Prothrombin Time Research Articles

Serum β2-microglobulin as an independent risk factor for mortality in patients with acute respiratory distress syndrome caused by bacterial infection

Acute respiratory distress syndrome (ARDS) is a heterogeneous disease with extremely high mortality. We hypothesized that the serum β2-microglobulin (β2MG) level would be elevated and be an independent risk factor for 28-day mortality in patients with ARDS caused by bacterial infection. We retrospectively enrolled 257 patients with ARDS caused by bacterial infection from January 1, 2015 to February 28, 2021. Patients were followed for up to 28 days and were divided into a survival group and non-survival group according to their clinical outcomes. The serum β2MG levels and other clinical data were collected. The relationship between β2MG levels and 28-day mortality was explored by performing a Cox regression analysis adjusted for age, updated Charlson comorbidity index, disorders of consciousness, septic shock, albumin level, cardiac troponin I level, procalcitonin level, lactic acid level, prothrombin time, partial pressure of arterial oxygen/fraction of inspired oxygen ratio, estimated glomerular filtration rate and Sequential Organ Failure Assessment. In this cohort, 96 patients died in 28 days, yielding a 28-day mortality of 37.4%. The median level of serum β2MG for all enrolled patients was 4.7 (interquartile range [IQR]: 2.9–8.5) mg/L. Higher β2MG levels were significantly associated with 28-day mortality when the β2MG level was analysed as a continuous variable (hazard ratio [HR]: 1.053; 95% confidence interval [CI] 1.004–1.104; P = 0.032) and when it was categorized into tertiles (HR: 3.241; 95% CI 1.180–8.905; P = 0.023). The β2MG level exhibited a high diagnostic accuracy for predicting 28-day mortality (area under the curve [AUC] = 0.732; 95% CI 0.673–0.785; sensitivity: 74.0%; specificity: 64.0%; P < 0.001). The level of serum β2MG is elevated and is an independent risk factor of 28-day mortality in patients with ARDS caused by bacterial infection.

The utility of the dilute prothrombin time in the interpretation of antiphospholipid syndrome testing.

To evaluate the utility of the dilute prothrombin time (DPT) in diagnosing antiphospholipid syndrome (APS), alone and when paired with the dilute Russell viper venom time (DRVVT). Dilute prothrombin time and DRVVT testing was performed on plasma samples spiked with apixaban or rivaroxaban, or depleted of vitamin K-dependent clotting factors. A retrospective analysis of all functional APS testing results over a 44-month period at the University of Chicago Medical Center was performed. In spiking studies, the screening clotting time in the DPT (DPTS) is more sensitive to deficiency of vitamin K-dependent factors than is the screening clotting time in the DRVVT (DRVVTS). The converse is true for factor Xa direct oral anticoagulant (DOAC)-spiked plasma. In a 44-month retrospective analysis, only 2.6% of clinical APS panels showed isolated positivity in the DPT-based system. Comparing the DPT-based system with the DRVVT-based system showed utility in identifying false-positive DRVVT results due to anticoagulation. A DRVVTS/DPTS ratio of 0.785 or lower predicted an international normalized ratio of 1.5 or higher (sensitivity, 86.3%; specificity, 60.4%; likelihood ratio, 2.18). Conversely, a DRVVTS/DPTS ratio of 1.165 or higher was the optimal cutoff for predicting the identification of factor Xa DOAC (sensitivity, 61.8%; specificity, 77.8%; likelihood ratio, 2.78). Within the data set that had full DRVVT and DPT results, parameters were identified that could further improve identification of samples with anticoagulation interference. Dilute prothrombin time lupus anticoagulant assay is rarely the sole laboratory functional evidence for APS, but when combined with the DRVVT, the DPT can serve as an effective screen for common anticoagulant interference.

A Prospective Study on the Spectrum of Liver Abscess With Special Reference to Ruptured Abscess in a Tertiary Care Hospital.

