Predictive value of thrombocytopenia for bloodstream infection in patients with sepsis and septic shock

BACKGROUND Thrombocytopenia is common in patients with sepsis and septic shock.AIM To analyse the decrease in the number of platelets for predicting bloodstream infection in patients with sepsis and septic shock in the intensive care unit.METHODS A retrospective analysis of patients admitted with sepsis and septic shock in Xingtai People Hospital was revisited.Patient population characteristics and laboratory data were collected for analysis.RESULTS The study group consisted of 85(39%)inpatients with bloodstream infection,and the control group consisted of 133(61%)with negative results or contamination.The percentage decline in platelet counts(PPCs)in patients positive for pathogens[57.1(41.3-74.6)]was distinctly higher than that in the control group[18.2(5.1–43.1)](P<0.001),whereas the PPCs were not significantly different among those with gram-positive bacteraemia,gram-negative bacteraemia,and fungal infection.Using receiver operating characteristic curves,the area under the curve of the platelet drop rate was 0.839(95%CI:0.783-0.895).CONCLUSION The percentage decline in platelet counts is sensitive in predicting bloodstream infection in patients with sepsis and septic shock.However,it cannot identify gram-positive bacteraemia,gram-negative bacteraemia,and fungal infection.

Predictive value of preoperative routine examination for the prognosis of patients with pT2N0M0 or pT3N0M0 colorectal cancer

BACKGROUND In recent years,the incidence of colorectal cancer(CRC)has been increasing.With the popularization of endoscopic technology,a number of early CRC has been diagnosed.However,despite current treatment methods,some patients with early CRC still experience postoperative recurrence and metastasis.AIM To search for indicators associated with early CRC recurrence and metastasis to identify high-risk populations.METHODS A total of 513 patients with pT2N0M0 or pT3N0M0 CRC were retrospectively enrolled in this study.Results of blood routine test,liver and kidney function tests and tumor markers were collected before surgery.Patients were followed up through disease-specific database and telephone interviews.Tumor recurrence,metastasis or death were used as the end point of study to find the risk factors and predictive value related to early CRC recurrence and metastasis.RESULTS We comprehensively compared the predictive value of preoperative blood routine,blood biochemistry and tumor markers for disease-free survival(DFS)and overall survival(OS)of CRC.Cox multivariate analysis demonstrated that low platelet count was significantly associated with poor DFS[hazard ratio(HR)=0.995,95% confidence interval(CI):0.991-0.999,P=0.015],while serum carcinoembryonic antigen(CEA)level(HR=1.008,95%CI:1.001-1.016,P=0.027)and serum total cholesterol level(HR=1.538,95%CI:1.026-2.305,P=0.037)were independent risk factors for OS.The cutoff value of serum CEA level for predicting OS was 2.74 ng/mL.Although the OS of CRC patients with serum CEA higher than the cutoff value was worse than those with lower CEA level,the difference between the two groups was not statistically significant(P=0.075).CONCLUSION For patients with T2N0M0 or T3N0M0 CRC,preoperative platelet count was a protective factor for DFS,while serum CEA level was an independent risk factor for OS.Given that these measures are easier to detect and more acceptable to patients,they may have broader applications.

Longitudinal changes in personalized platelet count metrics are good indicators of initial 3-year outcome in colorectal cancer

