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The Coronavirus disease 2019 (COVID-19) has spread globally. Although mixed liver impairment has been reported in COVID-19 patients, the association of liver injury caused by specific subtype especially chronic hepatitis B (CHB) with COVID-19 has not been elucidated. In this multi-center, retrospective, and observational cohort study, 109 CHB and 327 non-CHB patients with COVID-19 were propensity score matched at an approximate ratio of 3:1 on the basis of age, sex, and comorbidities. Demographic characteristics, laboratory examinations, disease severity, and clinical outcomes were compared. Furthermore, univariable and multivariable logistic and Cox regression models were used to explore the risk factors for disease severity and mortality, respectively. A higher proportion of CHB patients (30 of 109 (27.52%)) developed into severe status than non-CHB patients (17 of 327 (5.20%)). In addition to previously reported liver impairment markers, such as alanine aminotransferase, aspartate aminotransferase, alkaline phosphatase, and total bilirubin, we identified several novel risk factors including elevated lactate dehydrogenase (⩾ 245 U/L, hazard ratio (HR) = 8.639, 95% confidence interval (CI) = 2.528-29.523; P < 0.001) and coagulation-related biomarker D-dimer (⩾ 0.5 µg/mL, HR = 4.321, 95% CI = 1.443-12.939; P = 0.009) and decreased albumin (< 35 g/L, HR = 0.131, 95% CI = 0.048-0.361; P < 0.001) and albumin/globulin ratio (< 1.5, HR = 0.123, 95% CI = 0.017-0.918; P = 0.041). In conclusion, COVID-19 patients with CHB were more likely to develop into severe illness and die. The risk factors that we identified may be helpful for early clinical surveillance of critical progression.
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Humans , COVID-19 , Cohort Studies , Hepatitis B, Chronic/epidemiology , Retrospective Studies , Risk FactorsABSTRACT
Objective@#To investigate the prevalence and types of maternal near miss in Hangzhou City from 2015 to 2020, so as to provide insights into early identification and interventions for maternal near miss.@*Methods@#The data of maternal near miss in 5 hospitals of Hangzhou City from 2015 to 2020 were collected from China's National Maternal Near Miss Obstetrics Surveillance System, and the incidence and mortality of maternal near miss, types of pregnancy-related complications/comorbidities and types of critical illness were descriptively analyzed.@*Results@#Totally 230 490 pregnant and lying-in women were recruited in 5 hospitals in Hangzhou City from 2015 to 2020, and there were 182 514 live births, 177 428 women with pregnancy-related complications/comorbidities, and 1 790 cases of maternal near miss with a 0.98% annual incidence rate. The incidence of maternal near miss was high in 2019 (1.18%). The hospital mortality and death index were respectively 3.29/105 and 0.33% among pregnant and lying-in women from 2015 to 2020, and there was no death found among pregnant and lying-in women from 2018 to 2020. The main pregnancy-related complications/comorbidities included anemia (79.33%), obstetric hemorrhagic disorders (69.83%), and gestational hypertension (16.65%). The main critical illness among maternal near miss included coagulation dysfunction (87.23/104), cardiovascular dysfunction (20.44/104), and respiratory dysfunction (9.70/104).@*Conclusions@#The incidence of maternal near miss was high and the hospital mortality appeared a reduction tendency among pregnant and lying-in women in Hangzhou City from 2015 to 2020. Coagulation dysfunction is the primary critical illness among maternal near miss, and the management of anemia and hemorrhagic diseases requires to be improved.
