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【Objective】 To construct a blood transfusion prediction model for patients with severe traumatic brain injury (TBI), in order to predict the risk of blood transfusion and guide blood transfusion decision-making. 【Methods】 The clinical data of 756 patients with severe TBI admitted to the hospital from January 1, 2015 to June 30, 2021 were retrospectively analyzed. According to whether the patients were transfused with red blood cells after admission, the patients were divided into blood transfusion group (n=354) and non-blood transfusion group (n=402). The basic clinical data and prognostic indicators of the two groups were compared. Logistic regression algorithm was used to screen the risk factors related to blood transfusion in hospital to establish a nomogram prediction model, and the performance of the model was evaluated. 【Results】 No significant differences were noticed in gender, age, body temperature, cause of injury, ABO blood group, Rh blood group, serum Na and K concentrations between the two groups (P>0.05). Significant differences were found in Glasgow coma score (GCS), heart rate (HR), systolic blood pressure (SP), diastolic blood pressure (DP), shock index (SI), respiratory rate (RR), clinical diagnosis, treatment, hemoglobin concentration (Hb), hematocrit (Hct), platelet count (Plt) and coagulation function between the two groups (P0.05). Multivariate logistic regression analysis showed that surgical treatment, skull fracture, hemorrhagic shock, decreased Plt, decreased Hct and increased INR were independent risk factors for blood transfusion. A nomogram prediction model was constructed and the area under the ROC curve of the training set and the test set was 0.819(95% CI: 0.784-0.854) and 0.866(95% CI: 0.818-0.910), respectively, which had good predictive performance. 【Conclusion】 Surgical treatment, skull fracture, hemorrhagic shock, decreased Plt, decreased Hct and increased INR are independent risk factors for blood transfusion in adult patients with severe traumatic brain injury. The nomogram prediction model can better predict the blood transfusion demand of TBI patients and has high application value.
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OBJECTIVES@#To evaluate curative effects of coronavirus disease 2019 (COVID-19) patients by the transfusion of other convalescent plasma.@*METHODS@#Retrospective analysis of the clinical data of 18 patients with severe and critical COVID-19, who were hospitalized in the ICU of Xianghu Branch of the First Affiliated Hospital of Nanchang University from February 1 to March 15, 2020. Patients were subdivided into an experimental group (=6, who had transfused the plasma) and an observation group (=12, who had no plasma transfusion). Basic clinical data and prognosis indexes of these two groups were compared. Moreover, for the experimental group, the dynamic changes of blood oxygen saturation before and after the transfusion, the changes of lymphocyte absolute value 48 hours after the transfusion, and the detection of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) nucleic acid were analyzed.@*RESULTS@#There were no significant differences in age, gender, blood type and other basic clinical data between the two groups (all >0.05).There were no significant differences in ventilator machine weaning time, extracorporeal membrane oxygenation (ECMO) weaning time, body temperature recovery to normal time, and hospitalization days between these two groups (all >0.05). For the experimental group, before, during and after the convalescent plasma transfusion, the blood oxygen saturation of all 6 patients at all time (1, 6, 8, 12, 24, 36, and 48 h) was more than 90%, and there was no significant fluctuation. There were 3 patients whose absolute value of lymphocyte was increased 48 hours after the transfusion, and the remaining was decreased. There were 5 patients whose SARS-CoV-2 nucleic acid detection turned negative 48 hours after the transfusion, accounting for 83.3%.@*CONCLUSIONS@#Transfusion of convalescent plasma will not affect outcomesof COVID-19 patients, which can neutralize SARS-CoV-2 in patients and reduce the loading capacity of SARS-CoV-2.
Subject(s)
Humans , Betacoronavirus , Blood Component Transfusion , China , Coronavirus Infections , Therapeutics , Immunization, Passive , Pandemics , Plasma , Pneumonia, Viral , Therapeutics , Retrospective StudiesABSTRACT
OBJECTIVES@#To explore the influential factors and titer trend of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) specific IgG antibody in convalescent patients with coronavirus disease 2019 (COVID-19), and to provide theoretical basis for the feasibility of clinical treatment of convalescent plasma.@*METHODS@#Colloidal gold immunochromatography assay was used to detect the SARS-CoV-2 specific IgG antibody and its titer in 113 convalescent patients with COVID-19 who were followed up from February 19, 2020 to April 6, 2020. The basic characteristics and treatment factors of patients in the high titer group (antibody titer≥1꞉160, @*RESULTS@#The difference in the clinical type of COVID-19, onset time, first admission C-reactive protein, absolute value of lymphocyte, absolute value of CD19@*CONCLUSIONS@#Male COVID-19 patients might be more likely to produce high titer SARS-CoV-2 specific IgG antibodies than female. The peak level of SARS-CoV-2 specific IgG antibody in convalescent patients is maintained for a short period. Using plasma from convalescent COVID-19 patients for treatment should be within 28 d after discharge.