BACKGROUND Platelet count or complete blood count(CBC)-based ratios including lymphocyteto-monocyte(LMR),neutrophil-to-lymphocyte(NLR),hemoglobin-to-platelet(HPR),red blood cell count distribution width-to-platelet(RPR),and platelet-tolymphocyte(PLR)ratio are good predictors of colorectal cancer(CRC)survival.Their change in time is not well documented,however.AIM To investigate the effect of longitudinal CBC ratio changes on CRC survival and their possible associations with clinicopathological properties,comorbidities,and anamnestic data.METHODS A retrospective longitudinal observational study was conducted with the inclusion of 835 CRC patients,who attended at Semmelweis University,Budapest.CBC ratios and two additional newly defined personalized platelet count metrics(pPLT_(D)and pPLT_(S),the platelet counts relative to the measurement at the time of CRC diagnosis and to the one 4-6 wk after tumor removal surgery,respectively)were recorded.RESULTS The 835 CRC patients had a total of 4608 measurements(5.52 visits/patient,in average).Longitudinal survival models revealed that the increases/decreases in LMR[hazard ratio(HR):0.4989,P<0.0001],NLR(HR:1.0819,P<0.0001),HPR(HR:0.0533,P=0.0038),pPLT_(D)(HR:4.9229,P<0.0001),and pPLT_(S)(HR:4.7568,P<0.0001)values were poor prognostic signs of disease-specific survival.The same was obtained for all-cause mortality.Most abnormal changes occurred within the first 3 years after the diagnosis of CRC.RPR and PLR had an only marginal effect on diseasespecific(P=0.0675)and all-cause mortality(Bayesian 95%credible interval:0.90–186.05),respectively.CONCLUSION LMR,NLR,and HPR are good metrics to follow the prognosis of the disease.pPLT_(D)and pPLT_(S)perform just as well as the former,while the use of RPR and PLR with the course of the disease is not recommended.Early detection of the abnormal changes in pPLT_(D),pPLT_(S),LMR,NLR,or HPR may alert the practicing oncologist for further therapy decisions in a timely manner.

Platelet count reduction and outcomes in living liver donors

BACKGROUND: Platelet count reduction in living donors after graft harvesting is very common. The mechanisms and the subsequent adverse consequences are not clear. The present study was to explore the mechanisms and the consequences of platelet count reduction in living donors. METHODS: We collected data from 231 living liver donor patients who donated at our transplant center between July 2002 and August 2009. Baseline and post-operative platelet counts were collected and analyzed. Multivariate logistic regression analysis was used to compare the risk factors for the persistent decrease in platelet counts. Complications and other postoperative recovery were compared between the donors. RESULTS: Platelet count decreased differently at each of the follow-up intervals, and the average reduction from baseline evaluation to year 3 was 18.2%. A concomitant decrease in white blood cells was observed with platelet count reduction. All of the splenic volumes at the post-operative follow-up time points were significantly higher than those at baseline(P【0.01). Multivariate logistic regression analysis indicated that the graft-to-donor weight ratio was a risk factor for low postoperative platelet counts in living donors at the three followup time points: one week(P=0.047), one month(P=0.034), and three months(P=0.047). At the one week follow-up time, 77 donor platelet counts were higher(group 1) and 151 donor platelet counts were lower(group 2) than baseline levels. Two hemorrhage events(1.3%) were observed in group 2, while three hemorrhage events(3.9%) were observed in group 1(P=0.211). The overall complication rate was comparable between the two groups(P=0.972). CONCLUSION: An increase in harvesting graft may decrease platelet counts, but this reduction does not produce short- or long-term damage in living liver donors.

Combination of type Ⅳ collagen 7S, albumin concentrations, and platelet count predicts prognosis of non-alcoholic fatty liver disease

BACKGROUND Non-alcoholic fatty liver disease(NAFLD)is the most common cause of chronic liver disease and affects approximately 25%of the general global adult population.The prognosis of NAFLD patients with advanced liver fibrosis is known to be poor.It is difficult to assess disease progression in all patients with NAFLD;thus,it is necessary to identify patients who will show poor prognosis.AIM To investigate the efficacy of non-invasive biomarkers for predicting disease progression in patients with NAFLD.METHODS We investigated biomarkers associated with mortality in patients with NAFLD who visited the Kawasaki Medical School General Medical Center from 1996 to 2018 and underwent liver biopsy and had been followed-up for>1 year.Cumulative overall mortality and liver-related events during follow-up were calculated using the Kaplan-Meier analysis and compared using log-rank testing.We calculated the odds ratio and performed receiver operating characteristic curve analysis with logistic regression analysis to determine the optimal cut-off value with the highest prognostic ability.RESULTS We enrolled 489 patients who were followed-up for a period of 1-22.2 years.In total,13 patients died(2.7%of total patients enrolled);7 patients died due to liverrelated causes.Poor prognosis was associated with liver fibrosis on histological examination but not with inflammation or steatosis.Blood biomarkers associated with mortality were platelet counts,albumin levels,and type IV collagen 7S levels.The optimal cutoff index for predicting total mortality was a platelet count of 15×10^(4)/μL,albumin level of 3.5 g/dL,and type IV collagen 7S level of 5 mg/dL.In particular,only one-factor patients with NAFLD presenting with platelet counts≤15×10^(4)/μL,albumin levels≤3.5 g/dL,or type IV collagen 7S≥5 mg/dL showed 5-year,10-year,and 15-year survival rates of 99.7%,98.3%,and 94%,respectively.However,patients with two factors had lower 5-year and 10-year survival rates of 98%and 43%,respectively.Similarly,patients with all three factors showed the lowest 5-year and 10-year survival rates of 53%and 26%,respectively.CONCLUSION A combination of the three non-invasive biomarkers is a useful predictor of NAFLD prognosis and can help identify patients with NAFLD who are at a high risk of all-cause mortality.

