Propensity-matched comparison showed higher rates of in-hospital mortality (11.01% vs 8.97%; P < .001) and blood transfusions (27.20% vs 20.23%; P < .001) in patients with HIT compared with those without HIT. No significant differences were noted in intracranial hemorrhage rates (0.71% vs 0.51%; P > .05), gastrointestinal bleed (2.00% vs 2.22%; P > .05), length of hospital stay (median, 6.0 days; interquartile range [IQR], 3.0-11.0 vs median, 6.0 days; IQR, 3.0-10.0 days; P > .05), and total hospital charges (median, $36,325; IQR, $17,798-$80,907 vs median, $34,808; IQR, $17,654-$75,624; P > .05). CONCLUSIONS This nationwide observational study showed that 0.6% of hospitalized patients with VTE in the United States have HIT. The presence of HIT was associated with higher in-hospital mortality and blood transfusion rates compared with those without HIT.
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Affiliation(s)
- Neal B Shah
- Department of Internal Medicine, New York Medical College, Valhalla, NY
| | - Parija Sharedalal
- Department of Cardiovascular Disease, New York Medical College, Valhalla, NY
| | - Irfan Shafi
- Department of Internal Medicine, Wayne State University, Detroit, MI
| | - Alice Tang
- Department of Internal Medicine, Boston Medical Center, Boston, MA
| | - Huaqing Zhao
- Department of Clinical Sciences, Temple University Hospital, Philadelphia, PA
| | - Vladimir Lakhter
- Department of Cardiovascular Diseases, Temple University Hospital, Philadelphia, PA
| | - Raghu Kolluri
- Department of Cardiovascular Medicine, OhioHealth/Riverside Methodist Hospital, Columbus, OH
| | - A Koneti Rao
- Hematology Section and Sol Sherry Thrombosis Research Center, Lewis Katz School of Medicine at Temple University, Philadelphia, PA
| | - Riyaz Bashir
- Department of Cardiovascular Diseases, Temple University Hospital, Philadelphia, PA.
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Yang S, Guo W, Chen M, Hu J, Feng N, Ju M, Qian Y. Prevalence and risk factors for severe linezolid-associated thrombocytopenia in pediatric patients: An analysis of a public database. Medicine (Baltimore) 2023; 102:e34059. [PMID: 37327288 PMCID: PMC10270524 DOI: 10.1097/md.0000000000034059] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2023] [Accepted: 05/31/2023] [Indexed: 06/18/2023] Open
Abstract
Linezolid is widely used in various clinical settings. Studies have revealed that it may cause thrombocytopenia in adults. However, the correlation between the use of linezolid and thrombocytopenia in pediatric patients is still unclear. This study aimed to identify the impact of Linezolid on the occurrence of thrombocytopenia in children. A retrospective observational study was conducted using data on patients treated with linezolid from the Pediatric Intensive Care clinical database. Univariate and multiple logistic regression analyses were performed to identify the risk factors of linezolid-related severe thrombocytopenia. A total of 134 patients were included. The prevalence of severe thrombocytopenia was 8.96% (12/134). Univariate analysis indicated that the severe thrombocytopenia group showed significantly higher proportion of concomitant carbapenem (75% vs 44.3%; P < .05) and piperacillin/tazobactam (25% vs 6.6%; P < .05) than that of the non-severe thrombocytopenia group. Multivariate analysis also revealed that the occurrence of severe thrombocytopenia was significantly associated with concurrent use of carbapenem (odd ratio = 4.058; 95% confidence interval: 1.012-16.274; P = .048) and piperacillin/tazobactam (odd ratio = 5.335; 95% confidence interval: 1.117-25.478; P = .036). 75% of patients (9/12) developed severe thrombocytopenia within the first 7 days of linezolid use. The concomitant use of carbapenem and piperacillin/tazobactam was associated with an increased probability of severe thrombocytopenia in pediatric patients undergoing linezolid treatment. Further prospective clinical studies are required, and more detailed mechanisms of blood toxicity in pediatric patients must be investigated.
