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1.
BMC Infect Dis ; 21(1): 14, 2021 Jan 06.
Artigo em Inglês | MEDLINE | ID: mdl-33407216

RESUMO

BACKGROUND: The levels of serum D-dimer (D-D) in children with Mycoplasma pneumoniae pneumonia (MPP) were assessed to explore the clinical significance of D-D levels in refractory MPP (RMPP). METHOD: A total of 430 patients with MPP were enrolled between January 2015 and December 2015 and divided into a general MPP (GMPP) group (n = 306) and a RMPP group (n = 124). Clinical data, D-D level, white blood cell (WBC) count, proportion of neutrophils (N%), C-reactive protein (CRP), erythrocyte sedimentation rate (ESR), alanine transaminase (ALT), aspartate aminotransferase (AST), and lactate dehydrogenase (LDH) were compared between the two groups. Multivariate logistic regression was performed to identify independent predictors of RMPP. RESULTS: (1) Hospitalization time, preadmission fever duration, total fever duration, WBC, N %, CRP, LDH, ESR, ALT, AST, and D-D were significantly higher in the RMPP group than those in the GMPP group (all P < 0.05). (2) Correlation analysis showed that D-D was positively correlated with WBC, CRP, ESR, and LDH, and could be used to jointly evaluate the severity of the disease. (3) Multivariate logistic regression analysis identified preadmission fever duration, CRP, LDH and DD as independent risk factors for RMPP (all P < 0. 05). D-D had the highest predictive power for RMPP (P < 0.01). The D-D level also had a good ability to predict pleural effusion and liver injury (all P < 0.01). CONCLUSION: Serum D-D levels were significantly increased in patients with RMPP, indicating that excessive inflammatory response and vascular endothelial injury with prolonged duration existed in this patient population. Increased levels of serum D-D may be used as an early predictor of RMPP and the occurrence of complications. Our findings provide a theoretical basis for the early diagnosis of RMPP, early intervention and excessive inflammatory response in the pathogenesis of mycoplasma.


Assuntos
Produtos de Degradação da Fibrina e do Fibrinogênio/análise , Mycoplasma pneumoniae/genética , Pneumonia por Mycoplasma/sangue , Pneumonia por Mycoplasma/diagnóstico , Alanina Transaminase/sangue , Aspartato Aminotransferases/sangue , Sedimentação Sanguínea , Proteína C-Reativa/análise , Criança , Pré-Escolar , Feminino , Humanos , L-Lactato Desidrogenase/sangue , Contagem de Leucócitos , Modelos Logísticos , Masculino , Mycoplasma pneumoniae/isolamento & purificação , Neutrófilos/patologia , Derrame Pleural/etiologia , Pneumonia por Mycoplasma/complicações , Pneumonia por Mycoplasma/microbiologia , Estudos Retrospectivos , Fatores de Risco
2.
Int J Infect Dis ; 102: 17-19, 2021 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-33038556

RESUMO

OBJECTIVE: To describe the characteristics of COVID-19 patients seen in March-April and June-August 2020 in Marseille, France with the aim to investigate possible changes in the disease between these two time periods. METHODS: Demographics, hospitalization rate, transfer to intensive care unit (ICU), lethality, clinical and biological parameters were investigated. RESULTS: Compared to those seen in March-April, COVID-19 patients seen in June-August were significantly younger (39.2 vs. 45.3 years), more likely to be male (52.9% vs. 45.6%), and less likely to be hospitalized (10.7 vs. 18.0%), to be transferred to ICU (0.9% vs. 1.8%) and to die (0.1% vs. 1.1%). Their mean fibrinogen and D-dimer blood levels were lower (1.0 vs. 1.5 g/L and 0.6 vs. 1.1 µg/mL, respectively). By contrast, their viral load was higher (cycle threshold ≤16 = 5.1% vs. 3.7%). CONCLUSIONS: Patients in the two periods did not present marked age and sex differences, but markers of severity were undoubtedly less prevalent in the summer period, associating with a 10 times decrease in the lethality rate.


Assuntos
/epidemiologia , Adulto , Idoso , /mortalidade , Surtos de Doenças , Feminino , Produtos de Degradação da Fibrina e do Fibrinogênio/análise , França/epidemiologia , Hospitalização , Humanos , Unidades de Terapia Intensiva , Masculino , Pessoa de Meia-Idade , Estações do Ano , Fatores de Tempo
4.
Thromb Res ; 197: 94-99, 2021 01.
Artigo em Inglês | MEDLINE | ID: mdl-33190025