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Objective:To observe the effects of self-made Qingyuan Shenghua decoction on coagulation dysfunction in patients with sepsis, and to explore its possible mechanism.Methods:Eighty patients with sepsis and coagulation dysfunction admitted to the department of critical care medicine of Chengdu First People's Hospital from March 2018 to April 2020 were enrolled. The patients were divided into control group and observation group according to random number table method, with 40 cases in each group. Patients in both groups received basic treatment for sepsis. On this basis, the observation group was administrated with self-made Qingyuan Shenghua decoction, one dose a day, 100 mL in the morning and 100 mL in the evening; the control group was given the same amount of normal saline. Both groups were treated for 7 days. Prothrombin time (PT), activated partial thromboplastin time (APTT), international normalized ratio (INR), fibrinogen (Fib), D-dimer, platelet count (PLT), white blood cell count (WBC), C-reactive protein (CRP), and procalcitonin (PCT) were measured before and after treatment, and acute physiology and chronic health evaluation Ⅱ (APACHEⅡ) and sequential organ failure assessment (SOFA) were calculated. The length of intensive care unit (ICU) stay, the incidence of multiple organ dysfunction syndrome (MODS) and 28-day mortality was recorded.Results:The indexes of coagulation function and inflammation in the two groups were significantly improved after treatment, the improvement of various indexes in the observation group were better than those in the control group [PT (s): 16.01±1.08 vs. 19.21±1.38, APTT (s): 55.33±15.29 vs. 79.41±12.69, INR: 1.30±0.21 vs. 1.65±0.22, Fib (g/L): 2.87±0.89 vs. 5.44±1.13, D-dimer (mg/L): 2.56±1.67 vs. 6.41±2.42, PLT (×10 9/L): 125.79±18.51 vs. 95.46±18.50, WBC (×10 9/L): 7.50±0.78 vs. 12.75±4.09, CRP (mg/L): 21.27±9.32 vs. 65.44±13.40, PCT (μg/L): 1.15±0.58 vs. 6.31±1.29], and the differences were statistically significant (all P < 0.05). After treatment, APACHEⅡ and SOFA scores in the two groups decreased significantly compared with those before treatment, and the decrease in the observation group were more obvious than those in the control group (APACHEⅡ score: 10.29±1.86 vs. 15.35±2.06, SOFA score: 5.51±1.08 vs. 7.65±1.58, both P < 0.05). The length of ICU stay was shortened in the observation group than that in the control group (days: 12.22±9.48 vs. 20.22±15.35, P < 0.05). The incidence of MODS [35.0% (14/40) vs. 47.5% (19/40)] and the 28-day mortality [45.0% (18/40) vs. 47.5% (19/40)] was lower than that of the control group, but there was no statistical difference (both P > 0.05). Conclusion:Self-made Qingyuan Shenghua decoction can effectively improve the prognosis of patients with coagulation dysfunction and sepsis, and its mechanism may be related to inhibition of inflammatory reaction and improvement of coagulation function.
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【Objective】 To explore the prognosis of critically ill patients with coagulation dysfunction using thrombelastogram(TEG) and coagulation four items combined with APACHEⅡ score. 【Methods】 From March 2017 to March 2020, 287 critically ill patients with coagulation dysfunction in our hospital were selected as the study group, and 303 patients with normal coagulation function during the same period were set as the control. The study group was divided into low-risk group(group A), intermediate-risk group(group B) and high-risk group (group C) based on the APACHEⅡ score, and into survival group and death group according to the prognosis. The difference of TEG, coagulation four items, and APACHEⅡ scores between the two groups were analyzed. The correlation and difference between TEG, coagulation four items and APACHE II score in the study group were analyzed. The ROC curve was drawn to analyze the prognostic predictive value of research indicators. 【Results】 Blood coagulation function related indicators in the study group fluctuated significantly: in comparison to the control, the CI value, MA value, and α angle were smaller, while the K time and R time were longer; among the coagulation four items, PT, APTT and TT were higher; Fg level was lower, and the APACHE Ⅱ score was higher(P0.05). There were significant differences between the TEG and coagulation function related index levels in patients with different prognosis. Compared with the survivals, the CI value, MA value and α angle of the dead group were smaller, while the K time and R time were longer; and among the coagulation four items, PT, APTT, and TT were higher, the Fg level was lower, and the APACHEⅡ score was higher (PP4\\P5>APACHE Ⅱ score>P1>P2. 【Conclusion】 TEG, coagulation four items, and APACHE Ⅱ score can be used to assess the severity of patients with severe coagulation dysfunction. and the combined application of the 3 indicators are of high value in predicting the prognosis of such patients, and can provide reference for clinical formulation or adjustment of intervention programs to correct coagulation dysfunction.