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Affiliation(s)
- Shibo Yang
- Department of Emergency, Huashan Hospital, Fudan University, Shanghai, People’s Republic of China
| | - Wencheng Guo
- Department of Vascular Surgery, Huashan Hospital, Fudan University, Shanghai, People’s Republic of China
| | - Ming Chen
- Department of Respiratory Medicine, Tongde Hospital of Zhejiang Province, Hangzhou, Zhejiang, People’s Republic of China
| | - Jindong Hu
- Department of Integrative Medicine, Huashan Hospital, Fudan University, Shanghai, People’s Republic of China
| | - Nana Feng
- Department of Respiratory and Critical Medicine, Shanghai Eighth People’s Hospital Affiliated to Jiangsu University, Shanghai, People’s Republic of China
| | - Mohan Ju
- Institute of Antibiotics, Huashan Hospital, Fudan University, Shanghai, People’s Republic of China
| | - Yiyi Qian
- Department of Infectious Diseases, Zhongshan Hospital, Fudan University, Shanghai, People’s Republic of China
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Umehara K, Takada S, Yama K, Yamagishi K, Ebata K, Sakai T, Kobayashi M, Sato H, Mino K, Fujimoto K. Association between Area under the Curve Estimated from Carboplatin Dose and Incidence of Severe Thrombocytopenia in Patients with Non-Hodgkin's Lymphoma on DeVIC Therapy. Asian Pac J Cancer Prev 2023; 24:1963-1969. [PMID: 37378925 PMCID: PMC10505877 DOI: 10.31557/apjcp.2023.24.6.1963] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2023] [Accepted: 06/22/2023] [Indexed: 06/29/2023] Open
Abstract
BACKGROUND The degrees of adverse effects with carboplatin (CBDCA) are influenced by interindividual differences in the area under the curve (AUC), whereas renal function is not considered in the CBDCA dose design for dexamethasone, etoposide, ifosfamide, and CBDCA (DeVIC) therapy. We conducted this study to evaluate the association between the AUC and incidence of severe thrombocytopenia in patients treated with DeVIC with or without rituximab (DeVIC ± R). METHODS We retrospectively analyzed clinical data for 36 patients with non-Hodgkin's lymphoma who received DeVIC ± R between May 2013 and January 2021 at the National Hospital Organization Hokkaido Cancer Center. The AUC of CBDCA (AUCactual) was calculated backward using a variant of the Calvert formula. RESULTS The median AUCactual was 4.6 (interquartile range: 4.3-5.3) min mg/mL and AUCactual was negatively correlated with the nadir platelet count (r = -0.45; P < 0.01). Multivariate analysis showed that AUCactual ≥ 4.3 versus < 4.3 was an independent factor predictive of severe thrombocytopenia (odds ratio: 19.3, and 95% confidence interval: 1.45-258; P = 0.02). CONCLUSION This study suggests that the CBDCA dosing design considering renal function can reduce the risk of severe thrombocytopenia in DeVIC ± R therapy.
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Affiliation(s)
- Kengo Umehara
- Department of Pharmacy, National Hospital Organization Hokkaido Cancer Center; 2-3-54 Kikusui 4, Shiroishi-ku, Sapporo, Hokkaido, Japan.
| | - Shinya Takada
- Department of Pharmacy, National Hospital Organization Hokkaido Cancer Center; 2-3-54 Kikusui 4, Shiroishi-ku, Sapporo, Hokkaido, Japan.
| | - Kaori Yama
- Division of Clinical Pharmacy, Department of Pharmacy, Faculty of Pharmaceutical Sciences, Hokkaido University of Science, 15-4-1 Maeda 7, Teine-ku, Sapporo, Hokkaido, Japan.
| | - Kayo Yamagishi
- Department of Pharmacy, National Hospital Organization Hokkaido Cancer Center; 2-3-54 Kikusui 4, Shiroishi-ku, Sapporo, Hokkaido, Japan.
| | - Ko Ebata
- Department of Hematology, National Hospital Organization Hokkaido Cancer Center; 2-3-54 Kikusui 4, Shiroishi-ku, Sapporo, Hokkaido, Japan.
| | - Toshiya Sakai
- Department of Hematology, National Hospital Organization Hokkaido Cancer Center; 2-3-54 Kikusui 4, Shiroishi-ku, Sapporo, Hokkaido, Japan.
| | - Michiya Kobayashi
- Division of Pharmaceutics (Clinical Pharmaceutics), School of Pharmaceutical Sciences, Health Sciences University of Hokkaido, 1757 Kanazawa, Tobetsu-cho, Ishikari-gun, Hokkaido, Japan.
| | - Hideki Sato
- Division of Clinical Pharmacy, Department of Pharmacy, Faculty of Pharmaceutical Sciences, Hokkaido University of Science, 15-4-1 Maeda 7, Teine-ku, Sapporo, Hokkaido, Japan.
| | - Kozo Mino
- Department of Pharmacy, National Hospital Organization Hokkaido Cancer Center; 2-3-54 Kikusui 4, Shiroishi-ku, Sapporo, Hokkaido, Japan.
| | - Katsuya Fujimoto
- Department of Hematology, National Hospital Organization Hokkaido Cancer Center; 2-3-54 Kikusui 4, Shiroishi-ku, Sapporo, Hokkaido, Japan.
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Liang S, Xie W, Li Z, Zhang N, Wang X, Qin Y, Bao C, Hu J. Analysis of fatal cases of severe fever with thrombocytopenia syndrome in Jiangsu province, China, between 2011 and 2022: A retrospective study. Front Public Health 2023; 11:1076226. [PMID: 37033043 PMCID: PMC10076888 DOI: 10.3389/fpubh.2023.1076226] [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] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2022] [Accepted: 02/21/2023] [Indexed: 04/11/2023] Open
Abstract
Introduction Severe fever with thrombocytopenia syndrome (SFTS) is an emerging infectious disease caused by the SFTS virus (SFTSV), which has a high fatality rate. This disease has become increasingly prevalent in recent years in Jiangsu province, with a noticeable rise in its incidence. Notably, fatal cases have also been increasing. Our study aimed to analyze the epidemiological characteristics and risk factors associated with the fatal cases of SFTS in Jiangsu province from 2011 to September 2022. Methods A retrospective study was performed among 698 SFTS cases during 2011-2022 in Jiangsu Province, China. Cox regression analyses were used to determine the dependent and independent risk factors that affected patient survival time. ArcGIS 10.7 was used for the visualization of the geographical distribution of the deaths from SFTS. Results There were 698 SFTS cases reported, with an increasing incidence, over the 12-year period. Among these cases, 43 deaths were reported. Fatal cases of SFTS were reported in 12 district counties from 2011 to 2022. Notably, most of the deaths occurred in Lishui county of Nanjing City. The median age of those who died was 69 years, with age ranges from 50 to 83 years. Multivariable Cox regression analysis showed that older age (>70) and living in Lishui county were risk factors for death from SFTS in Jiangsu province. Therefore, older adults aged over 70 years and residing in Lishui county were the high-risk group for SFTS mortality. Discussion Over the past 12 years, we have observed a consistent rise in the incidence of SFTS, accompanied by a relatively high case fatality rate, making it a critical public health issue. Therefore, it is urgently necessary to study the impact of meteorological factors on SFTS epidemics and devise prevention and control strategies.