RESUMO

INTRODUCTION: Coronavirus disease 2019 (COVID-19) has been associated with cardiovascular complications and coagulation disorders. Previous studies reported pulmonary embolism (PE) in severe COVID-19 patients. Aim of the study was to estimate the prevalence of symptomatic PE in COVID-19 patients and to identify the clinical, radiological or biological characteristics associated with PE. PATIENTS/METHODS: We conducted a retrospective nested case-control study in 2 French hospitals. Controls were matched in a 1:2 ratio on the basis of age, sex and center. PE patients with COVID-19 were compared to patients in whom PE was ruled out (CTPA controls) and in whom PE has not been investigated (CT controls). RESULTS: PE was suspected in 269 patients among 1042 COVID-19 patients, and confirmed in 59 patients (5.6%). Half of PE was diagnosed at COVID-19 diagnosis. PE patients did not differ from CT and CTPA controls for thrombosis risk factors. PE patients more often required invasive ventilation compared to CTPA controls (odds ratio (OR) 2.79; 95% confidence interval (CI) 1.33-5.84) and to CT controls (OR 8.07; 95% CI 2.70-23.82). PE patients exhibited more extensive parenchymal lesions (>50%) than CT controls (OR 3.90; 95% CI 1.54-9.94). D-dimer levels were 5.1 (95% CI 1.90-13.76) times higher in PE patients than CTPA controls. CONCLUSIONS: Our results suggest a PE prevalence in COVID-19 patients close to 5% in the whole population and to 20% of the clinically suspected population. PE seems to be associated with more extensive lung damage and to require more frequently invasive ventilation.


Assuntos
/complicações , Embolia Pulmonar/etiologia , Idoso , /tratamento farmacológico , Estudos de Casos e Controles , Dor no Peito/etiologia , Terapia Combinada , Angiografia por Tomografia Computadorizada , Feminino , Produtos de Degradação da Fibrina e do Fibrinogênio/análise , França/epidemiologia , Humanos , Masculino , Pessoa de Meia-Idade , Prevalência , Embolia Pulmonar/sangue , Embolia Pulmonar/diagnóstico por imagem , Embolia Pulmonar/epidemiologia , Respiração Artificial/estatística & dados numéricos , Estudos Retrospectivos , Avaliação de Sintomas , Taquicardia/etiologia , Trombofilia/sangue , Trombofilia/etiologia , Tomografia Computadorizada por Raios X
5.
J Cardiothorac Vasc Anesth ; 35(2): 389-397, 2021 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-32994131

RESUMO

OBJECTIVE: To explore special coagulation characteristics and anticoagulation management in extracorporeal membrane oxygenation (ECMO)-assisted patients with coronavirus disease 2019 (COVID-19). DESIGN: Single-center, retrospective observation of a series of patients. PARTICIPANTS: Laboratory-confirmed severe COVID-19 patients who received venovenous ECMO support from January 20-May 20, 2020. INTERVENTIONS: This study analyzed the anticoagulation management and monitoring strategies, bleeding complications, and thrombotic events during ECMO support. MEASUREMENTS AND MAIN RESULTS: Eight of 667 confirmed COVID-19 patients received venovenous ECMO and had an elevated D-dimer level before and during ECMO support. An ECMO circuit pack (oxygenator and tubing) was replaced a total of 13 times in all 8 patients, and coagulation-related complications included oxygenator thrombosis (7/8), tracheal hemorrhage (5/8), oronasal hemorrhage (3/8), thoracic hemorrhage (3/8), bleeding at puncture sites (4/8), and cannulation site hemorrhage (2/8). CONCLUSIONS: Hypercoagulability and secondary hyperfibrinolysis during ECMO support in COVID-19 patients are common and possibly increase the propensity for thrombotic events and failure of the oxygenator. Currently, there is not enough evidence to support a more aggressive anticoagulation strategy.


Assuntos
Anticoagulantes/uso terapêutico , Oxigenação por Membrana Extracorpórea , Adulto , Idoso , Idoso de 80 Anos ou mais , Anticoagulantes/administração & dosagem , /diagnóstico por imagem , Cuidados Críticos , Oxigenação por Membrana Extracorpórea/efeitos adversos , Feminino , Produtos de Degradação da Fibrina e do Fibrinogênio/análise , Hemorragia/induzido quimicamente , Hemorragia/epidemiologia , Humanos , Masculino , Pessoa de Meia-Idade , Monitorização Fisiológica , Insuficiência Respiratória/diagnóstico por imagem , Insuficiência Respiratória/etiologia , Insuficiência Respiratória/terapia , Estudos Retrospectivos , Trombose/epidemiologia , Tomografia Computadorizada por Raios X , Traqueia/lesões
6.
J Med Virol ; 93(2): 962-972, 2021 02.
Artigo em Inglês | MEDLINE | ID: mdl-32706396

RESUMO

To systematically analyze the blood coagulation features of coronavirus disease 2019 (COVID-19) patients to provide a reference for clinical practice. An electronic search in PubMed, EMbase, Web of Science, Scopus, CNKI, WanFang Data, and VIP databases to identify studies describing the blood coagulation features of COVID-19 patients from 1 January 2020 to 21 April 2020. Three reviewers independently screened literature, extracted data, and assessed the risk of bias of included studies, then, the meta-analysis was performed by using Stata 12.0 software. Thirty-four studies involving 6492 COVID-19 patients were included. Meta-analysis showed that patients with severe disease showed significantly lower platelet count (weighted mean differences [WMD]: -16.29 × 109 /L; 95% confidence interval [CI]: -25.34 to -7.23) and shorter activated partial thromboplastin time (WMD: -0.81 seconds; 95% CI: -1.94 to 0.33) but higher D-dimer levels (WMD: 0.44 µg/mL; 95% CI: 0.29-0.58), higher fibrinogen levels (WMD: 0.51 g/L; 95% CI: 0.33-0.69) and longer prothrombin time (PT; WMD: 0.65 seconds; 95% CI: 0.44-0.86). Patients who died showed significantly higher D-dimer levels (WMD: 6.58 µg/mL; 95% CI: 3.59-9.57), longer PT (WMD: 1.27 seconds; 95% CI: 0.49-2.06) and lower platelet count (WMD: -39.73 × 109 /L; 95% CI: -61.99 to -17.45) than patients who survived. Coagulation dysfunction is common in severe COVID-19 patients and it is associated with severity of COVID-19.