Introduction Liver abscesses are one of the most concerning healthcare issues in Western countries, with a prevalence rate of three per 100,000. Although with the improvement in the socio-economic status and the health care system, its incidence has decreased in developed nations, pyogenic and amoebic liver abscesses are still high in resource-poor countries. Low socioeconomic conditions, improper hygiene, lack of awareness, and often a delay in diagnosis can lead to fatal complications and high mortality. Methods This prospective study was conducted in the Department of General Surgery, Calcutta National Medical College (CNMC) from 1st January 2019 to 31st August 2020 after obtaining approval from the Institute Ethical Committee (IRB no: EC-CNMC/2019/238/1). Patients over 10 years old with clinical and radiological features of liver abscesses were included in the study. Demographic, clinical, and treatment parameters were analyzed. Clinical and biochemical data were also compared statistically between ruptured and unruptured cases. Results Sixty patients with liver abscesses were included in the study. A pyogenic liver abscess (PLA) and amoebic liver abscess (ALA) were 28 and 32 cases, respectively. Most patients were between 21 and 40 years of age (53.3%, n=60), with male predominance (76.7%, n=60).The most common symptom was fever in both PLA (89.2%, n=28) and ALA (65.6%, n=32). Most abscesses were 5-10 cm in size (56.6%, n=60). Clinical parameters like pedal edema, ascites, respiratory distress, intercostal tenderness, and peritonitis were associated with ruptured abscesses. Biochemical parameters like low albumin raised total leucocyte count (TLC), increased prothrombin time, and large size of the abscess were predictors of ruptured abscess (p<0.001). Image-guided aspiration was performed in 14 patients (23.3%, n=60), and CT-guided percutaneous catheter drainage was done in 30 cases (50%, n=60). The most common organism isolated was E. coli. The ruptured abscess was diagnosed in six patients (10%, n=60). All ruptured abscesses required laparotomy and open surgical drainage. After three months of follow-up, a complete resolution of abscess cavities were seen in 38 patients (63.3%, n=60). Mortality in our study was 5 (8.3%, n=60). Conclusion Although modern diagnostic tools can efficiently diagnose liver abscesses, the identification of clinical features still has its place. Percutaneous catheter drainage is most commonly performed as a minimally invasive procedure without significant morbidity.Clinical suspicion of a ruptured liver abscess should be dealt without a delay. Improved hygiene and awareness can reduce its incidence, but early identification of clinical features, prompt diagnosis, and treatment can reduce mortality and morbidity.

A-148 Performance Evaluation ofthe Zybio EXT 4800: A Novel Optical-Magnetic Coagulation Analyzer