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Affiliation(s)
- Shuyi Liang
- Jiangsu Provincial Center for Disease Control and Prevention, Acute Infectious Disease Control and Prevention Institute, Nanjing, China
| | - Wei Xie
- Jiangsu Provincial Center for Disease Control and Prevention, Institute of Food Safety and Assessment, Nanjing, China
| | - Zhifeng Li
- Jiangsu Provincial Center for Disease Control and Prevention, Acute Infectious Disease Control and Prevention Institute, Nanjing, China
| | - Nan Zhang
- Jiangsu Provincial Center for Disease Control and Prevention, Acute Infectious Disease Control and Prevention Institute, Nanjing, China
| | - Xiaochen Wang
- Jiangsu Provincial Center for Disease Control and Prevention, Acute Infectious Disease Control and Prevention Institute, Nanjing, China
| | - Yuanfang Qin
- Jiangsu Provincial Center for Disease Control and Prevention, Acute Infectious Disease Control and Prevention Institute, Nanjing, China
| | - Changjun Bao
- Jiangsu Provincial Center for Disease Control and Prevention, Acute Infectious Disease Control and Prevention Institute, Nanjing, China
| | - Jianli Hu
- Jiangsu Provincial Center for Disease Control and Prevention, Acute Infectious Disease Control and Prevention Institute, Nanjing, China
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Liang S, Li Z, Zhang N, Wang X, Qin Y, Xie W, Bao C, Hu J. Epidemiological and spatiotemporal analysis of severe fever with thrombocytopenia syndrome in Eastern China, 2011-2021. BMC Public Health 2023; 23:508. [PMID: 36927782 PMCID: PMC10019416 DOI: 10.1186/s12889-023-15379-3] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2022] [Accepted: 03/06/2023] [Indexed: 03/18/2023] Open
Abstract
BACKGROUND Severe fever with thrombocytopenia syndrome (SFTS) is an emerging infectious disease, which is caused by severe fever with thrombocytopenia syndrome virus (SFTSV) with high fatality. Recently, the incidence of SFTS increased obviously in Jiangsu Province. However, the systematic and complete analysis of spatiotemporal patterns and clusters coupled with epidemiological characteristics of SFTS have not been reported so far. METHODS Data on SFTS cases were collected during 2011-2021. The changing epidemiological characteristics of SFTS were analyzed by adopting descriptive statistical methods. GeoDa 1.18 was applied for spatial autocorrelation analysis, and SaTScan 10.0 was used to identify spatio-temporal clustering of cases. The results were visualized in ArcMap. RESULTS The annual incidence of SFTS increased in Jiangsu Province from 2011 to 2021. Most cases (72.4%) occurred during May and August with the obvious peak months. Elderly farmers accounted for most cases, among which both males and females were susceptible. The spatial autocorrelation and spatio-temporal clustering analysis indicated that the distribution of SFTS was not random but clustered in space and time. The most likely cluster was observed in the western region of Jiangsu Province and covered one county (Xuyi county) (Relative risk = 8.18, Log likelihood ratio = 122.645, P < 0.001) located in southwestern Jiangsu Province from January 1, 2017 to December 31, 2021. The Secondary cluster also covered one county (Lishui county) (Relative risk = 7.70, Log likelihood ratio = 94.938, P < 0.001) from January 1, 2017 to December 31, 2021. CONCLUSIONS The annual number of SFTS cases showed an increasing tendency in Jiangsu Province from 2011 to 2021. Our study elucidated regions with SFTS clusters by means of ArcGIS in combination with spatial analysis. The results demonstrated solid evidences for the orientation of limited sanitary resources, surveillance in high-risk regions and early warning of epidemic seasons in future prevention and control of SFTS in Jiangsu Province.
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Affiliation(s)
- Shuyi Liang
- Acute Infectious disease control and prevention institute, Jiangsu Provincial center for disease control and prevention, Nanjing, China
| | - Zhifeng Li
- Acute Infectious disease control and prevention institute, Jiangsu Provincial center for disease control and prevention, Nanjing, China
| | - Nan Zhang
- Acute Infectious disease control and prevention institute, Jiangsu Provincial center for disease control and prevention, Nanjing, China
| | - Xiaochen Wang
- Acute Infectious disease control and prevention institute, Jiangsu Provincial center for disease control and prevention, Nanjing, China
| | - Yuanfang Qin
- Acute Infectious disease control and prevention institute, Jiangsu Provincial center for disease control and prevention, Nanjing, China
| | - Wei Xie
- Institute of Food Safety and Assessment, Jiangsu Provincial center for disease control and prevention, Nanjing, China
| | - Changjun Bao
- Acute Infectious disease control and prevention institute, Jiangsu Provincial center for disease control and prevention, Nanjing, China
| | - Jianli Hu
- Acute Infectious disease control and prevention institute, Jiangsu Provincial center for disease control and prevention, Nanjing, China.