Assuntos
Transtornos da Coagulação Sanguínea/virologia , /mortalidade , Produtos de Degradação da Fibrina e do Fibrinogênio/análise , Fibrinogênio/análise , Humanos , Contagem de Leucócitos , Contagem de Plaquetas , Tempo de Protrombina , Fatores de Risco
7.
J Med Virol ; 93(2): 934-944, 2021 02.
Artigo em Inglês | MEDLINE | ID: mdl-32706426

RESUMO

The outbreak of 2019 novel coronavirus disease (COVID-19) has posed a grave threat to the global public health. The COVID-19-induced infection is closely related to coagulation dysfunction in the affected patients. This paper attempts to conduct a meta-analysis and systematically review the blood coagulation indicators in patients with severe COVID-19. A meta-analysis of eligible studies was performed to compare the blood coagulation indicators in patients with severe and nonsevere COVID-19. PubMed, Embase, Web of Science, and the Cochrane Library were searched for studies published between 1 December 2019 and 7 May 2020. A total of 13 studies with 1341 adult patients were enrolled in this analysis. Platelet (weighted mean difference [WMD] = -24.83, 95% confidence interval [CI]: -34.12 to -15.54; P < .001), d-dimer (WMD = 0.19, 95% CI: 0.09-0.29; P < .001), and fibrinogen (WMD = 1.02, 95% CI: 0.50-1.54; P < .001) were significantly associated with the severity in patients with COVID-19. The meta-analysis revealed that no correlation was evident between an increased severity risk of COVID-19 and activated partial thromboplastin time (WMD = -1.56, 95% CI: -5.77 to 2.64; P = .468) or prothrombin time (WMD = 0.19, 95% CI: -0.13 to 0.51; P = .243). The single arm meta-analysis showed that compared with the nonsevere group, the severe group had a lower pooled platelet (165.12 [95% CI: 157.38-172.85] vs 190.09 [95% CI: 179.45-200.74]), higher d-dimer (0.49 [95% CI: 0.33-0.64] vs 0.27 [95% CI: 0.20-0.34]), and higher fibrinogen (4.34 [95% CI: 1.98-6.70] vs 3.19 [95% CI: 1.13-5.24]). Coagulation dysfunction is closely related to the severity of patients with COVID-19, in which low platelet, high d-dimer, and fibrinogen upon admission may serve as risk indicators for increased aggression of the disease. These findings are of great clinical value for timely and effective treatment of the COVID-19 cases.


Assuntos
Transtornos da Coagulação Sanguínea/virologia , /complicações , Plaquetas , Produtos de Degradação da Fibrina e do Fibrinogênio/análise , Fibrinogênio/análise , Hospitalização , Humanos , Tempo de Tromboplastina Parcial , Prognóstico , Fatores de Risco , Índice de Gravidade de Doença
8.
Int J Cardiol ; 323: 276-280, 2021 01 15.
Artigo em Inglês | MEDLINE | ID: mdl-32911000

RESUMO

BACKGROUND: Since the body of evidence addressing the coagulation derangements caused by Coronavirus disease (COVID-19) has been constantly growing, we investigated whether pre-hospitalization oral anticoagulation (OAC) or in-hospital heparin treatment could have a protective role among COVID-19 patients. METHOD: In this cohort study, consecutive COVID-19 patients admitted to four different Italian Institutions were enrolled. Baseline demographic, clinical, laboratory, and radiological characteristics, as well as in-hospital treatment and outcomes were evaluated. The primary outcome was mortality. RESULTS: A total of 844 COVID-19 patients were enrolled as study cohort, n = 65 (7.7%) taking OACs prior to hospitalization. Regarding clinical outcomes, OAC patients developed acute hypoxemic respiratory failure (AHRF) more frequently than non-OAC patients as well as presenting a higher mortality rate (44.6% vs 19.8%, p < 0.001). At overall multivariate logistical regression, use of heparin (n = 394, 46.6%) was associated with a better chance of survival to hospital discharge (OR 0.60 [0.38-0.94], p < 0.001), in particular in patients with AHRF, with no association found with the use of OACs. In a sub-analysis, the highest mortality rate was found for AHRF patients when heparin was not administered. CONCLUSION: In our cohort, OACs appeared to be ineffective in reducing mortality rate, while heparin resulted to be a useful treatment when lung disease was sufficiently severe, potentially suggesting a crucial role of microthrombosis in severe COVID-19. Due to the relatively small number of COVID-19 patients treated with OACs included in our analysis and their higher number of comorbidities, larger studies are needed in order to confirm our findings.