Subject(s)
Female , Humans , Male , Antibodies, Viral , Betacoronavirus , COVID-19/therapy , Immunization, Passive , Immunoglobulin G , Pandemics , Pneumonia, Viral/epidemiology , SARS-CoV-2ABSTRACT
Objective To analyze the influence of different factors and their relating correlation results on platelet transfusion during the bone marrow empty window period on the patients who have undergone allogeneic peripheral blood stem cell transplantation (allo-HSCT) with retrospective analysis of case-control data.Methods Clinical data of 153 cases were collected by the clinical blood management and evaluation information system with discharge diagnosis of allo-HSCT in the hematology department of The First Affiliated Hospital of Nanchang University within a time frame from January 2014 to December 2016.A total of 90 cases were considered valid for retrospective analysis according to the case exclusion criteria.The average transfusion dose for patients with allo-HSCT during the bone marrow empty window period was defined as the threshold value which divided the 90 cases into the observation group of 38 cases receiving more than 6 Units of platelet transfusion and the control group of 52 cases with less than 6Units of platelet transfusion.The amount of platelets transfused during the bone marrow empty window period,clinical indexes include Hb,ANC,Plt,SF before pretreatment,platelet engraftment time and the number of mononuclear cells implanted were compared and analyzed by Logistic regression.Results (1) There was no significant difference between the two groups in gender,age,primary diagnosis,HLA matching,Hb before pretreatment and the number of mononuclear cells implanted (P＞0.05).The ANC(×109/L) (1.24±0.57 vs 3.36±1.33) and Plt(×109/L) (43.55±68.29 vs 126.62±84.73) counts before pretreatment in the observation group were significantly lower than those in the control group(P＜0.05).SF(μg/L) (2351.05 ± 1 587.96 vs 1 000.96± 362.97)before pretreatment and P LT recovery time (d) (16.84± 2.47 vs 12.73 ± 1.65)was significantly higher than that in the control group(P＜0.05).Donor-recipient ABO blood group typing incompatibility (15 vs 10) was significantly higher than the control group (P＜0.05);(2) Single factor Logistic regression analysis showed that ABO blood group matching,clinical indexes include ANC,Plt,SF before pretreatment,PLT recovery time were statistically significant,Only ANC before pretreatment and PLT recovery time had significant effect on the platelet transfusion during bone marrow empty window period in patients with allo-HSCT in multivariate Logistic regression analysis(P＜0.05).Condusion The ANC before pretreatment and PLT recovery time are independent factors for platelet transfusion of the bone marrow empty window period in patients with allo-HSCT.The PLT recovery time is an independent risk factor,which indicates that the longer the duration of PLT implantation,the greater the amount of platelet transfusion will be needed.Besides,the ANC before pretreatment is the independent protective factor,which indicates that the greater the ANC,the smaller the amount of platelet transfusion is required.
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Objective To evaluate the clinical value of apheresis platelets throught heanalysisof case control on the clinical efficacy and safety of cryopreserved apheresis platelets and fresh apheresis platelets.Methods 2 035 clinical cases of platelet transfusion in August 2014 to December 2016 by Using the closed loop intelligent path management and evaluation information system,456 cases were selected as control cases.Platelets were divided into the cryopreserved apheresis platelets group (group A,n=199) and fresh apheresis platelets group (group B,n=257) according to the transfused platelet type.The clinical application value of cryopreserved single platelets was evaluated by comparing the basic data,the effective indexes and safety indexes of the two groups.Results 1) The cases were 43.6％ (199/456) in A groups,and 56.4％ (257/456) in B groups,there were no significant difference in gender,age and medical and surgical cases between A and B group (P＞0.05);2) 199 cases in group A were cryopreserved platelets of 2 275 U,including 121 medicine cases,the total amount of transfusion was about 60.9％ (1 385/2 275),78 surgical cases accounted for 39.1％ (890/2 275);In the distribution of diseases,the blood system diseases accounted for 49.2％ (1 120/2 275),the total amount of obstetrics and gynecology disease infusion accounted for 10.6％ (240/2 275),and the amount of tumor radiotherapy and chemotherapy accounted for 6.2％ (140/2 275);The proportion of ABO blood type distribution was O type 25.9％,A type 22.9％,Btype 20.7％,ABtype 30.5％,respectively;3) The Plt counts of group A and B were significantly different before and after transfusion (P ＜0.05).But there was no significant difference between the two groups of cases before transfusion and 24h Plt count after transfusion,the Plt counts difference,and 24 h CCI (P＞0.05);4) The effective rates of platelet transfusion in group A and B were 76.9％ and 76.7％,respectively.Which has no significant difference between the two groups (P＞0.05)).There was no significant difference between the two groups in medical and surgical cases (P＞0.05),but the effective rate of surgical cases in group A (84.6％) was higher than that in B group (75.3％).The difference effect of medicine and surgery cases in B group were not statistically significant (P＞0.05),but the difference effect of medicine and surgery cases in A group was statistically significant (P＜0.05),platelet transfusion inefficient in surgical cases (15.4％) was significantly lower than that of cases (28.1％);5) The incidence of adverse reactions of blood transfusion was 3.5％,4.7％ in group A and B,and the blood transfusion mortality rate was zero,the difference was not statistically significant (P＞ 0.05).Conclusion The clinical effectiveness and safety of cryopreserved apheresis platelets are similar to those of fresh apheresis platelets,and the former can be widely Used in clinic,in particular,it has certain advantages in the surgical hemostatic effect.but for repeated infusion cases or platelet transfusion ineffective cases should be given priority to fresh apheresis platelets.