Abstract Background Coagulation analysis, crucial in clinical diagnostics, predominantly employs optical and Mechanical methods. Optical methods are preferred for their simplicity and cost-effectiveness but are susceptible to hemolysis, icterus, and lipemia interferences. Mechanical methods, considered more accurate, are hindered by higher costs and operational complexity. This study evaluates the Zybio EXT 4800, a novel analyzer integrating both technologies(U.S. Patent:US11022558 B2), to harness their collective benefits. Methods The study compared optical, mechanical, and integrated optical-mechanical detection methods for Prothrombin Time (PT) testing, particularly under interference conditions such as chyle. To ensure reagent reliability, a comprehensive open-vial stability assessment was conducted for Zybio's reagents. Additionally, a clinical correlation study compared Zybio EXT 4800 with Siemens CS-2000i Systems, covering multiple parameters. Through this rigorous methodology, the study sought to establish the accuracy, reliability, and clinical applicability of these advanced coagulation analysis technologies. Results In the presence of lipemia interferents during PT testing, notable fluctuations were observed with the optical method, resulting in deviations ranging from 80% to 104% from the set values. Conversely, when utilizing the integrated optical-mechanical approach for analysis, the instrument automatically identifies interferences in the sample, intelligently switching the detection method from optical to mechanical.This intelligent adaptation to interference exhibits strong anti-interference capabilities. The experimental results of mechanical testing show deviations ranging from 0.8% to 1.7%, while the experimental results of optical retesting after high-speed centrifugation of samples show deviations ranging from 1.1% to 2.3%. Regarding reagent stability, Zybio's reagents showcased exceptional durability. Following an accelerated aging process of 50 days at 37°C, Zybio reagents exhibited smaller relative deviations compared to the comparator reagents, underscoring the remarkable stability and reliability offered by Zybio's reagents. Furthermore, in a clinical correlation analysis between Zybio's “EXT 4800 Automated Coagulation Analyzer” and Siemens' “CS-2000i Systems,” strong correlations were observed. The R-squared values perform well, with determinations of exemplary quantitative parameters: FIB for 0.985, D-Dimer for 0.983, and AT for 0.980. These results not only validate the performance equivalence between the two systems but also highlight the advanced stability and anti-interference capabilities of the EXT 4800, positioning it as a formidable alternative to existing solutions. Conclusions The EXT 4800 coagulation analyzer effectively merges optical and mechanical methodologies, offering high sensitivity, accuracy, and reduced susceptibility to interferences. It presents as a cost-effective, reliable alternative in coagulation analysis, with strong performance correlations to established systems and superior reagent stability, making it a valuable addition to clinical laboratories.

A-172 Feasibility of PT, aPTT, and Fibrinogen on a Multifunctional Digital Microfluidic Cartridge

Abstract Background Excessive bleeding is prevalent in severe trauma patients, and measurement of multiple coagulation parameters is vital to correcting coagulopathy and improving outcomes. There are no rapid, near-patient technologies that can perform multiple coagulation assays simultaneously on a single consumable. We are developing a point-of-care digital microfluidic (DMF) platform to test three critical coagulation markers: prothrombin time (PT), activated partial thromboplastin time (aPTT), and fibrinogen. Methods Five proficiency testing plasma samples were obtained from the College of American Pathologists (CAP) with normal, intermediate, and prolonged response of PT and aPTT, and normal and elevated fibrinogen levels. After loading 10 μL of sample onto the cartridge, autonomous digital microfluidic operations divided the sample into three droplets, which were then combined with reagents for PT, aPTT or fibrinogen. The viscosity of these droplets, measured from the electrical impedance on a toaster-sized instrument, changes at a rate proportional to the amount of coagulation precursors present from which time/activity was calculated. Results Classification of samples into normal, intermediate or prolonged categories along with the respective times obtained from the DMF cartridges matched those obtained on the Stago Compact Max instrument (Figure). We also demonstrated separation of plasma from whole blood within the DMF cartridge using agglutinating reagents, enabling an easy-to-use workflow without the need for centrifugation. Conclusions Our preliminary results demonstrate that PT, aPTT and fibrinogen can be measured on a single cartridge with performance similar to comparator methods, with a time to result of &amp;lt;15 minutes. To our knowledge, this is the first time these 3 assays have been performed simultaneously on a single consumable and furthermore, this is the first time viscoelastic tests have been performed on a multifunctional instrument that also performs chemistry and molecular tests. Studies are underway to evaluate analytical and clinical performance.

A-335 Evaluation of the Next Generation i-STAT® Point of Care Prothrombin Time Test