Assuntos
Anticoagulantes/uso terapêutico , Heparina/uso terapêutico , Insuficiência Respiratória/tratamento farmacológico , Insuficiência Respiratória/mortalidade , Administração Oral , Fatores Etários , Idoso , /virologia , Estudos de Coortes , Doença da Artéria Coronariana/epidemiologia , Feminino , Produtos de Degradação da Fibrina e do Fibrinogênio/análise , Hospitalização , Humanos , Itália/epidemiologia , Masculino , Pessoa de Meia-Idade , Análise Multivariada , Oxigênio/sangue , Fatores Sexuais
9.
Am J Emerg Med ; 39: 173-179, 2021 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-33069541

RESUMO

BACKGROUND: In this systematic review and meta-analysis, we aimed to investigate the correlation of D-dimer levels measured on admission with disease severity and the risk of death in patients with coronavirus disease 2019 (COVID-19) pneumonia. MATERIALS AND METHODS: We performed a comprehensive literature search from several databases. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines were followed in abstracting data and assessing validity. Quality assessment was performed using the Newcastle-Ottawa quality assessment scale (NOS). D-dimer levels were pooled and compared between severe/non-severe and surviving/non-surviving patient groups. Weighted mean difference (WMD), risk ratios (RRs) and 95% confidence intervals (CIs) were analyzed. RESULTS: Thirty-nine studies reported on D-dimer levels in 5750 non-severe and 2063 severe patients and 16 studies reported on D-dimer levels in 2783 surviving and 697 non-surviving cases. D-dimer levels were significantly higher in patients with severe clinical status (WMD: 0.45 mg/L, 95% CI: 0.34-0.56; p < 0.0001). Non-surviving patients had significantly higher D-dimer levels compared to surviving patients (WMD: 5.32 mg/L, 95% CI: 3.90-6.73; p < 0.0001). D-dimer levels above the upper limit of normal (ULN) was associated with higher risk of severity (RR: 1.58, 95% CI: 1.25-2.00; p < 0.0001) and mortality (RR: 1.82, 95% CI: 1.40-2.37; p < 0.0001). CONCLUSION: Increased levels of D-dimer levels measured on admission are significantly correlated with the severity of COVID-19 pneumonia and may predict mortality in hospitalized patients.


Assuntos
/diagnóstico , Produtos de Degradação da Fibrina e do Fibrinogênio/análise , /sangue , Hospitalização , Humanos , Prognóstico , Medição de Risco/métodos
10.
Transplantation ; 105(1): 158-169, 2021 01 01.
Artigo em Inglês | MEDLINE | ID: mdl-33009284

RESUMO

BACKGROUND: Data on coronavirus disease 2019 (COVID-19) in immunocompromised kidney transplant recipients (KTR) remain scanty. Although markers of inflammation, cardiac injury, and coagulopathy have been previously associated with mortality in the general population of patients with COVID-19, their prognostic impact amongst KTR with severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) infection has not been specifically investigated. METHODS: We conducted a cohort study of 49 KTR who presented with COVID-19. Clinical and laboratory risk factors for severe disease and mortality were prospectively collected and analyzed with respect to outcomes. The study participants were divided into 3 groups: (1) mild disease manageable in an outpatient setting (n = 8), (2) nonsevere disease requiring hospitalization (n = 21), and (3) severe disease (n = 20). RESULTS: Gastrointestinal manifestations were common at diagnosis. The 30-day mortality rate in hospitalized patients was 19.5%. Early elevations of C-reactive protein (>100 mg/L) and interleukin-6 (>65 ng/L) followed by increases in high-sensitivity troponin I (>30 ng/L) and D-dimer (>960 ng/mL) were significantly associated with severe disease and mortality. Viral load did not have prognostic significance in our sample, suggesting that outcomes were chiefly driven by a cytokine release syndrome (CRS). CONCLUSIONS: Regular monitoring of CRS biomarkers in KTR with COVID-19 is paramount to improve clinical outcomes.


Assuntos
/mortalidade , Síndrome da Liberação de Citocina/sangue , Transplante de Rim/mortalidade , Idoso , Biomarcadores/sangue , Proteína C-Reativa/análise , /complicações , Feminino , Produtos de Degradação da Fibrina e do Fibrinogênio/análise , Hospitalização , Humanos , Interleucina-6/sangue , Masculino , Pessoa de Meia-Idade , Índice de Gravidade de Doença , Troponina I/sangue
11.
Med Intensiva ; 45(1): 42-55, 2021.
Artigo em Inglês, Espanhol | MEDLINE | ID: mdl-32646669

RESUMO

During the new pandemic caused by SARS-CoV-2, there is short knowledge regarding the management of different disease areas, such as coagulopathy and interpretation of D-dimer levels, its association with disseminated intravascular coagulation (DIC) and controversy about the benefit of anticoagulation. Thus, a systematic review has been performed to define the role of D-dimer in the disease, the prevalence of DIC and the usefulness of anticoagulant treatment in these patients. A literature search was performed to analyze the studies of COVID-19 patients. Four recommendations were drawn based on expert opinion and scientific knowledge, according to the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach. The present review suggests the presence of higher levels of D-dimer in those with worse prognosis, there may be an overdiagnosis of DIC in the course of the disease and there is no evidence on the benefit of starting anticoagulant treatment based only on isolated laboratory data.


