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RESUMEN Introducción: La infección con el SARS-CoV-2 induce un estado protrombótico en los pacientes, atribuible a la combinación de la respuesta hiperinflamatoria y la hipoxia. En Cuba, se usa el fármaco Jusvinza, basado en un péptido inmunomodulador, para el tratamiento de los pacientes con la COVID-19, que presenten signos y síntomas de hiperinflamación. Objetivos: Describir la evolución clínica y las variaciones de biomarcadores asociados con la inflamación y la coagulación, en un grupo de pacientes críticos con la COVID-19, tratados con Jusvinza, en comparación con un grupo de pacientes que no recibieron tratamiento con este péptido. Métodos: Se incluyeron 40 pacientes críticos con la COVID-19; se dividieron en 2 grupos: 20 pacientes tratados con Jusvinza y 20 no fueron tratados con dicho péptido (grupo control). Las características demográficas, comorbilidades, signos vitales, parámetros respiratorios, biomarcadores de la inflamación y de la coagulación se obtuvieron a partir de las historias clínicas de cada paciente. Resultados: El tratamiento con Jusvinza indujo una mejoría clínica en los pacientes, asociada con la disminución de varios biomarcadores de la inflamación y la coagulación. La sobrevida de los pacientes tratados con Jusvinza fue significativamente superior a la sobrevida de los pacientes no tratados con este péptido. Conclusiones: Jusvinza es capaz de controlar la hiperinflamación y la hipercoagulación en pacientes críticos con la COVID-19.
ABSTRACT Introduction: Infection with SARS-CoV-2 induces a prothrombotic state in patients, by the combination of hyperinflammatory response and hypoxia. In Cuba, the drug called Jusvinza, based on an immunomodulatory peptide, is used for the treatment of patients with COVID-19, who present signs and symptoms of hyperinflammation. Objectives: To describe the clinical course and behavior of various biomarkers associated with the inflammation and coagulation, in a group of critically ill patients with COVID-19 treated with Jusvinza, compared to a group of patients who did not receive treatment with this peptide. Methods: 40 critically ill patients with COVID-19 were included. The patients were divided into 2 groups: 20 patients were treated with Jusvinza and 20 were not treated with this peptide (control group). Demographic characteristics, comorbidities, vital signs, respiratory parameters and inflammation and coagulation biomarkers were obtained from the medical records of each patient. Results: Treatment with Jusvinza induced a clinical improvement in the patients, associated with the decrease of several inflammation and coagulation biomarkers. Patients treated with Jusvinza had a significantly higher survival than patients not treated with this peptide. Conclusions: Jusvinza is able to control hyperinflammation and hypercoagulation in critical ill patients with COVID-19.
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Objective: To investigate the clinical and coagulation characteristics of the critical Coronavirus disease 2019 (COVID-19) patients with acro-ischemia in the intensive care unit (ICU). Methods: The retrospective study included 7 critical COVID-19 patients with acro-ischemia in a single center in Wuhan, from Feb 4 to Feb 15, 2020. The clinical and laboratory data before and during the ICU stay were analyzed. Results: The median age of 7 patients was 59 years and 4 of them were men. 3 of them were associated with underlying comorbidities. Fever, cough, dyspnea and diarrhea were common clinical symptoms. All patients had acro-ischemia presentations including finger/toe cyanosis, skin bulla and dry gangrene. D-dimer, fibrinogen and fibrinogen degradation product (FDP) were significantly elevated in most patients. Prothrombin time (PT) were prolonged in 4 patients. D-dimer and FDP levels increased progressively when COVID-2019 exacerbated, and 4 patients were diagnosed with definite disseminated intravascular coagulation (DIC). 6 patients received low molecular weight heparin (LMWH) treatment, after which their D-dimer and FDP decreased, but there was no significant improvement in clinical symptoms. 5 patients died finally and the median time from acro-ischemia to death was 12 days. Conclusions: The existence of hypercoagulation status in critical COVID-2019 patients should be monitored closely, and anticoagulation therapy can be considered in selected patients. More clinical data is needed to investigate the role of anticoagulation in COVID-2019 treatment.