Abstract Background The i-STAT® PTplus cartridge contains a point of care prothrombin time (PT) test. The purpose of this study was to assess the performance of the i-STAT PTplus cartridge compared to other commercially available PT tests namely, Dade® Innovin® on the Sysmex® CS-2500 and the Roche CoaguChek®. The i-STAT® PTplus cartridge is a point of care whole blood test for the determination of prothrombin time. It is used to aid in the monitoring of patients receiving anticoagulant therapy with coumarin derivatives. Methods Venous and capillary whole blood specimens were prospectively collected with IRB approved informed consent from 222 subjects undergoing coumarin therapy and from subjects who were not on anticoagulant therapy at three clinical sites to span the reportable range of 0.8 - 8.0 INR. Both venous and capillary whole blood specimens were tested in duplicate on the i-STAT 1 Wireless Analyzer and were tested in singlicate on the Roche CoaguChek® device. Plasma from a citrated venous blood specimen obtained from the same subjects was tested in duplicate on the Sysmex® CS-2500 instrument. Results The Passing-Bablok regression results in the table below demonstrate international normalized ratio (INR) in the first replicate of the i-STAT PTplus cartridge versus the first replicate comparative device for venous and capillary whole blood. Conclusions This study demonstrates that the i-STAT® PTplus cartridge has good agreement to both laboratory and point of care commercially available PT tests when tested with venous and capillary whole blood from subjects not on anticoagulant therapy and subjects receiving coumarin therapy. The studies were funded by Abbott Laboratories.

Mesoporous Silica Administration as a New Strategy in the Management of Warfarin Toxicity; In Vitro and In Vivo Study

Purpose: Warfarin is one of the most widely used anticoagulants that function by inhibiting vitamin K epoxide reductase. Warfarin overdose, whether intentional or unintentional, can cause life-threatening bleeding. Here, we present a novel warfarin adsorbent based on mesoporous silica that can act as an antidote to warfarin toxicity. Method: Amino-functionalized mesoporous silica (MS-NH2) was synthesized based on co-condensation method through a soft template technique followed by template removal. The prepared structure and functional group were studied by FT-IR, XRD. The morphology was checked by SEM and TEM. The capacity of MS-NH2 in the adsorption of warfarin was evaluated in vitro, at pH=7.4 and pH=1.2. In vivo evaluation was performed in control and warfarin-overdosed animal models. Overdosed animals were treated with MS-NH2 by oral gavage. Biomarkers of organ injury were assessed in animal serum. Results: The MS-NH2 were relatively uniform, spherical with defined diameters (400 nm) and homogeneous structure. synthesized particles had a large surface area (1015 m2 g-1) and mean pore diameter 2.4 nm which leaded considerable adsorption capacity for warfarin 1666 mg/g. In vivo studies revealed that oral administration of MS-NH2 in mice poisoned with warfarin caused a significant difference (p &lt; 0.05) on International Normalized Ratio (INR) and prothrombin time (PT). Moreover, the warfarin with MS-NH2 group demonstrated a notable decrease in biomarkers associated with tissue damage, such as bilirubin, lactate dehydrogenase (LDH), alanine aminotransferase (ALT), and aspartate aminotransferase (AST). Conclusion: The results confirm that MS-NH2 administration can be an effective treatment for warfarin toxicity and could potentially mitigate the adverse effects of warfarin poisoning.

B-136 From Result to Response: The Development of Laboratory-Based Scoring Models to Predict COVID-19 Patient Outcomes