Assuntos
Anticoagulantes/uso terapêutico , Transtornos da Coagulação Sanguínea/sangue , Coagulação Intravascular Disseminada/sangue , Produtos de Degradação da Fibrina e do Fibrinogênio/análise , Transtornos da Coagulação Sanguínea/tratamento farmacológico , Transtornos da Coagulação Sanguínea/mortalidade , /epidemiologia , Estado Terminal , Coagulação Intravascular Disseminada/diagnóstico , Coagulação Intravascular Disseminada/tratamento farmacológico , Coagulação Intravascular Disseminada/epidemiologia , Humanos , Sobremedicalização , Estudos Observacionais como Assunto , Pandemias , Prevalência , Prognóstico
12.
Blood Coagul Fibrinolysis ; 32(1): 23-28, 2021 Jan 01.
Artigo em Inglês | MEDLINE | ID: mdl-33196516

RESUMO

Coronavirus disease 2019 (COVID-19) has affected more than 6 million patients worldwide. Deep venous thrombosis (DVT) has been increasingly recognized complication in these patients and is associated with increased morbidity and mortality. However, the factors associated with development of DVT in patients with COVID-19 have not been elucidated due to the novelty of the virus. We performed a meta-analysis of published studies comparing laboratory results in COVID-19 patients with and without DVT with the aim of identifying risk factors. We searched major databases for studies evaluating DVT in COVID-positive patients and performed a meta-analysis of baseline laboratory markers associated with development of DVT. A total of six studies with 678 patients were included in the pooled analyses. Of the 678 patients, 205 of patients had a DVT. Patients diagnosed with DVT were more likely to be older [mean difference 4.59 years, 95% confidence interval (CI) 1.25-7.92], and needing admission to ICU (relative risk 1.96, 95% CI 1.09-3.51). Patients with DVT had significantly higher white cell count (mean difference 1.36 × 109/l, 95% CI 0.33-2.40) and d-dimer levels (mean difference 3229.8, 95% CI 1501.5-4958.1). Lymphocyte count was lower in patients with DVT (mean difference -0.19 × 109/l, 95% CI -0.37 to -0.02). Patients with COVID-19 who develop DVT are more likely to be older and have leukocytosis with lymphopenia. Moreover, d-dimer is statistically higher and patients that are admitted to the ICU are at great risk to develop DVT.


Assuntos
/complicações , Trombose Venosa/epidemiologia , Trombose Venosa/etiologia , Fatores Etários , Idoso , Proteína C-Reativa/análise , Feminino , Produtos de Degradação da Fibrina e do Fibrinogênio/análise , Hospitalização , Humanos , Unidades de Terapia Intensiva , Contagem de Leucócitos , Contagem de Linfócitos , Masculino , Pessoa de Meia-Idade , Fatores de Risco , Trombose Venosa/sangue
13.
J Crit Care ; 61: 39-44, 2021 02.
Artigo em Inglês | MEDLINE | ID: mdl-33075608

RESUMO

PURPOSE: To describe the clinical characteristics and outcomes of coronavirus disease-2019 (COVID-19)-associated pulmonary thromboembolism (PTE). MATERIALS AND METHODS: A case series of five patients, representing the clinical spectrum of COVID-19 associated PTE. Patients were admitted to four hospitals in Germany, Italy, and France. Infection with Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) was confirmed using a real-time reverse transcription polymerase chain reaction test. RESULTS: The onset of PTE varied from 2 to 4 weeks after the occurrence of the initial symptoms of SARS-CoV-2 infection and led to deterioration of the clinical picture in all cases. PTE was the primary reason for hospital admission after a 2-week period of self-isolation at home (1 patient) and hospital readmission after initial uncomplicated hospital discharge (2 patients). Three of the patients had no past history of clinically relevant risk factors for venous thromboembolism (VTE). Severe disease progression was associated with concomitant increases in IL-6, ferritin, and D-Dimer levels. The outcome from PTE was related to the extent of vascular involvement, and associated complications. CONCLUSION: PTE is a potential life-threatening complication, which occurs frequently in patients with COVID-19. Intermediate therapeutic dose of anticoagulants and extend thromboprophylaxis are necessary after meticulous risk-benefit assessment.


Assuntos
Anticoagulantes/uso terapêutico , Embolia Pulmonar/tratamento farmacológico , Adulto , Idoso , Progressão da Doença , Ferritinas/sangue , Produtos de Degradação da Fibrina e do Fibrinogênio/análise , França , Alemanha , Hospitalização , Humanos , Interleucina-6/sangue , Itália , Masculino , Pessoa de Meia-Idade , Embolia Pulmonar/complicações , Medição de Risco , Fatores de Risco , Tomografia Computadorizada por Raios X
14.
Ann Med ; 53(1): 181-188, 2021 12.
Artigo em Inglês | MEDLINE | ID: mdl-33183091

RESUMO

OBJECTIVE: To illustrate the effect of corticosteroids and heparin, respectively, on coronavirus disease 2019 (COVID-19) patients' CD8+ T cells and D-dimer. METHODS: In this retrospective cohort study involving 866 participants diagnosed with COVID-19, patients were grouped by severity. Generalized additive models were established to explore the time-course association of representative parameters of coagulation, inflammation and immunity. Segmented regression was performed to examine the influence of corticosteroids and heparin upon CD8+ T cell and D-dimer, respectively. RESULTS: There were 541 moderate, 169 severe and 156 critically ill patients involved in the study. Synchronous changes of levels of NLR, D-dimer and CD8+ T cell in critically ill patients were observed. Administration of methylprednisolone before 14 DFS compared with those after 14 DFS (ß = 0.154%, 95% CI=(0, 0.302), p=.048) or a dose lower than 40 mg per day compared with those equals to 40 mg per day (ß = 0.163%, 95% CI=(0.027, 0.295), p=.020) significantly increased the rising rate of CD8+ T cell in 14-56 DFS. CONCLUSIONS: The parameters of coagulation, inflammation and immunity were longitudinally correlated, and an early low-dose corticosteroid treatment accelerated the regaining of CD8+ T cell to help battle against SARS-Cov-2 in critical cases of COVID-19.


