Zinc supplementation with polaprezinc was associated with improvements in albumin, prothrombin time activity, and hemoglobin in chronic liver disease.

Zinc deficiency occurs in a variety of diseases, including chronic liver disease (CLD). We investigated the correlation between zinc levels and biochemical and hematological tests in CLD and the effect of zinc supplementation with polaprezinc on these values. The first study (Study 1) was a retrospective observational study of 490 patients with CLD not receiving zinc supplementation, with data available from September 2009 to August 2021. Univariate and multiple regression analysis showed that serum zinc levels correlated most strongly with albumin (Alb) and also significantly with prothrombin time activity (PT%) and hemoglobin (Hb). A subsequent study (Study 2) focused on patients with advanced CLD who used polaprezinc for more than 90 days between January 2005 and August 2021. Using a self-controlled design with the 6-month period prior to polaprezinc as the control period, comparisons showed that Alb (p<0.0001), PT% (p<0.0005), and Hb (p<0.01) were significantly improved in the polaprezinc-treated patients compared to the control group. In conclusion, serum zinc levels were correlated with serum Alb, Hb, and PT% in patients with CLD, and zinc supplementation with polaprezinc was associated with improvements in Alb, Hb, and PT% within at least 6 months.

Association between admission prothrombin time activity and hospital readmission in heart failure: A retrospective study.

BACKGROUND: Coagulopathy is a common complication of heart failure (HF), but the prognostic significance of coagulation abnormalities for HF is still poorly understood. This investigation sought to elucidate the association between admission prothrombin time activity (PTA) and short-term readmission in HF. METHODS: In this retrospective study, we extracted data from a publicly accessible database for hospitalized HF patients in China. The admission laboratory findings were screened by the least absolute shrinkage and selection operator (LASSO) regression. Afterward, the study population was stratified according to the admission PTA level. In univariate and multivariate analysis, we employed logistics regression model to evaluate the association of admission PTA level with short-term readmission. Subgroup analysis was preformed to examine the interaction effect between admission PTA level and covariates, including age, sex, and systolic blood pressure (SBP). RESULTS: A total of 1505 HF patients were included, of whom 58.7% were female and 35.6% were between 70 and 79 y. In LASSO procedure, admission PTA level was included in optimized models for short-term readmission, and readmitted patients tended to have a lower admission PTA level. Multivariate analysis suggested that the low admission PTA level (admission PTA ≤ 62.3%) was associated with increased risk of 90-day readmission (odds ratio 1.63 [95% CI, 1.09 to 2.46]; P = 0.02) and 180-day readmission (odds ratio 1.65 [95% CI, 1.18 to 2.33]; P = 0.01) compared with patients with the highest admission PTA level (admission PTA ≥ 76.8%) after full adjustment. Moreover, no significant interaction effect was observed in the subgroup analysis, except for admission SBP. CONCLUSION: Low admission PTA level is associated with an increased risk of 90-day and 180-day hospital readmission in patients with HF.

Characteristics of coagulation alteration in patients with COVID-19.

Abnormal blood coagulation often occurs in critically ill patients, which seriously affects their prognosis. This retrospective study investigated the implications of changes in blood coagulation in patients with coronavirus disease 2019 (COVID-19). Records were reviewed for patients admitted with COVID-19 between February 4 and 16, 2020. The primary outcome was in-hospital death. A total of 85 patients were included, of whom 12 died in the hospital. The admission prothrombin time (PT), international normalized ratio (INR), and levels of D-dimer and fibrin/fibrinogen degradation products (FDP) were significantly higher in non-survivors than in survivors, while the reverse was true for prothrombin time activity (PT-act) and PaO2/FiO2. Multivariate logistic regression showed that PT-act < 75% was independently associated with mortality. The area under the receiver operating characteristic curves for PT-act, D-dimer, and FDP at admission could significantly predict mortality. The AUCs for PT-act were larger than those for D-dimer and FDP; however, there was no significant difference. After 2 weeks of treatment, the coagulation parameters of the surviving patients improved. COVID-19 is often accompanied by abnormal coagulation. PT-act at admission is able to predict mortality in patients with COVID-19 as can D-dimer and FDP levels. PT-act < 75% is independently associated with mortality.

Research on clinical efficacy of liver transplantation for severe liver disease / 器官移植

@#Objective To explore the clinical efficacy of liver transplantation for severe liver disease. Methods The clinical data of 51 patients who underwent liver transplantation for severe liver disease were retrospectively analyzed. The general intraoperative conditions were observed, including operation duration, warm ischemia time, cold ischemia time, anhepatic phase, bleeding volume, blood transfusion volume, plasma transfusion volume and so on. The changes in indexes such as total bilirubin (TB), prothrombin time activity (PTA), and prothrombin time international normalized ratio (PT-INR) were observed before operation and at 3 d, 1 week and 2 weeks after operation. The postoperative survival and occurrence of complications were analyzed. The indexes that might affect the prognosis of patients with severe liver disease were analyzed by Cox regression analysis. Results For the 51 patients, operation duration, warm ischemia time and cold ischemia time was 8 (7, 9) h, 3 (2, 3) min and 6 (5, 8) h respectively, intraoperative anhepatic phase was 80 (70, 100) min, intraoperative bleeding volume was 1 000 (550, 1 500) mL, and intraoperative blood transfusion volume was 1 200 (200, 1 600) mL. Postoperative TB, PTA, PT-INR and other indexes improved significantly compared to those preoperatively. Among the 51 patients, 10 cases died, with the death causes of multiple organ failure and severe infection(7 cases), renal insufficiency (2 cases), and cardiovascular complications (1 case). Survival rates at 1 month and 1 year post-transplantation for patients with severe liver disease were 82% and 80%, respectively. Cox regression analysis suggested that abnormal preoperative PTA and PT-INR were the risk factors for post-transplantation death in patients with severe liver disease. Conclusions Liver transplantation significantly improves the survival rate for patients with severe liver disease, perioperative infection prevention and treatment as well as multiple organ function management play key roles in improving post-transplantation survival rate in patients with severe liver disease.

The product value of serum albumin and prothrombin time activity could be a useful biomarker for severity prediction in AP: An ordinal retrospective study.

AIM: To appraise the predictive function of 'the product value of serum albumin and prothrombin time activity' (PAA) on admission for the organ failure related events of acute pancreatitis (AP). BACKGROUND: 789 patients with AP were included in this retrospective study. 468 patients generated transient organ failure (TOF). 242 were diagnosed with persistent organ failure (POF), of which 63 patients died. STUDY: All the values of laboratory parameters were measured upon admission to hospital. Dunnett'T3 test, Uni- and multi-variate ordinal logistic regression were used. ROC curve was utilized to evaluate the ultimate predictive values. RESULTS: Among the patients with 4 different levels of severity of acute pancreatitis, PAA observably reduced as the disease aggravated (32.20 vs 29.56 vs 23.54 vs 17.89). PAA was also an independent risk factor for the aggravation of AP (OR: 0.873, 95% CI: 0.848, 0.899; p < 0.01). The Area Under the Curve (AUC) of PAA for OF was 0.828 (0.783, 0.872), 0.828 for POF (0.790, 0.865) and 0.905 for death cases (0.862, 0.948). CONCLUSION: The product value of serum albumin and prothrombin time activity is a good predictor of the severity, especially the events related to organ failure of acute pancreatitis.