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Since December 2019, a novel type of coronavirus disease (COVID-19) in Wuhan led to an outbreak throughout the world. To date, there have been more than 1,260,000 COVID-19 patients, with a mortality rate of approximately 5.44%. Studies have shown that coagulation dysfunction is a major cause of death in patients with severe COVID-19. Therefore, the People's Liberation Army Professional Committee of Critical Care Medicine and Chinese Thrombosis and Hemostasis Committee grouped experts from the frontline of the Wuhan epidemic to come together and develop an expert consensus on diagnosis and treatment of coagulation dysfunction associated with severe COVID-19 infection. This consensus includes an overview of COVID-19-related coagulation dysfunction, tests for coagulation, anticoagulation therapy, replacement therapy, supportive therapy and prevention. The consensus produced 18 recommendations which are being used to guide clinical work.
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Objective To systematically review the effect of Qingre Jiedu and Liangxue Sanyu method in patients with sepsis,and to discuss its effect in the treatment of sepsis.Methods The randomized controlled trials (RCTs) on the treatment of Qingre Jiedu and Liangxue Sanyu method for sepsis published on PubMed,Embase,Web of Science,CNKI and Wanfang database from the construction to December 31st,2017 were searched by electronical way.Conventional treatment measures for sepsis,such as fluid resuscitation,maintenance of hemodynamic stability,anti-infection,improvement of tissue perfusion,maintenance of organ function and nutritional support were used in the control group.While traditional Chinese medicine treatment based on Qingre Jiedu and Liangxue Sanyu method were applied in the experimental group besides the conventional treatment,including Chinese patent medicine or Chinese herbal medicine.The main outcome was 28-day mortality,and the second outcome was acute physiology and chronic health evaluation Ⅱ (APACHE Ⅱ),coagulation function,inflammatory mediators,procalcitonin (PCT),lactic acid (Lac),and the length of intensive care unit (ICU) stay.Two researchers independently searched literatures,collected data and evaluated risk bias.The statistical analysis was completed by RevMan 5.3 and STATA 13.0 software.The funnel plot and Egger test were used to evaluate the potential publication bias of the main outcomes.Results A total of 20 RCTs were enrolled in this Meta-analysis,including 1 347 patients,with 667 patients in the control group and 680 patients in the experimental group.Comprehensive risk bias assessment showed that the risk bias of 11 RCT items was unknown,and the risk bias of 9 RCT items was high.Meta-analysis results showed that compared with the control group,the 28-day mortality of the experimental group was significantly lowered [relative risk (RR) =0.54,95％ confidence interval (95％CI) =0.45-0.65,P ＜ 0.00001],the 7-day APACHE Ⅱ score was significantly lowered [mean difference (MD) =-3.86,95％CI =-4.82 to-2.90,P ＜ 0.00001],the 7-day prothrombin time (PT) and activated partial thromboplastin time (APTT) were significantly shortened (PT:MD =-1.72,95％CI =-2.29 to-1.14,P ＜ 0.00001;APTT:MD =-4.36,95％CI =-5.81 to-2.91,P ＜ 0.000 01),the 7-day D-dimer was slightly improved (MD =-0.13,95％CI =-0.37-0.11,P =0.29),the 10-day interleukin-6 (IL-6) and tumor necrosis factor-α (TNF-α) were significantly decreased (IL-6:MD =-40.33,95％CI =-59.55 to-21.11,P ＜ 0.000 1;TNF-α:MD =-7.26,95％CI =-11.31 to-3.21,P =0.000 4),the 7-day Lac was significantly declined (MD =-1.30,95％CI =-1.91 to-0.68,P ＜ 0.000 1),but no significance in PCT (MD =-1.57,95％CI =-3.25-0.11,P =0.07) or the length of ICU stay (MD =-4.02,95％CI =-8.60-0.56,P =0.09)was found.The results of publication bias assessment showed that 19 studies reported 28-day mortality were basically "funnel-shaped" distribution without potential publication bias (P =0.336).Conclusion The Meta-analysis showed that Qingre Jiedu and Liangxue Sanyu method may reduce the release of inflammatory mediators,improve the coagulation function,and reduce the 28-day mortality in patients with sepsis.
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Myeloproliferative neoplasm is a clonal hematopoietic stem cell disease, which is often complicated by coagulation dysfunction, manifested as thrombosis and bleeding tendency. The mechanism of coagulation dysfunction in myeloproliferative neoplasm is unclear, which may be the result of multiple factors, such as proliferation and activation of leukocyte, abnormality of platelet and its receptors, JAK2V617 F mutation, vWF consumption and drugs. High-risk patients should be assessed to prevent and reduce adverse events.