Assuntos
Linfócitos T CD8-Positivos/efeitos dos fármacos , Glucocorticoides/administração & dosagem , Inflamação/tratamento farmacológico , Adulto , Idoso , Idoso de 80 Anos ou mais , Coagulação Sanguínea/efeitos dos fármacos , Coagulação Sanguínea/imunologia , Linfócitos T CD8-Positivos/imunologia , /diagnóstico , Relação Dose-Resposta a Droga , Feminino , Produtos de Degradação da Fibrina e do Fibrinogênio/análise , Produtos de Degradação da Fibrina e do Fibrinogênio/imunologia , Heparina/administração & dosagem , Humanos , Inflamação/sangue , Inflamação/diagnóstico , Inflamação/imunologia , Modelos Lineares , Estudos Longitudinais , Contagem de Linfócitos , Masculino , Metilprednisolona/administração & dosagem , Pessoa de Meia-Idade , Modelos Biológicos , Estudos Retrospectivos , /isolamento & purificação , Índice de Gravidade de Doença , Fatores de Tempo , Tempo para o Tratamento , Adulto Jovem
15.
J Med Virol ; 93(2): 1078-1098, 2021 02.
Artigo em Inglês | MEDLINE | ID: mdl-32776551

RESUMO

BACKGROUND: To determine the utility of admission laboratory markers in the assessment and prognostication of coronavirus disease-2019 (COVID-19), a systematic review and meta-analysis were conducted on the association between admission laboratory values in hospitalized COVID-19 patients and subsequent disease severity and mortality. MATERIAL AND METHODS: Searches were conducted in MEDLINE, Pubmed, Embase, and the WHO Global Research Database from December 1,2019 to May 1, 2020 for relevant articles. A random effects meta-analysis was used to calculate the weighted mean difference (WMD) and 95% confidence interval (95% CI) for each of 27 laboratory markers. The impact of age and sex on WMDs was estimated using meta-regression techniques for 11 markers. RESULTS: In total, 64 studies met the inclusion criteria. The most marked WMDs were for neutrophils (ANC) at 3.82 × 109 /L (2.76, 4.87), lymphocytes (ALC) at -0.34 × 109 /L (-0.45, -0.23), interleukin-6 (IL-6) at 32.59 pg/mL (23.99, 41.19), ferritin at 814.14 ng/mL (551.48, 1076.81), C-reactive protein (CRP) at 66.11 mg/L (52.16, 80.06), D-dimer at 5.74 mg/L (3.91, 7.58), LDH at 232.41 U/L (178.31, 286.52), and high sensitivity troponin I at 90.47 pg/mL (47.79, 133.14) when comparing fatal to nonfatal cases. Similar trends were observed comparing severe to non-severe groups. There were no statistically significant associations between age or sex and WMD for any of the markers included in the meta-regression. CONCLUSION: The results highlight that hyper inflammation, blunted adaptive immune response, and intravascular coagulation play key roles in the pathogenesis of COVID-19. Markers of these processes are good candidates to identify patients for early intervention and, importantly, are likely reliable regardless of age or sex in adult patients.


Assuntos
Imunidade Adaptativa , /mortalidade , Hospitalização/estatística & dados numéricos , Inflamação , Biomarcadores/sangue , Proteína C-Reativa/análise , Feminino , Produtos de Degradação da Fibrina e do Fibrinogênio/análise , Humanos , Linfócitos , Masculino , Neutrófilos , Análise de Regressão , Índice de Gravidade de Doença
16.
Heart Lung ; 50(1): 9-12, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-33041057

RESUMO

AIM: To determine if D-dimers are elevated in individuals with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection who have adverse clinical outcomes including all-cause mortality, intensive care unit (ICU) admission or acute respiratory distress syndrome (ARDS). METHODS: We conducted a systematic review and meta-analysis of the published literature in PubMed, Embase and Cochrane databases through April 9, 2020 for studies evaluating D-dimer levels in SARS-COV-2 infected patients with and without a composite clinical endpoint, defined as the presence of all-cause of mortality, Intensive care unit (ICU) admission or acute respiratory distress syndrome (ARDS). A total of six studies were included in the meta-analysis. RESULTS: D-dimers were significantly increased in patients with the composite clinical end point than in those without (SMD, 1.67 ug/ml (95% CI, 0.72-2.62 ug/ml). The SMD of the studies (Tang et al, Zhou et al, Chen et al), which used only mortality as an outcome measure was 2.5 ug/mL (95% CI, 0.62-4.41 ug/ml). CONCLUSION: We conclude that SARS-CoV-2 infected patients with elevated D-dimers have worse clinical outcomes (all-cause mortality, ICU admission or ARDS) and thus measurement of D-dimers can guide in clinical decision making.