Predictive Values of Platelets Count and Spleen Diameter in the Diagnosis of Esophageal Varices in Black African Cirrhotic Patients

Background: Gastrointestinal hemorrhage from ruptured esophageal varices is of concern in Africa where gastrointestinal fibroscopy for diagnosis is lacking. Purpose: To determine the performance of the length of the spleen, of the platelet count in the diagnosis of esophageal varices (OVs) by specifying the diagnostic thresholds in order to facilitate the prophylaxis of varicose hemorrhages in black African cirrhotic patients. Material and Method: This was a prospective study with a descriptive and analytical aim on cirrhotic patients hospitalized at the university hospital of Bouake (Ivory Coast) from 2017 to 2019. The patients included in the study were the cirrhotic of black race hospitalized having carried out an abdominal ultrasound with measurement of the spleen diameter (SD), an eso-gastro-duodenal endoscopy, and a blood count with platelet count (PC). The first primary endpoint was the diagnosis of esophageal varices in cirrhosis. Cirrhosis was retained by the combination of clinical, biological, ultrasound and endoscopic arguments. The OVs were distributed according to size and the presence of red signs. The platelet count, and the measurement of the spleen to calculate the PC/SD ratio were the second endpoint. The secondary endpoints studied were, the viral and ethyl etiologies of the cirrhosis, the Chlid-Pugh prognostic score. Performance was assessed using the ROC curve. The difference was significant for p less than 0.05. Results: The study included 101 patients;they were 79 men (78.2%) and 22 women (21.8%). The mean age of the cirrhotic patients was 48 ± 14. Esophageal varices were present in (n = 93;92%) of cases. The different etiologies were hepatitis B virus (HBV) (n = 65;78.3%), hepatitis C virus (HCV) (n = 21;25, 3%), and alcohol (n = 6;7.2%). Platelet count (PC) < 100,000/mm3 was statistically related to the presence of OV with red signs. Splenomegaly (SD > 130 mm) and PC/SD ratio < 1000 were significantly related to the presence of OVs and large OVs. SD with a cutoff of > 102 mm predicted 75% of OVs (AUROC = 0.797). CP with a cutoff < 131,000/mm3, predicted 100% of OVs (AUROC = 0.756). The PC/SD ratio < 1205 diagnosed 100% of OV (AUROC = 0.801). The PC/SD ratio < 818 and SD > 129 mm predicted large OVs. Conclusion: Platelet count, spleen diamater, and PC/SD ratio were all performant for the diagnosis of OVs in our setting with better diagnostic performance for PC/SD. This report could help initiate prophylactic treatment for OVs rupture in cirrhotic patients in health centers where gastrointestinal endoscopy is lacking.