Abstract Background Patient characteristics relating to increased risk for COVID-19 severity are well-documented, including older age and pre-existing health concerns; however, methods to accurately predict patients’ acute reaction to SARS-CoV-2 infections remain lacking. Identification of specific laboratory tests informative of patient outcomes could effectively screen incoming patients and better inform physicians regarding optimal treatment plans. The aim of this study was to examine associations between frequently ordered laboratory markers and COVID-19 patient mortality to develop an objective laboratory-based scoring system that estimates patients’ risk of mortality. Methods Study participants included inpatients from 3 hospitals recruited into the GENCOV project based in Ontario, Canada. Participants (n=325) were at least 18 years of age, provided consent, and were hospitalized within 1 month of having a PCR confirmed COVID-19 infection between January 2020 and February 2022. Extensive clinical data including patient demographics, laboratory results, and treatment outcomes were extracted from patient’s electronic medical records (EMR). Results for 32 biochemical and hematological tests including complete blood cell counts, coagulation (activated partial thromboplastin time, D-dimer, fibrinogen, prothrombin time), general chemistry (albumin, blood gases, creatine kinase, electrolytes, glucose, triglycerides), inflammatory (lactate dehydrogenase, ferritin, C-reactive protein), liver (alanine aminotransferase, aspartate aminotransferase, total bilirubin), renal (creatinine, urea) and cardiac (troponin, NT-proBNP, BNP) markers were collected from each chart. Univariable logistic regression with nested likelihood ratio tests were used to determine significant associations between laboratory results and patient outcomes. Significant markers were incorporated into multivariable models and variable risk values were assigned. Total calculated risk scores for each participant were compared using univariable and multivariable risk values. Validation of each scoring method was performed on a 20% subset of inpatients. Receiver operating characteristic (ROC) curves evaluated model performance. Results Six laboratory markers were associated with COVID-19 patient mortality when controlling for age and sex. Univariable regression showed that elevated creatinine, elevated lactate, elevated white blood cell, low base excess, low bicarbonate, or low pH results upon admission were significantly associated with increased odds of mortality, in comparison to test results within the reference range for these same markers. Multivariable regression revealed fewer markers (only low bicarbonate and low base excess) showing significant associations with COVID-19 mortality. Area under the ROC curves (AUC) determined that risk scores derived from univariable values performed similarly to multivariable values in validation (0.800 vs 0.802) and development cohorts (0.821 vs 0.829). Total risk scores calculated from the univariable vs multivariable models suggest higher sensitivity (90% vs 85%) than specificity (58% vs 67%) in the validation cohort, whereas the development cohort had higher sensitivity (88%) than specificity (66%) with univariable scores, and higher specificity (81%) than sensitivity (74%) with multivariable scores. Conclusions Laboratory results associated with COVID-19 mortality following both univariable and multivariable analyses suggest hospitalized patients infected with SARS-CoV-2 may present with acidosis. Total risk scores derived from univariable and multivariable values performed similarly in predicting mortality; however, differences in marker significance between models indicate discrepancies with risk interpretation. Further comparison of the created risk score assessments with equivalent models in other populations is warranted.

A murine experimental model of the pulmonary thrombotic effect induced by the venom of the snake Bothrops lanceolatus.

The venom of Bothrops lanceolatus, a viperid species endemic to the Lesser Antillean Island of Martinique, induces thrombosis in a number of patients. Previous clinical observations indicate that thrombotic events are more common in patients bitten by juvenile specimens. There is a need to develop an experimental model of this effect in order to study the mechanisms involved. The venoms of juvenile and adult specimens of B. lanceolatus were compared by (a) describing their proteome, (b) assessing their ability to induce thrombosis in a mouse model, and (c) evaluating their in vitro procoagulant activity and in vivo hemostasis alterations. Venom proteomes of juvenile and adult specimens were highly similar, albeit showing some differences. When injected by the intraperitoneal (i.p.) route, the venom of juvenile specimens induced the formation of abundant thrombi in the pulmonary vasculature, whereas this effect was less frequent in the case of adult venom. Thrombosis was not abrogated by the metalloproteinase inhibitor Batimastat. Both venoms showed a weak in vitro procoagulant effect on citrated mouse plasma and bovine fibrinogen. When administered intravenously (i.v.) venoms did not affect classical clotting tests (prothrombin time and activated partial thromboplastin time) but caused a partial drop in fibrinogen concentration. The venom of juvenile specimens induced partial alterations in some rotational thromboelastometry parameters after i.v. injection. When venoms were administered i.p., only minor alterations in classical clotting tests were observed with juvenile venom, and no changes occurred for either venom in rotational thromboelastometry parameters. Both juvenile and adult venoms induced a marked thrombocytopenia after i.p. injection. An experimental model of the thrombotic effect induced by B. lanceolatus venom was developed. This effect is more pronounced in the case of venom of juvenile specimens, despite the observation that juvenile and adult venom proteomes are similar. Adult and juvenile venoms do not induce a consumption coagulopathy characteristic of other Bothrops sp venoms. Both venoms induce a conspicuous thrombocytopenia. This experimental model reproduces the main clinical findings described in these envenomings and should be useful to understand the mechanisms of the thrombotic effect.