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Objective:To investigate the effect of constant temperature blankets on intravascular hypothermia for severe traumatic brain injury (sTBI). Methods:A total of 112 inpatients with sTBI from January, 2013 to December, 2018 were reviewed. They were divided into control group (n = 58) and observation group (n = 54) according to whether a self-warming blanket was used. They were assessed with Bedside Shivering Assessment Scale (BSAS). Their dosages of anti-shivering medicine, coagulation and intracranial pressure were recorded. The scores of Glasgow Outcome Scale Extended (GOSE) and the mortality one, six and twelve months after discharge were observed. Results:The incidence and severity were less in the observation group than in the control group (χ2 = 16.212, P < 0.01). The dosage of anti-shivering medicine was less in the observation group than in the control group (t > 1.269, P < 0.05). The hypercoagulation relieved significantly six hours after hypothermia in the observation group, and it was stable twelve hours after hypothermia. For the control group, the hypercoagulation relieved significantly twelve hours after hypothermia, and it was stable 24 hours after hypothermia. The intracranial pressure decreased more in the observation group than in the control group. The GOSE score and the mortality were less in the observation group than in the control group (t > 1.168, P < 0.05) one, six and twelve months after discharge. Conclusion:Application of self-warming blankets in intravascular hypothermia for sTBI may relieve shivering, hypercoagulation and intracranial pressure, to improve the outcome of patients.
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The school-age boy was admitted to Tianjin Children's Hospital for "fever and cough for 6 days".After detail examinations,the diagnosis of severe Mycoplasma pneumoniae pneumonia was proved.Treatments:anti-infection with Azithromycin and Meropenem;the obstruction of air way was relieved;assisted with symptomatic and supportive treatment.During the treatment,disorder of consciousness and hemiplegia of right limbs occurred,cerebral infarction was proved later by magnetic resonance angiography(MRA).Severe Mycoplasma pneumoniae pneumonia complicated with cerebral infarction is clinically rare with a high morbidity and mortality.Attention should be paid to body examination and Laboratory test.Multi-disciplinary cooperation is helpful.
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Objective To investigate the predictive significance of thromboelastography ( TEG) for early neurological deterioration ( END) in patients with acute cerebral infarction. Methods This was a case-control study. From March 2016 to August 2017,a total of 195 consecutive patients with acute mild to moderate cerebral infarction (National Institute of Health stroke scale [NIHSS] score <16) within 24 h after onset were registered prospectively. The demography, clinical data, and laboratory test results were collected. The TEG examinations were completed after admission. According to whether having END or not within 3 d after admission,they were divided into either a END group (n=60) or a non-END group (n=135). A logistic regression model was established to analyze the relationship between TEG parameters and END. Results Of the 195 eligible patients,60 (30. 8%) experienced END. TEG reaction time (RT) and kinetic time ( RT) in patients of the END group were significantly less than those of the non-END group (4. 1 ± 1. 1 min vs. 4. 4 ± 1. 2 min;1. 3 ± 0. 3 min vs. 1. 5 ± 0. 4 min,t=3. 395 and 3. 093,respectively;all P<0. 01). The proportions of the shortened RT and KT in patients of the END group were significantly higher than those of the non-END group (80. 0％ [48/60] vs. 63. 0％ [85/135],18. 3％ [11/60] vs. 8. 1％ [11/135]). There were significant differences (χ2 =5. 560 and 4. 305,all P <0. 05). After adjusting for the factors of age,sex,diabetes mellitus,smoking,baseline NIHSS score,and serum hypersensitive C-reactive protein, logistic regression analysis showed that the shortened RT was independently correlated with END (OR,1. 612,95％ CI 1. 094-2. 376,P=0. 016). Conclusion The shortened TEG coagulation time RT on admission has a certain predictive value for END within 3 d after onset of acute mild to moderate cerebral infarction.