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Objective To investigate the mechanism underlying the activation of tissue factor (TF) that leads to coagulation dysfunction in the recipients after liver xenotransplantation. Methods Auxiliary heterotopic liver xenotransplantation was performed in 3 minipigs with α-1,3-galactosyltransferase gene-knockout (GTKO) as the donors and Tibetan macaque (Macaca thibetana) as the recipients. Postoperative coagulation function changes in the recipients were observed. Reverse transcription polymerase chain reaction (RT-PCR) and immunohistochemical staining were adopted to quantitatively measure the expression levels of monkey and minipig TF messenger RNA (mRNA) and protein in the liver tissues of the primary and transplant livers at different time points before and after transplantation. The recalcification time of peripheral blood mononuclear cell (PBMC) was recorded in the normal control monkeys and the recipient monkeys before and 2 h after liver transplantation to evaluate the coagulation status in the recipients. Results All three recipients presented with different degrees of coagulation dysfunction after surgery, manifested as a decrease in fibrinogen level and a reduction in platelet count. The monkey TF protein was positively expressed in the primary livers after surgery, whereas negatively expressed in transplant livers before and after liver transplantation. The minipig TF protein was negatively expressed in both primary livers and transplant livers. At postoperative 2 h, monkey TF mRNA was up-regulated by (2.10±0.24) times in the primary liver compared with the preoperative level, whereas the minipig TF mRNA was up-regulated by (1.42±0.15) times compared with preoperative level. There was statistical significance between the primary livers and transplant livers (P=0.014). Compared with PBMC in the normal control monkeys and recipient monkeys before liver transplantation, the recalcification time of the PBMC in the recipient monkeys was significantly shortened at postoperative 2 h (both P<0.001). Conclusions At the presence of coagulation dysfunction after liver xenotransplantation, the level of TF activation in the primary livers is significantly higher than that in the transplant livers. The TF activation in the primary livers is the main cause of coagulation dysfunction after liver xenotransplantation.
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Neutrophil extracellular traps (NETs) are net-like structure composed of DNA and nuclear proteins, which are produced by activated neutrophils under the circumstances of a variety of pathogens or drugs. As part of defensive mechanism, NETs have been proved to restrict the spread of pathogens and release of antimicrobial molecules. NETs can not only strengthen the adhesion between neutrophils and platelets, promote platelet mediated procoagulant reaction, but also lead to endothelial cell damage and coagulopathy in sepsis. In addition, NETs also plays an important role in pathophysiological processes of venous thrombosis. Therefore, NETs may become the biomarkers of evaluating coagulation dysfunction and potential therapy target in sepsis.
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Objective To study and analyze the prognostic value of psychological dredging nursing combined with edaravone and naloxone in the treatment of craniocerebral injury. Methods 100 patients with craniocerebral injury treated in our hospital from February 2012 to October 2016 were selected and randomly divided into the control group and the experimental group,50 patients in each group. The control group was treated with edaravone combined with naloxone,experimental group were treated with edaravone combined with naloxone in treatment, and psychological counseling,pay attention to the psychological status of patients,strengthen communication and exchanges,increase confidence and compliance of patients. Compared and analyzed the blood coagulation indexes of the two groups. Results After corresponding treatment, the prothrombin time of the experimental group was (16.8±2.5)s, and the prothrombin time of the control group was (20.7±2.3)s. There was significantly statistical difference (P<0.05).In addition, the platelet count,activated partial thromboplastin time and thrombin time index in the experimental group were significantly better than those in the control group(P<0.05).Conclusion Edaravone combined with naloxone and psychological counseling in the treatment of craniocerebral injury can improve the abnormal coagulation function of patients significantly, and recover consciousness, and has clinical significance.