Analysis of prognostic factors in patients with emergency sepsis

BACKGROUND Emergency sepsis is a common and serious infectious disease,and its prognosis is influenced by a number of factors.AIM To analyse the factors influencing the prognosis of patients with emergency sepsis in order to provide a basis for individualised patient treatment and care.By retrospectively analysing the clinical data collected,we conducted a comprehensive analysis of factors such as age,gender,underlying disease,etiology and site of infection,inflammatory indicators,multi-organ failure,cardiovascular function,therapeutic measures,immune status and severity of infection.METHODS Data collection:Clinical data were collected from patients diagnosed with acute sepsis,including basic information,laboratory findings,medical history and treatment options.Variable selection:Variables associated with prognosis were selected,including age,gender,underlying disease,etiology and site of infection,inflammatory indicators,multi-organ failure,cardiovascular function,treatment measures,immune status and severity of infection.Data analysis:The data collected are analysed using appropriate statistical methods such as multiple regression analysis and survival analysis.The impact of each factor on prognosis was assessed according to prognostic indicators,such as survival,length of stay and complication rates.RESULTS Descriptive statistics:Descriptive statistics were performed on the data collected from the patients,including their basic characteristics and clinical presentation.CONCLUSION Type 2 diabetes mellitus were independent factors affecting the prognosis of patients with sepsis.

Factors Predicting Transformation of Non-Severe Pre-Eclampsia into Pre-Eclampsia with Severe Features

Background: Pre-eclampsia (PE), a complex, multisystem, pregnancy-associated hypertensive disorder, typically developing after the 20th week of gestation, that complicates 2% - 8% of pregnancies, is a leading cause of neonatal and maternal mortality and morbidity. Aim of the Work: To identify different factors predicting transformation of non-severe pre-eclampsia in to pre-eclampsia with severe features. Patients and Methods: This prospective cohort study was conducted at tertiary care hospital at Ain Shams University hospitals from June 2021 till January 2022 and performed on total of 100 patients who diagnosed as non-severe pre-eclampsia after exclusion of severity features. Results: The current study revealed that transformation to severe pre-eclampsia occurred in 33% of the studied cases. Body mass index (BMI), past and family histories of preeclampsia statistically were significantly higher in cases transformed into preeclampsia with severe features. Admission blood pressure, albumin dipstick, Oligohydramnios and IUGR statistically were significantly higher in cases with transformation from non-severe pre-eclampsia into pre-eclampsia with severe features. Platelet count statistically was significantly lower in cases with transformation from non-severe pre-eclampsia into pre-eclampsia with severe features Conclusion: Our study results identified the most important clinical risk factors for transformation to severe features of pre-eclampsia from non-severe features and provided new information on the level of risk associated with specific combinations of risk factors (BMI ≥ 35.4, admission systolic blood pressure, admission diastolic blood pressure, albumin dipstick 4+ and platelets count) with low significant diagnostic performance in predicting transformation from non-severe pre-eclampsia into pre-eclampsia with severe features.

Close Correlation between Development of MODS during the Initial 72h of Hospitalization and Hospital Mortality in Severe Fever with Thrombocytopenia Syndrome

An emerging infectious disease was identified as severe fever with thrombocytopenia syn- drome （SFTS） in central China since late March 2009. We found the patients with SFTS had severe clinical symptoms, and progressed rapidly to multiple organ dysfunction syndrome （MODS） with high fatality rate of 25%-30%. The aim of this study was to assess the significance of risk factors predicting the development of MODS and death in SFTS patients. Consecutive SFTS admissions between May 2009 and September 2011 were analyzed for parameters of organ function during hospitalization using Marshall scoring system for MODS, and platelet counts were recorded on admission and at 24, 48, 72 h and one week after admission. We investigated the kinetics of organ failures and analyzed the associa- tion between age, platelet count and development of MODS or death. A total of 92 SFTS patients were enrolled in this study. Among them, 32 patients with dysfunction of over 4 organs were identified, 45% of them died within 72 h, 72% died within 5 days, and 76% died within 7 days after admission. We also found cumulative Marshall score was significantly higher in death patients （11.76＋2.05） than in survival patients （4.22~1.98） （P〈0.001）. In addition, SFTS patients had older age and lower platelet counts in MODS and death groups. Furthermore, we also observed that there was a close correlation between platelet count on admission and Marshall score （P〈0.001）. High Marshall score, advanced age and lower platelet counts were the main risk factors for the development of MODS, and those factors could predict mortality in SFTS patients, suggesting prompt treatment and close monitoring of severe complications, especially MODS, are of great importance in saving patients＇ lives.