Identification of compounds from Origanum compactum and Origanum elongatum using HPLC/UV-ESI-MS and comparative analysis of their antioxidant, antimicrobial, anticoagulant, and antidiabetic properties

The aim was to assess the phytochemical composition, phenolic component levels, and biological properties of the flowering tops of Origanum compactum and Origanum elongatum. The study employed phytochemical assays, spectrophotometric techniques for quantitative analysis of polyphenols, flavonoids, and tannins, and compound identification using HPLC/UV-ESI-MS. The antimicrobial, antioxidant, anticoagulant, and antidiabetic properties were examined both in vitro and in vivo. The results showed that the O. compactum extract had significantly high levels of total polyphenols, measuring 47.368 mg gallic acid equivalents per gram, and flavonoids, measuring 14.839 mg quercetin equivalents per gram. The phytochemical examination of O. compactum revealed that lithospermic acid accounted for 36.82 % of the chemicals detected, followed by salvianolic acid C at 12.57 % and ros-marinic acid at 6.01 %. The main constituents of O. elongatum are salvianolic acid C (14.46 %), luteolin-3-O-glucuronide (13.51 %), salvianolic acid B (12.24 %), rosmarinic acid (7.83 %), and rutin (6.18 %). The results demonstrated different levels of effectiveness against the investigated microorganisms, with the extract from O. compactum exhibiting better activity, particularly against Gram-negative bacteria, certain yeasts, and the fungus Aspergillus niger. The aqueous extracts of both Origanum species demonstrate significant antioxidant activity. O. compactum has a higher total antioxidant capacity (IC50 of 35.083 μg/mL) compared to O. elongatum (IC50 of 77.080 μg/mL). However, O. elongatum has a higher reducing power (35.697 μg/mL) compared to O. compactum (42.563 μg/mL). In vivo evaluations revealed that the aqueous extracts of O. compactum and O. elongatum possess significant antihyperglycemic and anticoagulant properties. The extracts demonstrated a marked reduction in blood glucose levels during the oral glucose tolerance test (OGTT) in Wistar rats and effectively prolonged both prothrombin time (PT) and activated partial thromboplastin time (aPTT), highlighting their ability to inhibit coagulation pathways. Moreover, their comparable efficacy to standard antihyperglycemic medications and absence of severe toxicity, even at high doses, underscore their therapeutic potential for safe and effective treatment applications. Between the two species, O. compactum exhibited superior efficacy in key biological activities such as antioxidant, antimicrobial, and anticoagulant properties, making it a strong candidate for therapeutic applications. This study underscores the value of Origanum species as a rich source of bioactive compounds, offering significant potential in pharmaceuticals, nutraceuticals, and agri-food industries. The findings pave the way for further exploration of their diverse applications.

A-150 Extended Pre-Analytical Stability Validation for Coagulation Tests in Brazilian Clinical Laboratory