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Objective To analyze the influencing factors of perioperative coagulation dysfunction in neonates with gastrointestinal surgery.Methods Coagulation indexs, including plasma prothrombin time (PT), partial activated thromboplastin time (APTT), thrombin time (TT) and plasma fibrinogen (Fib), were collected retrospectively from June 2002 to April 2016 in gastrointestinal neonatal surgery, as well as perioperative clinical data and the perioperative coagulation dysfunction associated risk factors were analyzed.Results There were 158 cases with abnormal coagulation indexs within 4 hours after operation, including 61 cases of mild abnormalities and 97 cases of obvious abnormalities.Multivariate logistic regression analysis showed that preoperative pneumonia (OR=2.880, 95%CI 1.417-5.852), perioperative low calcium (OR=2.381, 95%CI 1.167-4.857) and invasive puncture catheter (OR=2.490, 95%CI 1.299-4.773) were independent risk factors for neonatal coagulation index abnormality within 4 hours after surgery (P<0.05).Conclusion In the perioperative management, pneumonia should be actively treated, correcting hypocalcemia and choosing concentrations of less than 6.25 U/ml of heparin solution or normal saline careing arteriovenous catheter reduces the occurrence of neonatal postoperative coagulation dysfunction.
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Objective To study the effect of massive blood transfusion program(MTP) in early massive blood transfusion and preventing coagulopathy.Methods Fifty cases of massive blood transfusion were clinically collected and performed the statistical analysis and processing before and after intervention according to the blood transfusion scheme of MTP.The statistical comparison was performed by using the data before and after intervention.Results PLT was decreased with the increase of transfusing of RBC.After transfusing 15 U of RBC,the PT test,INR and APTT were increased significant(P＜0.05).After transfusing 20 U of RBC,the Fib was decreased significant(P＜0.05).The MTP had statistical difference between before and after intervention(P＜0.01).Conclusion The MTP application has an important significance to prevent the occurrence of coagulopathy and evaluate the coagulation status.
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OBJECTIVE:To study the hemostatic effect of porcine fibrin sealant patch (DBT) on bleeding wound of liver in rats and gluteus maximus in heparinized rabbits. METHODS:48 rats and 24 rabbits were randomly divided into sham operation group,operation control group (gauze hemostasis),medical collagen sponge group and DBT group. Except for sham operation group,animals in other groups were reduced for rat model with liver bleeding or heparinized rabbit model with gluteus maximus bleeding. The hemostatic time was recorded,bleeding amount was calculated;DBT degradation and wound adhesion in liver after 3,13 weeks were observed;re-bleeding rate of heparinized rabbits in medical collagen sponge group and DBT group were investi-gated. RESULTS:Compared with sham operation group,the hemostatic time and bleeding amount of animals in operation control group were significantly increased(P<0.01). Compared with operation control group,the hemostatic time and bleeding amount of animals in DBT group and medical collagen sponge group were significantly reduced (P<0.01). After 3,13 weeks,different de-gree of adhesion appeared in the wound of rats in each group,while the adhesion scores had no statistical significances(P>0.05). After 13 weeks,liver margin of rats in administration groups was slightly blunt,but it basically had been restored to preoperative state,with good healing. DBT can be degraded and absorbed completely. The re-bleeding rate of rabbits in DBT group were33.3%,66.7% in medical collagen sponge group. CONCLU-SIONS:DBT has good hemostatic effect on fragile organs and the body with blood coagulation dysfunction,and can be de-graded and absorbed. Its effect is equivalent to medical colla-gen,while the adhesive strength is slightly better than the latter.
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OBJECTIVE:To study the hemostatic effect of porcine fibrin sealant patch (DBT) on bleeding wound of liver in rats and gluteus maximus in heparinized rabbits. METHODS:48 rats and 24 rabbits were randomly divided into sham operation group,operation control group (gauze hemostasis),medical collagen sponge group and DBT group. Except for sham operation group,animals in other groups were reduced for rat model with liver bleeding or heparinized rabbit model with gluteus maximus bleeding. The hemostatic time was recorded,bleeding amount was calculated;DBT degradation and wound adhesion in liver after 3,13 weeks were observed;re-bleeding rate of heparinized rabbits in medical collagen sponge group and DBT group were investi-gated. RESULTS:Compared with sham operation group,the hemostatic time and bleeding amount of animals in operation control group were significantly increased(P<0.01). Compared with operation control group,the hemostatic time and bleeding amount of animals in DBT group and medical collagen sponge group were significantly reduced (P<0.01). After 3,13 weeks,different de-gree of adhesion appeared in the wound of rats in each group,while the adhesion scores had no statistical significances(P>0.05). After 13 weeks,liver margin of rats in administration groups was slightly blunt,but it basically had been restored to preoperative state,with good healing. DBT can be degraded and absorbed completely. The re-bleeding rate of rabbits in DBT group were33.3%,66.7% in medical collagen sponge group. CONCLU-SIONS:DBT has good hemostatic effect on fragile organs and the body with blood coagulation dysfunction,and can be de-graded and absorbed. Its effect is equivalent to medical colla-gen,while the adhesive strength is slightly better than the latter.