The Pattern of Eosinophil Count among Nigerians with Frequent Use of the Commonly Available Non-Steroidal Anti-Inflammatory Drugs (NSAIDs)

Introduction: Non-steroidal anti-inflammatory drugs (NSAIDs) use is very common. NSAIDs use could be associated with elevated eosinophil count which could be a class effect or patient-related. Inflammation could be the link between NSAIDs use and eosinophilia. Aims: To compare the pattern of eosinophil count in the peripheral blood of frequent users of NSAIDs and healthy controls. Methodology: Two hundred (one hundred frequent users of NSAIDs and 100 healthy controls) participants who had no known risk factor for kidney disease and had given informed consent were recruited. Blood was taken to determine the white cell count and differentials, serum electrolyte and creatinine, and random blood sugar. Results: The mean age of NSAIDs users was not significantly different from controls, P = 0.3. The mean eosinophil count was higher in males than females. The incidence of eosinophilia in NSAIDs users was 4%. The mean Eosinophil count of NSAIDs users was insignificantly higher than controls, 164.3 ± 51 6 vs 135. 6 ± 53.4, P = 0.4. The mean platelet count of NSAIDs users was significantly higher compared to controls, P = 0.04. The mean hematocrit of NSAIDs users was significantly lower than the controls, P = 0.02. Propionic acid derivatives were associated with the highest eosinophil count. Eosinophil count was positively related to age and serum creatinine and inversely related to blood glucose, hematocrit and glomerular filtration rate. Conclusion: The incidence of eosinophilia was 4%. The eosinophil count was higher in frequent NSAIDs users than occasional and non-users, in males than females and with use propionic acid derivatives compared to other NSAIDs. The Eosinophil count was positively related to age and platelet count. Being commoner in inflammatory states, the tissue destruction associated with elevated EC can be avoided by the prevention and prompt treatment of inflammatory conditions.

Post-gastrectomy spleen enlargement and esophageal varices: Distal vs total gastrectomy

AIM: To study the relationship between platelet count-to-spleen diameter ratio and post-gastrectomy esopha-geal varices (EVs) development in patients without liver cirrhosis or hepatitis. METHODS: We retrospectively studied 92 patients who underwent gastrectomy. They were divided into 2 groups on the basis of the surgical treatment: the distal gastrectomy (DG) group and total gastrectomy (TG) group. The incidence of EVs was determined and postoperative platelet counts, spleen diameters, and platelet count-to-spleen diameter ratios were com-pared between the 2 groups. RESULTS: EVs were not detected during the first 6 mo after surgery in either group; however, at 12 mo after surgery, EVs were detected in 2 patients (3%) in the DG group and in 1 patient (3.6%) in the TG group; their mean platelet count-to-spleen diameter ratio was 2628 ± 409, and 2604 ± 360, respectively.CONCLUSION: Endoscopy should be performed to detect EVs when the platelet count-to-spleen diameter ratio is < 2600.

Hematologic Characteristics of Patients with Active Pulmonary, Extra-Pulmonary and Disseminated Tuberculosis: A Study of over Six Hundred Patients

Background: Many inflammatory cells, cytokines, acute phase reactants as well as platelets are recruited in the battle against the invading mycobacterium. As a result, alterations in the hematologic profile of infected patients are anticipated. Objectives: The primary objective was to investigate the various hematologic characteristics of patients with active tuberculosis. The secondary objective was to study the correlation between such hematologic characteristics and the type of tuberculosis including pulmonary, extra-pulmonary, and disseminated. Methods: This was a retrospective, descriptive study investigating the hematological findings in adult patients (aged 18 years or older) with active, bacteriologically-confirmed tuberculosis infection. Results: Among the 605 confirmed active tuberculosis cases, 465 (78.8%) were pulmonary, 104 (17.6%) extra-pulmonary, and 21 (3.6%) disseminated type. The mean age at diagnosis was 33.4 ± 11.4 years and males constituted 80.2% of cases. Peripheral leukocytosis was observed in 177 (30.1%) and leukopenia in 7 (1.2%) (Pulmonary type of tuberculosis was significantly associated with leukocytosis (P = 0.000)). Neutrophilia, lymphocytosis, monocytosis, eosinophilia, and basophilia were observed in 15.3%, 3.1%, 10.4%, 6.3% and 4.7% respectively. Thrombocytopenia and thrombocytosis were observed in 3.9% and 26.7% respectively. Anemia was observed in 44.8% of all cases with 4.4% had severe anemia and 60.3% had anemia of chronic diseases. Erythrocyte sedimentation rate was high in 77.2% of cases and ≥100 mm/hr in 5%. C-reactive protein was high in 93.4% and it exceeded 40 mg/L in 69.3%. Conclusion: There is a wide range of variability in the leukocyte and differential leukocyte abnormalities observed in patients with active tuberculosis. Leukocytosis can be seen in one-third of patients with pulmonary tuberculosis. Anemia of chronic diseases is the most common type of anemia observed in tuberculosis patients. Erythrocyte sedimentation rate and C-reactive protein are elevated in the majority of patients with active tuberculosis. Levels of the sedimentation rate can be useful indices to determine the extent of the disease.