Assuntos
Produtos de Degradação da Fibrina e do Fibrinogênio , /sangue , Tomada de Decisão Clínica , Produtos de Degradação da Fibrina e do Fibrinogênio/análise , Humanos , Pacientes Internados , Unidades de Terapia Intensiva , Prognóstico
17.
J Trauma Acute Care Surg ; 90(1): e7-e12, 2021 01 01.
Artigo em Inglês | MEDLINE | ID: mdl-33009340

RESUMO

BACKGROUND: Critically ill coronavirus disease 2019 (COVID-19) patients have frequent thrombotic complications and laboratory evidence of hypercoagulability. The relationship of coagulation tests and thrombosis requires investigation to identify best diagnostic and treatment approaches. We assessed for hypercoagulable characteristics in critically ill COVID-19 patients using rotational thromboelastometry (ROTEM) and explored relationships of D-dimer and ROTEM measurements with thrombotic complications. METHODS: Critically ill adult COVID-19 patients receiving ROTEM testing between March and April 2020 were analyzed. Patients receiving therapeutic anticoagulation before ROTEM were excluded. Rotational thromboelastometry measurements from COVID-19 patients were compared with non-COVID-19 patients matched by age, sex, and body mass index. Intergroup differences in ROTEM measurements were assessed using t tests. Correlations of D-dimer levels to ROTEM measurements were assessed in COVID-19 patients who had available concurrent testing. Intergroup differences of D-dimer and ROTEM measurements were explored in COVID-19 patients with and without thrombosis. RESULTS: Of 30 COVID-19 patients receiving ROTEM, we identified hypercoagulability from elevated fibrinogen compared with non-COVID-19 patients (fibrinogen assay maximum clot firmness [MCF], 47 ± 13 mm vs. 20 ± 7 mm; mean intergroup difference, 27.4 mm; 95% confidence interval [CI], 22.1-32.7 mm; p < 0.0001). In our COVID-19 cohort, thrombotic complications were identified in 33%. In COVID-19 patients developing thrombotic complications, we identified higher D-dimer levels (17.5 ± 4.3 µg/mL vs. 8.0 ± 6.3 µg/mL; mean difference, 9.5 µg/mL; 95% CI, 13.9-5.1; p < 0.0001) but lower fibrinogen assay MCF (39.7 ± 10.8 mm vs. 50.1 ± 12.0 mm; mean difference, -11.2 mm; 95% CI, -2.1 to -20.2; p = 0.02) compared with patients without thrombosis. We identified negative correlations of D-dimer levels and ROTEM MCF in these patients (r = -0.61; p = 0.001). CONCLUSION: We identified elevated D-dimer levels and hypercoagulable blood clot characteristics from increased fibrinogen on ROTEM testing in critically ill COVID-19 patients. However, we identified lower, albeit still hypercoagulable, ROTEM measurements of fibrinogen in COVID-19 patients with thrombotic complications compared with those without. Further work is required to externally validate these findings and to investigate the mechanistic drivers for these relationships to identify best diagnostic and treatment approaches for these patients. LEVEL OF EVIDENCE: Epidemiologic, level IV.


Assuntos
/fisiopatologia , Produtos de Degradação da Fibrina e do Fibrinogênio/análise , Tromboelastografia/métodos , Trombofilia/sangue , Trombose/etiologia , Idoso , Estudos de Casos e Controles , Estado Terminal , Feminino , Hemostasia , Humanos , Masculino , Pessoa de Meia-Idade , Cidade de Nova Iorque , Tempo de Tromboplastina Parcial , Trombose/diagnóstico
18.
Medicine (Baltimore) ; 99(49): e23329, 2020 Dec 04.
Artigo em Inglês | MEDLINE | ID: mdl-33285710

RESUMO

Ovarian cancer is one of the common female malignant tumors. The early diagnosis and treatment of ovarian cancer has been a research hotspot. Therefore, we aimed to investigate the correlations between the levels of carbohydrate antigen 125 (CA125), human epididymis protein 4 (HE4), D-dimer (DDI), and fibrinogen degradation product (FDP) in patients with type II epithelial ovarian cancer.From January 2018 to January 2019, a total of 952 patients who underwent initial surgery for epithelial ovarian cancer were enrolled in this study. Peripheral venous blood was taken before operation, and the levels of CA125, HE4, DDI, and FDP were tested. The correlations between the levels of CA125, HE4, DDI, and FDP and other clinical indicators (such as presence or absence of chemotherapy, surgical conditions) were analyzed.The level of DDI or FDP was statistically associated with age, chemotherapy, Figo staging, surgical procedure, HE4 level, and CA125 level, respectively. Moreover, the Figo staging was statistically correlated with the levels of HE4 and CA125. Besides, we found the levels of CA125 and HE4 were positively correlated with the levels of DDI and FDP.The levels of CA125 and HE4 are the traditional detection indexes for patients with type II epithelial ovarian cancer, and these 2 indicators reflected the degree of disease and prognosis. The levels of DDI and FDP were closely related to the levels of CA125 and HE4 in type II epithelial ovarian cancer, and they also helped to assess the prognosis of epithelial ovarian cancer. Further larger-scale prospective cohort studies are warranted to determine these associations in the future.


