ABSTRACT
INTRODUCTION: Linezolid is an antimicrobial with broad activity against Gram-positive bacteria. Thrombocytopenia is one of its most common side effects often leading to severe complications. The aim of this study is to identify factors related with development of this condition in critically ill patients and to develop and evaluate a predictive machine learning-based model considering easy-to-obtain clinical variables. METHODS: Data was obtained from the Medical Information Mart for Intensive Care III. Patients who received linezolid for over three days were considered, excluding those under 18 years and/or lacking laboratory data. Thrombocytopenia was considered as a platelet decrease of at least 50% from baseline. RESULTS: Three hundred and twenty patients met inclusion criteria of which 63 developed thrombocytopenia and presented significant greater duration of treatment, aspartate-aminotransferase, bilirubin and international normalized ratio; and lower renal clearance and platelet count at baseline. Thrombocytopenia development was associated with a worse outcome (30 days mortality [OR: 2.77; CI95%: 1.87-5.89; P < .001], 60 days mortality [OR: 3.56; CI95%: 2.18-7.26; P < .001]). Thrombocytopenia was also correlated with higher length of hospital stays (35.56 [20.40-52.99] vs 22.69 [10.05-38.61]; P < .001). Median time until this anomaly was of 23 days (CI95%:19.0-NE). Two multivariate models were performed. Accuracy, sensitivity, specificity and AUROC obtained in the best of them were of 0.75, 0.78, 0.62 and 0.80, respectively. CONCLUSION: Linezolid associated thrombocytopenia entails greater mortality rates and hospital stays. Although the proposed predictive model has to be subsequently validated in a real clinical setting, its application could identify patients at risk and establish screening and surveillance strategies.
Subject(s)
Anemia , Thrombocytopenia , Adolescent , Anemia/chemically induced , Critical Illness , Humans , Linezolid/adverse effects , Machine Learning , Retrospective Studies , Risk Factors , Thrombocytopenia/diagnosisABSTRACT
Blinatumomab es el primer anticuerpo biespecífico para células T que ha mostrado eficacia para conseguir enfermedad mínima residual negativa en pacientes con leucemia linfoblástica aguda B recidivante o refractaria tras la quimioterapia convencional. Sin embargo, existe escasa evidencia en cuanto a su utilización off label como optimizador de la remisión citológica previa al trasplante de progenitores hematopoyéticos (TPH). Se expone el caso de un paciente que se sometió en condiciones óptimas a TPH alogénico tras un único ciclo de blinatumomab, describiendo el manejo de los efectos adversos presentados y los resultados obtenidos
Blinatumomab is a first class bispecific T-cell engager that has been shown to achieve negative minimal residual disease in patients with relapsed or refractory pre-B acute lymphoblastic leukemia after conventional chemotherapy. Nevertheless, there is little evidence about its role as an off label enhancer of cytological remission prior to stem cell transplantation (SCT). We describe the case of a patient with an excellent performance status who was allowed to undergo alogenic SCT after a single blinatumomab cycle, as well as the management of adverse events and the observed results
Subject(s)
Humans , Antibodies, Monoclonal/pharmacokinetics , Antibodies, Bispecific/pharmacokinetics , Precursor B-Cell Lymphoblastic Leukemia-Lymphoma/therapy , Biological Therapy/methods , Hematopoietic Stem Cell Transplantation/methods , Treatment OutcomeABSTRACT
No disponible
Subject(s)
Humans , Male , Middle Aged , Antibodies, Monoclonal/adverse effects , Anticholesteremic Agents/adverse effects , Everolimus/adverse effects , Immunosuppressive Agents/adverse effects , Kidney Transplantation , Pneumonia/therapy , Hyperlipidemias/chemically induced , Pneumonia/etiologySubject(s)
Antibodies, Monoclonal/adverse effects , Anticholesteremic Agents/adverse effects , Everolimus/adverse effects , Immunosuppressive Agents/adverse effects , Kidney Transplantation , Pneumonia/therapy , Antibodies, Monoclonal, Humanized , Humans , Hyperlipidemias/chemically induced , Male , Middle Aged , Pneumonia/etiologyABSTRACT
No disponible
Subject(s)
Humans , Excipients/adverse effects , Tooth Discoloration/chemically induced , Coloring Agents/adverse effects , Indigo Carmine/adverse effects , Gingival Diseases/chemically induced , Tooth Diseases/chemically inducedABSTRACT
BACKGROUND: The use of eculizumab during pregnancy has generally been discouraged. Published data on related studies provides conflicting information and establishing a benefit-risk relationship proves to be a complicated task. Miscarriage rates, concomitant medications, and the stages of pregnancy when eculizumab treatment was initiated varied among the patients included in the case series. The aim of this report is to discuss eculizumab use during pregnancy. CASE PRESENTATION: A case of a woman diagnosed with Paroxysmal Nocturnal Hemoglobinuria (PNH) and treated with eculizumab, who expressed desire for pregnancy is presented. Six months after her eculizumab treatment, the patient experienced spontaneous abortion in her first trimester. The direct relation between eculizumab and the miscarriage is not clear. Other factors may have influenced this case, thus demonstrating the difficulty of managing pregnancy in women with PNH. CONCLUSION: Controversy on eculizumab risk during pregnancy encourages further review on its use, highlighting the importance to assess each case individually.
ABSTRACT
No disponible