Pre-mobilization platelet count predicts stem cell yield during mobilization in patients with multiple myeloma

Background Autologous hematopoietic stem cell(HSC)transplantation remains the recommended treatment for eligible patients with multiple myeloma(MM).Increasing the number of transplanted CD34^(+)cells shorten the time to hematopoietic reconstitution and increases the overall survival of patients.With the harvest of a sufficient CD34^(+)cell number being crucial,this study aimed to predict the factors that affect stem cell collection.Methods We conducted a retrospective study of 110 patients who were newly diagnosed with MM and underwent autologous HSC collection at Beijing Jishuitan Hospital between March 2016 and July 2022.Multiple factors were analyzed using the Mann-Whitney U tests for between-group comparisons.Differences were considered statistically significant at P<0.05.Results We found that patient age affected stem cell collection significantly;for patients younger than 55 years,the number of CD34^(+)cells harvested may be≥2×10^(6)/L,is unlikely to reach 5×10^(6)/L.Platelet count at initial mobilization was a predictor of the number of CD34^(+)cells collected.Collection may fail when the platelet count at initial mobilization is below 17×10^(9)/L and may be excellent when it is higher than 199×10^(9)/L.Conclusions This finding could guide us to predict the approximate number of CD34^(+)cells collected in advance during autologous transplant mobilization for MM and to decide in advance whether to apply plerixafor to improve the number of HSCs collected.

Use of Platelet Indices for Determining Illness Severity and Predicting Prognosis in Critically III Patients

Background：Decreased platelet （PLT） count is one of the independent risk factors for mortality in intensive care unit （ICU） patients.This study was to investigate the relationship between PLT indices and illness severity and their performances in predicting hospital mortality.Methods：Adult patients who admitted to ICU of Changzheng Hospital from January 2011 to September 2012 and met inclusion criteria were included in this study.Univariate analysis was used to identify potential independent risk factors for mortality.Multiple logistic regression analysis was used to calculate adjusted odds ratio for mortality in patients with normal or abnormal PLT indices.The relationship between PLT indices and illness severity were assessed by the Acute Physiology and Chronic Health Evaluation Ⅱ （APACHE Ⅱ） scores or sequential organ failure assessment （SOFA） scores in patients with normal and abnormal PLT indices.The performances of PLT indices in predicting mortality were assessed by receiver operating curves and diagnostic parameters.The survival curves between patients with normal and abnormal PLT indices were compared using Kaplan-Meier method.Results：From January 2011 to September 2012,261 of 361 patients （204 survivors and 57 nonsurvivors） met the inclusion criteria.After adjustment for clinical variables,PLT count 〈 100 × 10^12/L （P =0.011）,plateletcrit （PCT） 〈0.108 （P =0.002）,mean platelet volume （MPV） 〉11.3 fL （P =0.023） and platelet distribution width （PDW） percentage 〉17% （P =0.009） were identified as independent risk factors for mortality.The APACHE Ⅱ and SOFA scores were 14.0 （9.0-20.0） and 7.0 （5.0-10.5） in the ＂low PLT＂ tertile,13.0 （8.0-16.0） and 7.0 （4.0-11.0） in the ＂low PCT＂ tertile,14.0 （9.3-19.0） and 7.0 （4.0-9.8） in the ＂high MPV＂ tertile,14.0 （10.5-20.0） and 7.0 （5.0-11.0） in the ＂high PDW＂ tertile,all of which were higher than those in patients with normal indices.Patients with decreased PLT and PCT values （all P 〈 0.001）,or increased MPV and PDW values （P =0.007 and 0.003,respectively） had shortened length of survival than those with normal PLT indices.Conclusions：Patients with abnormally low PLT count,high MPV value,and high PDW value were associated with more severe illness and had higher risk of death as compared to patients with normal PLT indices.