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Lubega J, Kim TO, Airewele G, Grimes A, Bulsara S, Peckham E, Wanless SR, Haq H, Elyanu P, Musoke P, Lumumba M, Kekitiinwa A, Matshaba M, Scheurer M, Despotovic J. Risk factors and prognostic significance of platelet count abnormalities in children with HIV infection on antiretroviral therapy. AIDS 2023; 37:413-421. [PMID: 36129118 PMCID: PMC9877116 DOI: 10.1097/qad.0000000000003387] [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: 01/28/2023]
Abstract
OBJECTIVES To establish the incidence, risk factors and correlation with survival of thrombocytopenia and thrombocytosis (T/T) among children with HIV infection (CWH). DESIGN A retrospective nested case control study of patients 0-18 years in five Baylor International Pediatric AIDS Initiative (BIPAI) centers in sub-Sahara Africa, 2004-2014. METHODS Clinical and laboratory variables including complete blood counts (CBC) were extracted from the BIPAI electronic medical record system. Incident cases of T/T were identified and frequency-matched on follow-up time with controls with normal platelets. We calculated the prevalence and incidence density of T/T and used conditional logistic regression to evaluate their association with selected clinical variables. We constructed Kaplan-Meier curves and a Cox proportional hazards model to evaluate the impact of T/T on survival. RESULTS Two thousand, one hundred and nine children were sampled. The incidence density of thrombocytopenia was 1 per 57.9 (95% confidence interval [CI] 50.3-66.8) CWH-years. Thrombocytopenia was higher in children with WHO Stage III/IV, lower in children on zidovudine, and had no association with use of lamivudine or nevirapine, CD4 + suppression, age, and nutrition status. Thrombocytopenia was independently associated with 2.2-fold higher mortality (95% CI 1.62-3.08). The incidence density of thrombocytosis was 1 per 11.4 (95% CI 10.7-12.1) CWH-years. Thrombocytosis was associated with higher CD4 + cell count, younger age, and use of lamivudine or nevirapine, and did not impact survival. CONCLUSIONS Platelet count is a clinically valuable biomarker of HIV clinical progression and mortality. Laboratory studies are necessary to elucidate the mechanisms of T/T.
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Affiliation(s)
- Joseph Lubega
- Baylor College of Medicine, Houston, Texas, 77030, United States
| | - Taylor O Kim
- Baylor College of Medicine, Houston, Texas, 77030, United States
| | | | - Amanda Grimes
- Baylor College of Medicine, Houston, Texas, 77030, United States
| | - Shaun Bulsara
- Baylor College of Medicine, Houston, Texas, 77030, United States
| | - Erin Peckham
- Baylor College of Medicine, Houston, Texas, 77030, United States
| | | | - Heather Haq
- Baylor College of Medicine, Houston, Texas, 77030, United States
| | | | | | | | | | | | - Michael Scheurer
- Baylor College of Medicine, Houston, Texas, 77030, United States
| | - Jenny Despotovic
- Baylor College of Medicine, Houston, Texas, 77030, United States
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Simon TG, Schneeweiss S, Singer DE, Sreedhara SK, Lin KJ. Prescribing Trends of Oral Anticoagulants in US Patients With Cirrhosis and Nonvalvular Atrial Fibrillation. J Am Heart Assoc 2023; 12:e026863. [PMID: 36625307 PMCID: PMC9973619 DOI: 10.1161/jaha.122.026863] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2022] [Accepted: 11/30/2022] [Indexed: 01/11/2023]
Abstract
Background Many patients with cirrhosis have concurrent nonvalvular atrial fibrillation (NVAF). Data are lacking regarding recent oral anticoagulant (OAC) usage trends among US patients with cirrhosis and NVAF. Methods and Results Using MarketScan claims data (2012-2019), we identified patients with cirrhosis and NVAF eligible for OACs (CHA2DS2-VASc score ≥2 [men] or ≥3 [women]). We calculated the yearly proportion of patients prescribed a direct OAC (DOAC), warfarin, or no OAC. We stratified by high-risk features (decompensated cirrhosis, thrombocytopenia, coagulopathy, chronic kidney disease, or end-stage renal disease). Among 32 487 patients (mean age=71.6 years, 38.5% women, 15.1% with decompensated cirrhosis, mean CHA2DS2-VASc=4.2), 44.6% used OACs within 180 days of NVAF diagnosis, including DOACs (20.2%) or warfarin (24.4%). Compared with OAC nonusers, OAC users were less likely to have decompensated cirrhosis (18.6% versus 10.7%), thrombocytopenia (19.5% versus 12.5%), or chronic kidney disease/end-stage renal disease (15.5% versus 14.0%). Between 2012 and 2019, warfarin use decreased by 21.0% (32.0% to 11.0%), whereas DOAC use increased by 30.6% (7.4% to 38.0%), and among all DOACs between 2012 and 2019, apixaban was the most commonly prescribed (46.1%). Warfarin use decreased and DOAC use increased in all subgroups, including in compensated and decompensated cirrhosis, thrombocytopenia, coagulopathy, chronic kidney disease/end-stage renal disease, and across CHA2DS2-VASc categories. Among OAC users (2012-2019), DOAC use increased by 58.9% (18.7% to 77.6%). Among DOAC users, the greatest proportional increase was with apixaban (61.2%; P<0.001). Conclusions Among US patients with cirrhosis and NVAF, DOAC use has increased substantially and surpassed warfarin, including in decompensated cirrhosis. Nevertheless, >55% of patients remain untreated, underscoring the need for clearer treatment guidance.