Assuntos
Carcinoma Epitelial do Ovário/sangue , Carcinoma Epitelial do Ovário/patologia , Neoplasias Ovarianas/sangue , Neoplasias Ovarianas/patologia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Biomarcadores Tumorais , Antígeno Ca-125/sangue , Feminino , Produtos de Degradação da Fibrina e do Fibrinogênio/análise , Humanos , Pessoa de Meia-Idade , Estadiamento de Neoplasias , Estudos Prospectivos , Proteína 2 do Domínio Central WAP de Quatro Dissulfetos/análise , Adulto Jovem
19.
Clin Appl Thromb Hemost ; 26: 1076029620982669, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-33372807

RESUMO

Deep venous thrombosis (DVT) is a severe complication of coronavirus disease 2019 (COVID-19). The purpose of this study was to study the prevalence, risk factors, anticoagulant therapy and sex differences of DVT in patients with COVID-19. The enrolled 121 hospitalized non-ventilator patients were confirmed positive for COVID-19. All suspected patients received color Doppler ultrasound (US) to screen for DVT in both lower extremities. Multivariate logistic regression was performed to identify risk factors related to DVT in COVID-19 patients. DVT was found in 48% of the asymptomatic COVID-19 patients with an increased PADUA or Caprini index using US scanning. The multivariate logistic regression determined that age (OR, 1.05; p = .0306), C-reactive protein (CRP) (OR, 1.02; p = .0040), and baseline D-dimer (OR, 1.42; p = .0010) were risk factors among COVID-19 patients. Although the most common DVT location was infrapopliteal (classes I and II), higher mortality in DVT-COVID-19 patients was confirmed. DVT-COVID-19 patients presented significant increases in CRP, neutrophil count, and D-dimer throughout the whole inpatient period compared to non-DVT-COVID-19 patients. Although anticoagulation therapy accelerated the recovery of lymphocytopenia in DVT patients, men DVT-COVID-19 patients with anticoagulant therapy showed significant higher CRP and neutrophil count vs. lymphocyte count (N/L) ratio, but showed lower lymphocyte counts compared to women DVT-COVID-19 patients. DVT is common in COVID-19 patients with high-risk factors, especially for older age and higher CRP and baseline D-dimer populations. It is important to consider sex differences in anticoagulant therapy among DVT-COVID-19 patients.


Assuntos
/complicações , Trombose Venosa/etiologia , Adulto , Idoso , Idoso de 80 Anos ou mais , Anticoagulantes/uso terapêutico , Proteína C-Reativa/análise , Feminino , Produtos de Degradação da Fibrina e do Fibrinogênio/análise , Humanos , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Caracteres Sexuais
20.
Zhonghua Xue Ye Xue Za Zhi ; 41(11): 927-931, 2020 Nov 14.
Artigo em Chinês | MEDLINE | ID: mdl-33333696

RESUMO

Objective: To analyze the association of D-dimer levels, inflammatory indicators, cytokine abnormality, and disease severity in COVID-19 severe/critical type patients. Methods: The medical records of 41 patients were collected from a single center in Wuhan from February 8, 2020 to March 25, 2020. The patients were divided into severe type group (28 patients) and critical type group (13 patients) . The levels of D-dimer, WBC, ANC, PCT, hsCRP, IL-2R, IL-6, IL-8, and TNF-α were compared among patients with different clinical types of COVID-19 infection. Moreover, the changes in the cytokines were analyzed in patients with different D-dimer levels. And, the levels of D-dimer, IL-2R, IL-6, IL-8, and TNF-α before and after anticoagulant therapy were assessed. Statistical analyses were performed using Student t test, Mann-Whitney U test, and Chi-square test. Results: Among the 41 patients, 23 were men (56.1%) and 18 were women (43.9%) ; the median patient age was 57 y. The age of the critical type patients [ (61.1±10.4) y] was higher than that of severe type patients [ (52.8±11.7) y]; the difference was significant (t=-2.264, P=0.032) . The proportion of critical type patients with chronic diseases, especially hypertension, cardiovascular disease, and cerebrovascular disease, was higher as compared to that in those with severe type patients; the differences were significant (all P<0.05) . The prevalence of dyspnea, sweats, and fatigue symptoms in the critical type patients was higher than that in those with severe type disease; the differences were significant (χ(2)=14.898, 6.972, 7.823; P<0.001, 0.008, 0.005) . The levels of D-dimer, WBC, ANC, PCT, hsCRP, and IL-8 in critical type patients were higher than those in severe type patients; the differences were significant (all P<0.05) . The levels of IL-2R, IL-8, and TNF-α in patients with abnormal D-dimer were higher as compared to those in patients with normal D-dimer levels; the differences were significant (all P<0.05) . Eight patients were treated with prophylactic anticoagulation; the levels of D-dimer, IL-2R, IL-6 and IL-8 after anticoagulant therapy were lower than those before treatment. Conclusions: COVID-19 critical type patients have more serious coagulation-immune dysfunction and dynamic monitoring of D-dimer and cytokines levels helps in identifying critical type patients as early as possible; anticoagulant therapy may improve the patient's condition by correcting coagulation-immune dysfunction.


Assuntos
/diagnóstico , Citocinas/sangue , Produtos de Degradação da Fibrina e do Fibrinogênio/análise , Adulto , Idoso , Biomarcadores/sangue , China , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Índice de Gravidade de Doença
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