Clinical utility of automated platelet clump count in the screening for ethylene diamine tetraacetic acid-dependent pseudothrombocytopenia

Background Platelet （PLT） clumping occurring in pseudothrombocytopenia （PTCP） can result in inaccurate PLT. Automated platelet clump count （APCC） is a quantitative parameter of platelet aggregation. In this study, we evaluated the clinical utility of APCC in the screening for platelet aggregation related ethylene diamine tetraacetic acid （EDTA）-dependent PTCP （EDTA-PTCP）. Methods A total of 105 patients and 200 healthy individuals were enrolled in this study. Blood samples were collected with dipotassium EDTA and sodium citrate respectively. ADVIA 2120 hematology analyzer was used to perform complete blood count （CBC） and APCC. Blood smears of both EDTA- and citrate-anticoagulated samples were made for microscope observation and manual PLT counting. Results In 25 patients with EDTA-PTCP patients, for EDTA-2K anticoagulated-blood, PLT was （55±6）×10^9/L, significantly lower than citrate anticoagulated blood （（186±13）×10^9/L））. APCC was （905±694）×10^9/L, significantly higher than citrate anticoagulated blood （98±37）×10^9/L. In true thrombocytopenia and healthy control groups, APCC was （63±60）×10^9/L and （69±59）×10^9/L respectively and there was no significant difference between EDTA and citrate anticoagulants. Receiver operator characteristic （ROC） curve showed both sensitivity and specificity of APCC were 96% when the cutoff value of APCC was set as 182×10^9/L. Other platelet parameters had poor performance. Conclusion The APCC has a good sensitivity and specificity in differentiating EDTA-PTCP from true thrombocytopenia compared with other platelet parameters.

Laparoscopic splenectomy for immune thrombocytopenic purpura at a teaching institution

Background High anatomic location, fragility, and generous blood supply of the spleen makes laparoscopic splenectomy （LS） difficult to master, and few patients need splenectomy for benign disorders. The aim of this research was to assess operative outcomes and hematological results of a large series of patients treated with LS for chronic immune thrombocytopenic purpura （ITP） and to determine which clinical variables predict favorable hematological outcome.Methods LS was successfully performed for 154 patients with chronic ITP from September 1999 to April 2009 at the First Affiliated Hospital of Sun Yat-sen University. Operative outcomes were assessed retrospectively. Long-term follow-up data were obtained from outpatient medical records and phone interviews. Clinical and laboratory variables （including gender, age, disease duration before surgery, previous response to steroids, preoperative platelet count, and postoperative peak platelet count） were evaluated by univariate analysis to identify potential predictors of hematological outcome. Multivariate Logistic regression model was used to determine independent predictors of hematological outcome.Results One patient died from subphrenic abscess and postoperative sepsis. The overall major morbidity rate was 8.4%. None of the patients required a second surgery for complications. Of the 127 patients available for a mean follow-up of 43.6 months （range 9-114 months）, the overall initial response （i.e., at two months after LS） and long-term response to LS were achieved in 89.0% and 80.3%, respectively. Five patients （3.9%） developed pneumonia 3-35 months after LS. Univariate analysis showed a significant difference in mean age between responders （29.1 years） and nonresponders （38.8 years; P ＜0.05）. Patients who responded to steroid therapy had better hematological outcome than those who did not respond （P ＜0.05）. Compared to nonresponders, responders to LS had a significantly higher postoperative peak platelet count （404x109/L versus 213×109/L, P ＜0.001）. Multivariate Logistic regression analysis identified postoperative peak platelet count as the only independent predictor of favorable response to LS （P＜0.001）.Conclusiona LS is a safe and effective treatment for chronic ITP. Postoperative peak platelet count may serve as a major predictor of long-term response.