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Affiliation(s)
- Tracey G. Simon
- Division of Pharmacoepidemiology and PharmacoeconomicsDepartment of Medicine, Brigham and Women’s HospitalHarvard Medical SchoolBostonMA
- Division of Gastroenterology and HepatologyDepartment of Medicine, Massachusetts General HospitalHarvard Medical SchoolBostonMA
| | - Sebastian Schneeweiss
- Division of Pharmacoepidemiology and PharmacoeconomicsDepartment of Medicine, Brigham and Women’s HospitalHarvard Medical SchoolBostonMA
| | - Daniel E. Singer
- Division of General Internal MedicineDepartment of MedicineMassachusetts General Hospital, Harvard Medical SchoolBostonMA
| | - Sushama Kattinakere Sreedhara
- Division of Pharmacoepidemiology and PharmacoeconomicsDepartment of Medicine, Brigham and Women’s HospitalHarvard Medical SchoolBostonMA
| | - Kueiyu Joshua Lin
- Division of Pharmacoepidemiology and PharmacoeconomicsDepartment of Medicine, Brigham and Women’s HospitalHarvard Medical SchoolBostonMA
- Division of General Internal MedicineDepartment of MedicineMassachusetts General Hospital, Harvard Medical SchoolBostonMA
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Delaney J, Nunes GDC, Simoneau J, Beltempo M, Malhamé I, Goudie C, Altit G. Thrombocytopenia and neonatal outcomes among extremely premature infants exposed to maternal hypertension. Pediatr Blood Cancer 2023; 70:e30131. [PMID: 36478101 DOI: 10.1002/pbc.30131] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/23/2022] [Revised: 11/04/2022] [Accepted: 11/12/2022] [Indexed: 12/12/2022]
Abstract
BACKGROUND Hypertensive disorders of pregnancy (HDP) are associated with neonatal hematological disturbances, such as thrombocytopenia. The association of HDP to platelet counts in the context of extreme prematurity, to trends of platelet counts during neonatal hospitalization, and to frequency of platelet transfusions remain to be explored. PROCEDURE Retrospective study of infants born at less than 29 weeks born between 2015 and 2019. Platelet counts were collected on initial complete blood count, at 2 weeks, 32 weeks post-menstrual age (PMA), 36 weeks PMA, and closest to discharge. We examined the association between HDP and platelet counts at each time point, frequency of platelet transfusions and intraventricular hemorrhage (IVH) grade 3 or more. RESULTS Total 296 infants were included, 43 exposed to HDP. Infants exposed had lower platelet counts at each time point, as well as a higher prevalence of platelet less than 150 × 109 /L on one of the time points (32% vs. 65%, p < .001). Infants exposed to maternal hypertension were more frequently exposed to platelet transfusions (63% vs. 18%, p < .001). Mixed effect model demonstrated an association between HDP and a lower trend in platelet counts at each time point (β = -94 × 103 /μl, p < .001). Although initial platelet count was associated with severe IVH, it was not associated to exposure to HDP. CONCLUSION Premature infants exposed to HDP have a higher prevalence of thrombocytopenia, increased frequency of platelet transfusion, and an altered trend in platelet counts during neonatal hospitalization.