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Background: Chronic Obstructive Pulmonary Disease (COPD) is a systemic disorder rather than a respiratory disease. A significant complication that COPD can lead to a hypercoagulable state, which can lead to life-threatening diseases like Ischemic heart disease, deep vein thrombosis and Pulmonary embolism. Therefore, Fibrinogen is a useful biomarker to predict the risk of such hyper-coagulable state in COPD patients. Objectives: The study was aimed to measure the fibrinogen levels in COPD patients, to correlate the fibrinogen levels with severity of airway obstruction based on spirometry and also to compare the fibrinogen levels in COPD exacerbation patients with stable COPD individuals and healthy non-smokers. Methods: Spirometric measurement and measurement of Plasma Fibrinogen was performed on 60 patients (20 COPD patients with exacerbation; 20 stable COPD patients and 20 healthy non-smokers). Results: Raised plasma fibrinogen levels were observed in COPD patients when compared to healthy non-smokers. There was increase in the fibrinogen levels with severity of air obstruction. Among the COPD patients, raised fibrinogen levels were observed in exacerbation individuals when compared to stable COPD individuals. Conclusion: Plasma fibrinogen is a useful biomarker to monitor the disease severity in addition to the spirometric parameters in COPD patients. It gives a clue to the possibility of developing systemic complication of a hypercoagulable in COPD patients.
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Objective To detect the plasma level of tissue factor (TF) in non-small cell lung cancer (NSCLC) patients,and to discuss its association with hypercoagulation,venous thromboembolism and prognosis of lung cancer.Methods Sixty-one impatients in our hospital with confirmed lung cancer were enrolled as the study group.Thirteen patients with benign pulmonary diseases and 14 healthy volunteers were selected as the control groups.Bseline and follow-up clinical data were collected from participants.Enzyme-linked immunosorbent assay (ELISA) was used to detect the levels of TF in plasma of all subjects.Results The levels of TF in plasma from NSCLC patients and participants with benign pulmonary diseases was significantly higher than that in healthy controls((550.88 ± 201.58) ng/L vs (510.77 ± 201.20) ng/L vs (178.34 ±66.73) ng/L,P ＜0.05).According to the plasma levels of TF,which have been detected in all subjects,the patients were divided into two groups:low level group (range from 103.73 ng/L to 476.22 ng/L) and high level group (range from 476.221 ng/L to 1003.00 ng/L).Statistical analysis showed that there was a positive correlation between plasma TF levels and TNM stages in NSCLC patients (P =0.026).Patient with metastasis had a higher plasma TF level than other patients (P =0.020).The log-rank test revealed that there was no significant difference in survival between the high level group and low level group (x2 =0.145,P =0.704).Multivariate Cox proportional hazards regression analysis indicated that plasma TF levels did not predicted for death(RR =1.001,95％CI0.998-1.004,P=0.452).Conclusion The plasma TF level in NSCLC patients was correlated with TNM stages;it had no significant relationship with hypercoagulation state and survival rate in NSCLC patients.Limitations should be aware of while evaluating the clinical course and prediction of prognosis of NSCLC patients using plasma TF levels.
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Protein C (PC) deficiency is an inherited thrombotic disorder with a prevalence of 0.19% among the general population. PC deficiency is associated with an increased risk of thrombosis when other risk factors are present, such as trauma, surgery, or infection, and is an important cause of mechanical valve thrombosis. We performed tricuspid valve replacement with a 29mm Carpentier-Edwards Perimount valve in a 20-year-old man with PC deficiency. The patient had corrected transposition of the great vessels with severe tricuspid insufficiency, as well as a history of cerebral infarction. In the perioperative period, we used only heparin sodium as the anticoagulant. When we restarted administration of warfarin, changing over from heparin, transient increases of serum plasmin inhibitor-plasmin complex (PIC) and thrombin antithrombin complex (TAT) levels were observed. Despite an increased dose of heparin, an appropriate activated partial thromboplastin time (APTT) was not obtained. This suggested a hypercoagulatory state, but the postoperative course was uneventful. Management of perioperative anticoagulation, prevention of late thrombotic events, and prosthetic valve selection in this particular situation are discussed.