Prediction of effective percutaneous transhepatic biliary drainage in patients with hepatocellular carcinoma: A multi-central retrospective study

Background and aim:Percutaneous transhepatic biliary drainage(PTBD)does not always lead to a reduction in serum total bilirubin(TBil)level in patients with hepatocellular carcinoma and obstructive jaundice.We aimed to develop a model for pre-PTBD prediction of post-procedural TBil decrease in these patients.Materials and methods:Retrospective database searches were conducted at four teaching hospitals(reference period:January 2010 to December 2018),and baseline characteristics of eligible patients were extracted.Any decrease in TBil after PTBD and the lowest level of TBil post-PTBD<5 mg/dL,3 mg/dL,and 2 mg/dL were each taken as the standard of effectiveness for computation of its own predictive nomogram.For data dimension decrease and feature selection,the least absolute shrinkage and selection operator(LASSO)regression model was used.A multivariable logistic regression analysis was used to develop nomograms.Each nomogram's performance was internally evaluated for its calibration,discriminative ability,and clinical usefulness.Results:Included in the study were 138 patients.The model for end-stage liver disease(MELD)score,platelet count,and portal vein thrombosis(PVT)were predictors in the nomogram for any decrease in TBil;international normalized ratio(INR),MELD score,platelet count,and PVT were predictors for a decrease to<5 mg/dL;MELD score,cholinesterase level(CHE),platelet count,and PVT were predictors for a decrease to<3 mg/dL;and MELD score,CHE,platelet count,and pre-albumin level were predictors for a decrease to<2 mg/dL.The clinical value of the nomograms was proven by decision curve analysis.Conclusions:These models may help inform clinical decision making for performing PTBD procedures.

A Prognostic Model to Predict Recovery of COVID-19 Patients Based on Longitudinal Laboratory Findings

The temporal change patterns of laboratory data may provide insightful clues into the whole course of COVID-19.This study aimed to evaluate longitudinal change patterns of key laboratory tests in patients with COVID-19,and identify independent prognostic factors by examining the associations between laboratory findings and outcomes of patients.This multicenter study included 56 patients with COVID-19 treated in Jilin Province,China,from January 21,2020 to March 5,2020.The laboratoryfindings,epidemiological characteristics and demographic data were extracted from electronic medical records.The average value of eosinophils and carbon dioxide combining power continued to significantly increase,while the average value of cardiac troponin I and mean platelet volume decreased throughout the course of the disease.The average value of lymphocytes approached the lower limit of the reference interval for the first 5 days and then rose slowly thereafter.The average value of thrombocytocrit peaked on day 7 and slowly declined thereafter.The average value of mean corpuscular volume and serum sodium showed an upward trend from day 8 and day 15,respectively.Age,sex,lactate dehydrogenase,platelet count and globulin level were included in the final model to predict the probability of recovery.The above parameters were verified in 24 patients with COVID-19 in another area of Jilin Province.The risk stratification and management of patients with COVID-19 could be improved according to the temporal trajectories of laboratory tests.

Lymphocyte oscillation is associated with the progression of COVID-19:a retrospective study

Lymphopenia has been implicated in patients infected with Severe Acute Respiratory Syndrome Coronavirus-2,while the association of Lymphocyte count and changes with subsequent the progression of COVID-19 remains unclear.The clinical and laboratory data of 228 patients with the definite outcome by February 19,2020 in the First Hospital of Changsha were reviewed.The characteristics of COVID-19 with lymphopenia patients in age distribution,underlying diseases,hospitalization,treatment and hospitalization time were analyzed.Meanwhile,we analyzed the difference between the change of lymphocyte count and the progress of the disease within15 days.Among the 228 patients,226(99.1%)were discharged and survived,and 2(0.8%)were died.The hospitalization days(≥15)of patients with lymphopenia(77.2%)of almost three times as high as that for nonlymphopenia(23.6%)(P<0.05).Compared with the non-lymphopenia,COVID-19 with lymphopenia had a higher proportion of severe patients(32.4%vs.67.6%)(P<0.05).Dynamic changes of lymphocyte were also closely related to the progress of COVID-19 during hospitalization.Baseline lymphocyte levels and changes were associated with subsequent progression.Monitoring lymphocyte during hospitalization may be important in the prognosis of COVID-19.