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Affiliation(s)
- Joanne Delaney
- Department of Pediatrics, Hematology-Oncology, Montreal Children's Hospital, McGill University Health Centre, McGill University, Montreal, Quebec, Canada
| | - Gabriela De Carvalho Nunes
- Department of Pediatrics, Neonatology, Montreal Children's Hospital, McGill University Health Centre, McGill University, Montreal, Quebec, Canada
| | - Jessica Simoneau
- Department of Pediatrics, Neonatology, Montreal Children's Hospital, McGill University Health Centre, McGill University, Montreal, Quebec, Canada
| | - Marc Beltempo
- Department of Pediatrics, Neonatology, Montreal Children's Hospital, McGill University Health Centre, McGill University, Montreal, Quebec, Canada
| | - Isabelle Malhamé
- Department of Medicine, General Internal Medicine, McGill University Health Centre, McGill University, Montreal, Quebec, Canada
| | - Catherine Goudie
- Department of Pediatrics, Hematology-Oncology, Montreal Children's Hospital, McGill University Health Centre, McGill University, Montreal, Quebec, Canada
| | - Gabriel Altit
- Department of Pediatrics, Neonatology, Montreal Children's Hospital, McGill University Health Centre, McGill University, Montreal, Quebec, Canada
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Müllerová H, Medin J, Arnold M, Gomes da Silva H, Kumar S, Nord M, Hubbard R, de Lusignan S. Background rate estimations for thrombosis with thrombocytopaenia: challenges in evaluating rare safety signals following vaccination in real time during a pandemic. BMJ Open 2023; 13:e063645. [PMID: 36639216 PMCID: PMC9842598 DOI: 10.1136/bmjopen-2022-063645] [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] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/15/2023] Open
Abstract
OBJECTIVES During COVID-19 vaccination programmes, new safety signals have emerged for vaccines, including extremely rare cases of thrombosis with thrombocytopaenia syndrome (TTS). Background event rates before and during the pandemic are essential for contextualisation of such infrequent events. In the literature, most studies do not report an overall TTS event rate. Rather, background rates are mainly reported for subtypes of thrombotic/thromboembolic diagnoses included in the TTS clinical definition mostly by anatomical location, with reported rates for TTS subtypes varying widely. The objective of this study was to report prepandemic TTS background event rates in the general population. METHODS Prepandemic background TTS rates were generated via secondary data analysis using a cohort design in the IBM Truven MarketScan (now Merative MarketScan) US health insurance claims database, from 1 January 2019 to 31 December 2019. Two algorithms were applied: thrombocytopaenia occurring±7 days (algorithm 1) or occurring 1 day prior to ≤14 days after the thrombotic/thromboembolic event (algorithm 2). RESULTS The study population derived from the MarketScan database analysis included approximately 9.8 million adults (aged ≥18 years; mean age 45 years, 52% females). Using this study population, prepandemic background TTS incidence was estimated as 9.8-11.1 per 100 000 person-years. Event rates were higher in males and increased with age. Similar patterns were observed with both algorithms. CONCLUSIONS This study presents an estimate of aggregate prepandemic background TTS event rates including by type of thrombosis/thromboembolism and age group. The background event rates are dependent on the precision of capturing underlying TTS events in variable data sources, and the ability of electronic health records or insurance claims databases to reflect the TTS clinical definition. Differences between reported event rates demonstrate that estimating background event rates for rare, unprecedented safety events is methodologically challenging.
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Affiliation(s)
- Hana Müllerová
- Medical Evidence, BioPharmaceuticals Medical, AstraZeneca, Cambridge, UK
| | - Jennie Medin
- Medical Evidence, BioPharmaceuticals Medical, AstraZeneca, Gothenburg, Sweden
| | - Matthew Arnold
- Real World Evidence Data and Analytics, BioPharmaceuticals Medical, AstraZeneca, Cambridge, UK
| | - Hugo Gomes da Silva
- Vaccines and Immune Therapies, BioPharmaceuticals Medical, AstraZeneca, Cambridge, UK
| | - Supriya Kumar
- Real World Evidence Data and Analytics, BioPharmaceuticals Medical, AstraZeneca, Gaithersburg, Maryland, USA
| | - Magnus Nord
- Patient Safety, Chief Medical Office, R&D, AstraZeneca, Gothenburg, Sweden
| | - Richard Hubbard
- Faculty of Medicine and Health Sciences, University of Nottingham, Nottingham, UK
| | - Simon de Lusignan
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
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Liao R, Dong Y, Chen L, Wang T, Li H, Dong H. A standard dose of linezolid puts patients with hepatic impairment at risk of overexposure. Eur J Clin Pharmacol 2023; 79:149-157. [PMID: 36434292 DOI: 10.1007/s00228-022-03427-7] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2022] [Accepted: 11/15/2022] [Indexed: 11/27/2022]
Abstract
PURPOSE The purpose of this retrospective observational study conducted in patients with hepatic impairment was to assess the variability of linezolid trough concentrations, to determine the risk factors for linezolid overexposure, and to investigate the effect of linezolid overexposure on linezolid-induced thrombocytopenia. METHODS All enrolled patients received a standard dose (600 mg every 12 h) of linezolid and underwent therapeutic drug monitoring. The Child-Pugh-Turcotte score was used to divide patients into three groups: mild, moderate, and severe hepatic impairment. The risk factors for linezolid overexposure (Cmin > 8 mg/L) and linezolid-induced thrombocytopenia were examined using logistic regression. And the Kaplan-Meier curve was used to describe the association between linezolid overexposure and linezolid-induced thrombocytopenia. RESULTS Seventy-seven patients were included, 37 (48.1%) of whom experienced linezolid overexposure. Patients with severe hepatic impairment had a substantially higher median Cmin of linezolid than those with mild (20.7 mg/L vs 5.51 mg/L, P < 0.001) or moderate (20.7 mg/L vs 6.70 mg/L, P = 0.001) hepatic impairment. Severe hepatic impairment was significantly associated with linezolid overexposure (OR 7.037, 95%CI 1.426-34.727, P = 0.017). After linezolid treatment, linezolid-induced thrombocytopenia occurred in 32 (41.6%) patients, and Cmin > 8 mg/L was a significant predictor of linezolid-induced thrombocytopenia (OR 3.024, 95%CI 1.083-8.541, P = 0.035). CONCLUSION Patients with hepatic impairment who received standard doses of linezolid are at greater risk of linezolid overexposure, which may lead to a higher incidence of linezolid-induced thrombocytopenia.