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Objective To analyze the potential factors affecting the prognosis of patients with sepsis and evaluate their values in predicting the disease outcome. Methods A clinical prospective study was conducted. Fifty-three septic patients admitted to intensive care unit (ICU) of the First Affiliated Hospital of Guangzhou Medical University from October 17th, 2012 to August 8th, 2013 were enrolled, and in the same term 35 volunteers having passedphysical check-up were assigned in the healthy control group. According to the severity of the patients, they were divided into sepsis, severe sepsis and septic shock groups. Furthermore, based on the difference in scores of acute physiology and chronic health evaluation Ⅱ (APACHE Ⅱ), the patients were divided into low-risk (APACHE Ⅱ scores 0.05). The IL-8 level of non-coagulation defect group was significantly lower than that of adjusted (ng/L:24.67 vs. 27.23, P0.05). Conclusions The grade of sepsis severity, APACHEⅡscore, whether existence of coagulation dysfunction being present or not and whether its presence being adjusted or not during the septic patients' stay in ICU, the levels of blood lactate, PCT, IL-6 and IL-8 on the first day in ICU are significantly correlated to the prognosis of septic patients. Whether the existence of coagulation dysfunction being present or not, whether coagulation dysfunction being adjusted or not and the blood lactate level are the independent prognostic factors of septic patients, and the plasma concentrations of IL-6 and IL-8 are the independent affecting factors of whether coagulation dysfunction occurring or not, therefore they have predicting value concerning the occurrence of coagulation dysfunction in septic patients.
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Objective To discuss the safety of percutaneous puncture drainage for liver abscess in patients with blood coagulation dysfunction. Methods A total of 85 patients with liver abscess, who were admitted to authors’ hospital during the period from January 2013 to January 2014 to receive ultrasound-guided percutaneous puncture drainage, were included in this study. According to the international normalized ratio of prothrombin time≥1.5 and platelet count≤50 ×109/L, the patients were divided into group A (normal coagulation group,n=67) and group B (coagulation dysfunction group,n=18). The occurrence of postoperative complications was recorded and the results were compared between the two groups. Results In both groups, no statistically significant difference in hemoglobin level existed between preoperative level and postoperative one, and no bleeding complications occurred in all patients after the procedure. Conclusion For patients with liver abscess complicated by blood coagulation dysfunction, percutaneous puncture drainage treatment is safe and reliable.
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OBJECTIVE:To explore the effect and mechanism of ulinastatin on blood coagulation dysfunction of ICU sepsis pa-tients. METHODS:64 ICU sepsis patients were randomly divided into treatment and control groups,with 32 cases in each group. Control group received routine treatment,while treatment group was additionally given Ulinastatin injection on the basis of control group,100 000 u dissolved in 500 ml 15% Glucose injection or Sodium chloride injection intraveously,3 times/d,for consecutive 7 days. The mechanical ventilation time,ICU length of stay and survival rate within 30 d were analyzed statistically in 2 groups. The platelet count (PLT),prothrombin time (PT),activated partial thromboplastin time (APTT),fibrinogen (FIB),D-dimer (D-D), white blood cell count (WBC) and IL-6 were detected before treatment and on first,third and seventh day after treatment. RE-SULTS:After treatment,mechanical ventilation and ICU length of stay in treatment group were significantly shorter than in control group,and survival rate was significantly higher than control group,with statistical significance (P<0.05). The peripheral blood WBC and IL-6 level of treatment group were significantly lower than those of control group,with statistical significance(P<0.05). There was a significant difference in blood coagulation indicators between treatment group after 7 days of treatment and before treat-ment,control group after treatment(P<0.05). The blood coagulation indicators recovered to normal level after 7 days of treatment. CONCLUSIONS:Ulinastatin can improve blood coagulation of ICU sepsis patients by a mechanism of inhibiting the release of in-flammatory cytokines and corresponding blood coagulation factor function.