Abstract Background The transport of samples for coagulation tests is a challenge for clinical laboratories, due to their limited stability and short time for processing according to the manufacturer's recommendations. The objective of this study was to evaluate the possibility of extending the stability of samples collected for Prothrombin Time and Activity (PTA), activated Partial Thromboplastin Time (aPTT) and Fibrinogen tests for up to 10 hours at room temperature, in comparison with the stability described in the literature and by the manufacturer of the reagents (4 hours for aPTT, 8 hours for PTA and Fibrinogen). We verified the acceptability of the samples with a longer period between collection and analysis, including its impact on the clinical management Methods Four tubes of 3.2% sodium citrate from 40 volunteers were analyzed at times of up to 4 h, 6 h, 8 h and 10 h. The results obtained were compared with the dosage performed within 4 hours (recommended by manufacturer) and the Total Error obtained in the analysis of the samples was evaluated. The tubes remained at controlled room temperature of 15 to 25°C and were centrifuged at 1500 g for 15 minutes. Then, the analyses were performed by coagulometric method. Results The results showed safety in the analysis of samples for coagulation tests even within 10 hours after collection at ambient temperature and were within the Maximum Allowable Total Error (Carmen Ricós): 95% of the PTA results (TE 5,3%); 92.2% of aPTT results (TE 4,5%) and 98% of Fibrinogen analyses (TE 13,6%) (Figures 1, 2 and 3). In addition, even the results that exceeded the specified Total Error showed no impact on the clinical decision. Conclusions The study demonstrated that there was no significant loss of stability for the analyses of PTA, aPTT and Fibrinogen performed on samples kept at room temperature within 10 hours after collection. Most of the results showed variation within the specified Total Error and all results showed acceptability from a medical point of view

Clinical Value of Coagulation Function Indicators in Children with Severe Pneumonia.

This study aimed to probe the changes in coagulation function-related indicators (prothrombin time (PT), activated partial thromboplastin time (APTT), fibrinogen (FIB), D-dimer (D-D), and fibrinogen degradation product (FDP)) in severe pneumonia and their clinical significance. The levels of coagulation function indicators of all the children were measured within 24 hours of admission. Pearson correlation analysis was utilized to analyze the correlation between PT, APTT, FIB, D-D, FDP and PCIS in children with severe pneumonia. The ROC curve was drawn to assess the power of PT, APTT, FIB, D-D and FDP in diagnosing severe pneumonia and predicting the prognosis of severe pneumonia. A logistic regression analysis was implemented to analyze the factors influencing the prognosis of children with severe pneumonia. PT, APTT, FIB, FDP, and D-D in the critically severe pneumonia and the extremely severe pneumonia groups were higher versus the common pneumonia group (P < 0.05). FDP and D-D levels in children with severe pneumonia were negatively correlated with PCIS. PT, APTT, FIB, FDP, and D-D of children in the poor prognosis group were higher compared with those in the good prognosis group (P < 0.05). Further logistic regression analysis unveiled that FDP and APTT were influential factors impacting the prognosis of severe pneumonia. The levels of D-D, FDP, FIB, APTT, and PT in severe pneumonia are increased. Detecting the contents of coagulation function indicators can help clinical judgment of the changes in the condition of severe pneumonia and evaluate prognosis.

Evaluating preoperative coagulation panels in dogs undergoing liver lobectomy for primary liver tumors: A multi-institutional retrospective study.

The objectives of this study were to: (i) Determine whether operable primary liver tumors were associated with prolongations in prothrombin time (PT) and activated partial thromboplastin time (aPTT) and (ii) determine if these secondary hemostatic abnormalities were more prevalent with specific liver tumors. Multi-institutional retrospective study. Dogs (n = 359) undergoing liver lobectomy for a primary liver tumor with a preoperative coagulation panel. Data was identified via electronic medical record review at eight veterinary teaching hospitals. Baseline dog characteristics, coagulation panel values, platelet count, emergency versus non-emergency procedure, whether the dogs received transfusion(s) of a blood product, liver lobe removed, and histopathological diagnosis were extracted from the medical record. Chi-square analysis was used to compare categorical variables between groups. Continuous variables were assessed for normality using the Shapiro-Wilk test. A total of 74 of 359 dogs (20.6%) had a prolongation in either PT or aPTT preoperatively. A total of 20 of 359 dogs (5.6%) were found to have prolongation of both PT and aPTT. Hemangiosarcoma was the only histopathological diagnosis associated with concurrent prolongations of both PT and aPTT (p < .001) in 6/16 (37.5%) dogs. Coagulation panels including PT and aPTT are unlikely to detect substantial deficiencies in secondary hemostasis in most dogs with primary liver tumors except in dogs with a histopathological diagnosis of hemangiosarcoma. PT and aPTT testing is low yield as an elective preoperative screening test in dogs with primary liver tumors except in dogs where there is a hemoabdomen or high suspicion for hepatic hemangiosarcoma.