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Affiliation(s)
- Ru Liao
- Department of Pharmacy, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, 710061, China
| | - Yalin Dong
- Department of Pharmacy, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, 710061, China
| | - Lihong Chen
- Department of International Medical Center, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, 710061, China
| | - Taotao Wang
- Department of Pharmacy, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, 710061, China
| | - Houli Li
- Department of Pharmacy, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, 710061, China
| | - Haiyan Dong
- Department of Pharmacy, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, 710061, China.
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Xia Y, Tang L, Hu Y. The risk factors for coagulation disorder of chimeric antigen receptor-T cell therapy in patients with hematological tumors: A systematic review and meta-analysis. Technol Health Care 2023; 31:2363-2380. [PMID: 37545264 DOI: 10.3233/thc-220537] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/08/2023]
Abstract
BACKGROUND Currently, the frequency of coagulation dysfunction associated with chimeric antigen receptor-T cell (Car-T) therapy cannot yet be determined. OBJECTIVE We performed a systematic review and meta-analysis to examine the prevalence of abnormal laboratory tests related to coagulation disorders in patients receiving Car-T therapy and provide a reference for future risk assessment mechanisms. METHODS We searched PubMed, Embase, and Web of Science for relevant studies and evaluated their quality using the methodology index of non-random research (MINORS). 2672 quotations were retrieved via systematic searches. After screening of titles, abstracts and full-text, 45 trials involving 2541 patients were ultimately included. 41 studies reported the incidence of thrombocytopenia, 8 studies reported the rate of low fibrin, 4 trials reported the rate of APTT or PT abnormalities and only 3 trials reported the incidence of venous thromboembolism (VTE). We performed a quantitative meta-analysis to explore the incidence of thrombocytopenia following Car-T treatment. The incidence of hypofibrinogenemia, VTE, and abnormal APTT or PT was only qualitatively assessed, as fewer reports were included in this study. RESULTS The overall incidence of thrombocytopenia associated with Car-T therapy was 45.8% (95%[CI], 0.384-0.533). The highest rates of thrombocytopenia occurred in patients with multiple myeloma (60.1%, 95%[CI], 0.507-0.688) and aged between 18 to 60 (50%, 95%[CI], 0.367-0.633). There was greater prevalence of thrombocytopenia in BCMA-Car-T therapy of 58.7% (95%[CI], 0.482-0.685). Thrombocytopenia occurred most frequently in Car-T patients treated with a dosage of 1 × 105-1 × 106 cell/kg, at a rate of 66.2% (95%[CI], 0.561-0.749). CONCLUSION Overall, 45.8 percent of patients receiving Car-T treatment suffered from thrombocytopenia. Multiple myeloma patients, ages between 18-60, a dose of 1 × 105-1 × 106 cell/kg and BCMA-Car-T therapy are all considered high-risk factors.
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Affiliation(s)
- Yunqing Xia
- Institute of Hematology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Liang Tang
- Institute of Hematology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Yu Hu
- Institute of Hematology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
- Collaborative Innovation Center of Hematology, Huazhong University of Science and Technology, Wuhan, China
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Hu Y, Zhou Z, Luo M. Efficacy and safety of endostar combined with cisplatin in treatment of non-small cell lung cancer with malignant pleural effusion: A meta-analysis. Medicine (Baltimore) 2022; 101:e32207. [PMID: 36595983 PMCID: PMC9803422 DOI: 10.1097/md.0000000000032207] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND Although there are new treatments for non-small cell lung cancer with malignant pleural effusion, these therapies are prone to recurrent pleural effusion and poor in efficacy. And recombinant human endostatin is a new type of anti-tumor angiogenesis drug independently developed in my country. It has the effect of inhibiting tumor angiogenesis, inhibiting tumor proliferation and differentiation, and effectively inhibiting the formation and recurrence of malignant pleural effusion. Therefore, this study is aim to systematically review the efficacy and safety of intrapleural injection of endostar combined with cisplatin in the treatment of non-small cell lung cancer (NSCLC) with malignant pleural effusion. METHODS Databases including Cochrane Library, PubMed, CBM, Embase, CNKI, and WanFang Data were searched to collect randomized controlled trials about endostar combined with cisplatin for NSCLC with malignant pleural effusion from inception to April 2022. Two reviewers independently screened the literature, extracted data, and assessed the risk of bias in included studies. Finally, the meta-analysis was made by using RevMan 5.4.1 software. RESULTS A total of 11 randomized controlled trials involving 814 patients were finally included. The results of the meta-analysis showed that: The overall response rate and the improvement rate of quality of life in the endostar combined with cisplatin group were higher than that of the cisplatin alone group (relative risk = 1.58, 95% confidence interval = 1.42-1.76, P < .00001; relative risk = 1.63, 95% confidence interval = 1.38-1.93, P < .00001, respectively). Meanwhile, there were no significant differences between the 2 groups in the incidence of gastrointestinal reaction, the incidence of leucopenia, the incidence of thrombocytopenia, and the incidence of hypodynamia (all P values > .05). CONCLUSION Compared with cisplatin, intrapleural injection of endostar combined with cisplatin could improve the overall response rate and the quality of life of NSCLC patients with malignant pleural effusion. Due to the limited quality and quantity of included studies, more high-quality studies are needed to verify the above conclusion.
