RESUMO
Some patients affected by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) experience acute hypoxemic respiratory failure progressing toward atypical acute respiratory distress syndrome (ARDS). The aim of the study is to evaluate whether a correlation between ratio of peripheral saturation of oxygen (SpO2) and fraction of inspired oxygen (S/F) and ratio of arterial partial pressure of oxygen and fraction of inspired oxygen (P/F) exists in COVID-19-related ARDS as already known in classical ARDS. In this multicenter, retrospective, observational study, consecutive, adult (≥ 18 years) patients with symptomatic coronavirus disease 2019 (COVID-19) admitted to different COVID-19 divisions in Italy between March and December 2020 were included. Patients with SpO2 > 97% or missing information were excluded. We included 1,028 patients (median age 72 years, prevalence of males [62.2%]). A positive correlation was found between P/F and S/F (r = 0.938, p < 0.0001). A receiver operating characteristic (ROC) curve analysis showed that S/F accurately recognizes the presence of ARDS (P/F ≤ 300 mmHg) in COVID-19 patients, with a cut-off of ≤ 433% showing good sensitivity and specificity. S/F was also tested against P/F values ≤ 200 and ≤ 100 mmHg (suggestive for moderate and severe ARDS, respectively), the latter showing great accuracy for S/F ≤ 178%. S/F was accurate in predicting ARDS for SpO2 ≥ 92%. In conclusion, our findings support the routine use of S/F as a reliable surrogate of P/F in patients with COVID-19-related ARDS.
Assuntos
COVID-19 , Síndrome do Desconforto Respiratório , Adulto , Idoso , COVID-19/complicações , Humanos , Masculino , Oxigênio , Estudos Prospectivos , Estudos Retrospectivos , SARS-CoV-2RESUMO
Recent studies suggested that JAK2V617F mutation is frequent in patients with splanchnic vein thrombosis (SVT) but not in patients with other venous thromboembolic events (VTE). However, whether screening for the JAK2V617F mutation in VTE patients is justified remains unclear. Therefore, we performed a systematic review to assess the frequency of JAK2 mutation in VTE patients and the role of JAK2V617F mutation in the diagnosis of myeloproliferative neoplasms. MEDLINE and EMBASE databases were searched. Two reviewers independently performed study selection and extracted study characteristics. Pooled odds ratios of case-control studies and weighted mean proportion of the prevalence of JAK2V617F mutation of uncontrolled series were calculated. Twenty-four studies involving 3123 patients were included. Mean prevalence of JAK2 mutation was 32.7% (95% confidence interval, 25.5%-35.9%) in SVT patients. JAK2 mutation was associated with increased risk of SVT (odds ratio, 53.98; 95% confidence interval, 13.10-222.45). Mean prevalence of JAK2 mutation in other VTE patients was low (range, 0.88%-2.57%). Presence of JAK2V617F mutation in SVT patients was associated with a subsequent diagnosis of myeloproliferative neoplasm in many patients. JAK2 mutation is strongly associated with SVT, and routine screening of JAK2 mutation appears to be indicated in these patients.
Assuntos
Janus Quinase 2/genética , Transtornos Mieloproliferativos/complicações , Transtornos Mieloproliferativos/diagnóstico , Mutação Puntual , Tromboembolia Venosa/complicações , Algoritmos , Substituição de Aminoácidos , Biomarcadores Tumorais/análise , Biomarcadores Tumorais/genética , Estudos de Casos e Controles , Detecção Precoce de Câncer , Feminino , Frequência do Gene , Humanos , Janus Quinase 2/análise , Masculino , Transtornos Mieloproliferativos/genética , Neoplasias/complicações , Neoplasias/diagnóstico , Neoplasias/genética , Fenilalanina/genética , Cromossomo Filadélfia , Mutação Puntual/fisiologia , Valina/genética , Tromboembolia Venosa/genéticaRESUMO
We have analysed a series of 96 patients with multiple myeloma (MM) to the purpose to verify the prognostic meaning of the beta2-microglobulin (B2M) and the validity of the staging systems proposed by Bataille and Jacobson who use the B2M respectively associated to the serum C-reactive protein (CRP) and to the serum albumin. In our series of patients the serum level of B2M at the diagnosis was directly correlated with the myelomatous cellular mass. We have found besides an inverse correlation between B2M and survival. Also the serum level of CRP was inversely correlated with the survival, while a direct correlation was found between the serum albumin and the survival: ipoalbuminemia was confirmed as a predictive index of short survival. Staging our patients with MM according to the proposal of Bataille, we identified also in our series three prognostic groups with different median survival: respectively 72, 40 and 18 months. Applying finally the staging proposal of Jacobson to our series, four stages were individualized, with median survival respectively of 70, 52, 26 and 10 months. We confirm the prognostic value of the B2M in MM.
Assuntos
Mieloma Múltiplo/sangue , Microglobulina beta-2/sangue , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Mieloma Múltiplo/mortalidade , Prognóstico , Taxa de SobrevidaRESUMO
VTE can be considered as a multicausal disease involving various inherited and acquired prothrombotic conditions. Although greater emphasis has classically been given to traditional thrombophilic risk factors, there is increasing recognition of less typical precipitating conditions and events. In this article, the authors focus on the most promising, persistent, and potentially treatable novel risk factors.