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Affiliation(s)
- Yongqi Hu
- Guilin Medical University, Guilin, China
| | | | - Miao Luo
- Affiliated Hospital of Guilin Medical University, Guilin, China
- * Correspondence: Miao Luo, Affiliated Hospital of Guilin Medical University, Guilin, China (e-mail: )
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Naik M, Bhat T, Wani AA, Amin A, Jalaalie U. Clinical and Laboratory Profile of Dengue in Kashmir Valley. J Assoc Physicians India 2022; 69:11-12. [PMID: 35057590] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
BACKGROUND As majority of cases of dengue are associated with thrombocytopenia, it is indispensable to study clinical presentation, biochemical parameters and outcome of dengue fever in a population known with low platelet count. METHODOLOGY A prospective observational study was conducted from September 2016 to August 2017that included forty NS-1 antigen (IgM) Dengue positive patients. Clinical features, laboratory parameters and outcome of dengue patients were noted. RESULTS All the patients had travel history outside the valley into the neighbouring state. Most patients (70%) had duration of stay between 21-30 days in dengue prevalent areas before catching the illness. Duration of symptoms was between 4-9 days in majority of patients (92.5%). Most patients (85%) presented in months of September to November. The three most common symptoms were fever (100%), chills (92.5%) and headache (80%). The most common laboratory features were thrombocytopenia (97.5%), leukopenia (87.5%), transaminitis (87.5%) and raised LDH (32.5%). One patient developed Dengue Hemorrhagic Fever (DHF). All patients recovered completely. CONCLUSION DF in Kashmir is seen exclusively in travellers to other states especially in the monsoon season.DF in Kashmiri patients has a favourable outcome despite low baseline platelet count. DHF is uncommon in Kashmiri population.
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Affiliation(s)
- Muzafar Naik
- Associate Professor, SKIMS MCH, Srinagar, Jammu and Kashmir
| | - Tariq Bhat
- Associate Professor, SKIMS MCH, Srinagar, Jammu and Kashmir
| | - Abdul Ahad Wani
- Assistant Professor, SKIMS MCH, Srinagar, Jammu and Kashmir; Corresponding Author
| | - Abid Amin
- Senior Resident, SKIMS MCH, Srinagar, Jammu and Kashmir
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Han SW, Oh YI, Rim JM, Cho YK, Kim DH, Kang JG, Choi KS, Chae JS. Clinical features and epidemiology of severe fever with thrombocytopenia syndrome in dogs in the Republic of Korea: an observational study (2019-2020). Vet Res Commun 2022; 46:1195-1207. [PMID: 35932407 PMCID: PMC9362334 DOI: 10.1007/s11259-022-09979-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2022] [Accepted: 07/28/2022] [Indexed: 11/13/2022]
Abstract
Severe fever with thrombocytopenia syndrome (SFTS) is a zoonotic disease with a high mortality rate for humans and cats. The clinical course and prognosis of SFTS in dogs remains unclear. In the present study, we investigated the clinical and epidemiological characteristics of SFTS virus (SFTSV) infection in dogs. All evaluated dogs exhibited an acute course and symptoms including fever (57.1%), anorexia (57.1%), depression (42.9%), and vomiting (35.7%). Thrombocytopenia was present in 45.5% of dogs, while jaundice was not observed. C-reactive protein, alanine transaminase, and alkaline phosphatase were elevated in some cases. Viral clearance occurred within 6 to 26 days. Phylogenetic analysis revealed that the SFTSV sequences were consistent with viruses circulating in the Republic of Korea. As dogs often live in close contact with humans, awareness of the clinical and epidemiological features of SFTS in dogs is crucial. Further large-scale studies are necessary to investigate SFTSV infection in dogs.
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Affiliation(s)
- Sun-Woo Han
- Laboratory of Veterinary Internal Medicine, BK21 FOUR Future Veterinary Medicine Leading Education and Research Center, Department of Veterinary Clinical Science, College of Veterinary Medicine, Seoul National University, Seoul, 08826, Republic of Korea
| | - Ye-In Oh
- Department of Veterinary Clinical Science, College of Veterinary Medicine, Seoul National University, Seoul, 08826, Republic of Korea
| | - Ji-Min Rim
- Laboratory of Veterinary Internal Medicine, BK21 FOUR Future Veterinary Medicine Leading Education and Research Center, Department of Veterinary Clinical Science, College of Veterinary Medicine, Seoul National University, Seoul, 08826, Republic of Korea
| | - Yoon-Kyoung Cho
- Laboratory of Veterinary Internal Medicine, BK21 FOUR Future Veterinary Medicine Leading Education and Research Center, Department of Veterinary Clinical Science, College of Veterinary Medicine, Seoul National University, Seoul, 08826, Republic of Korea
| | - Dong-Hoo Kim
- Gogang Animal Hospital, 473 Yeokgok-ro, Bucheon-si, Gyeonggi-do, 14416, Republic of Korea
| | - Jun-Gu Kang
- Korea Zoonosis Research Institute, Jeonbuk National University, 54531, Iksan, Republic of Korea
| | - Kyoung-Seong Choi
- College of Ecology and Environmental Science, Kyungpook National University, Sangju, 37224, Republic of Korea
| | - Joon-Seok Chae
- Laboratory of Veterinary Internal Medicine, BK21 FOUR Future Veterinary Medicine Leading Education and Research Center, Department of Veterinary Clinical Science, College of Veterinary Medicine, Seoul National University, Seoul, 08826, Republic of Korea.
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