Serum microRNA-181a Expression Level in Patients with Acute Liver Failure and Its Correlation with Prognosis.

This paper examined miR-181a expression in the serum of patients with acute liver failure (ALF) and investigated the impact of its expression in the prognosis of ALF patients. A total of 112 ALF patients (ALF group) and 100healthy controls during the same period (control group) were recruited as study subjects, and ALF patients were separated into the survival group and the death group. Serum ALT, AST, SCr, TBil, PTA, and International Normalized Ratio (INR) indices as well as serum miR-181a expression were assessed by using a fully automated biochemistry analyzer and RT-qPCR. Patients in the ALF group were evaluated using the Model for End-Stage Liver Disease (MELD) score. Correlation between serum miR-181a expression and MELD scores of ALF patients was processed by Pearson correlation analysis, and the diagnostic value of miR-181a level for the occurrence of ALF was estimated by ROC curve analysis. Multivariate logistic regression analysis was executed to assess the factors influencing the occurrence of death in ALF patients. ALF patients had higher levels of ALT, AST, TBiL, SCr, INR and miR-181a and lower PTA levels in comparison to healthy controls. Serum miR-181a expression level in ALF patients revealed a significant positive correlation with MELD score. Multivariate logistic regression analysis unveiled that TBil, INR, SCr, and miR-181a were the independent risk factors for the occurrence of death in ALF patients, and that PTA was an independent protective factor for the prognosis of ALF patients. miR-181a exhibited a favorable diagnostic value in ALF and its prognosis. miR-181a expression is upregulated in the serum of ALF patients, and it can be utilized as an indicator for ALF diagnostic and prognostic assessment.

LDH and NLR, as inflammatory markers, the independent risk factors for COVID-19 complicated with respiratory failure in elderly patients.

Lactate dehydrogenase (LDH) is an enzyme that is responsible for the production of lactic acid, which is a necessary byproduct when the body does not have enough oxygen. LDH levels in the blood can be used as a marker to predict mortality in patients with ARDS, severe COVID-19, and cancer. To analyze the clinical characteristics of COVID-19 in the elderly and the correlation between LDH and respiratory failure in COVID-19 patients, to improve the identification and management of this type of pneumonia by clinicians. This was a single-center retrospective study. We performed routine laboratory tests in 105 COVID-19 patients admitted to the affiliated hospital of Qingdao University (Qingdao, China) from October 1, 2022 to February 1, 2023. The diagnosis of respiratory failure was established based on the results of blood gas analysis upon admission. The median age was 79 years. Among all univariable parameters, LDH, neutrophil to lymphocyte ratio (NLR) and Prothrombin Time (PT) were significantly independent risk factors of RF in elderly COVID-19 patients. LDH (AUC=0.829) also had a maximum specificity (96.5%), with the cutoff value of 280.5. The levels of LDH, NLR, and PT may serve as potential indicators for elderly COVID-19 patients combined with respiratory failure. LDH, NLR and PT assays can be beneficial for patients who need closer respiratory monitoring and more aggressive supportive care to prevent a negative prognosis.

Effect of low-molecular-weight heparin calcium combined with magnesium sulfate and labetalol on coagulation, vascular endothelial function and pregnancy outcome in early-onset severe preeclampsia.

This paper was aimed at unveiling the effect of low-molecular-weight heparin calcium (LMWH) combined with magnesium sulfate and labetalol on coagulation, vascular endothelial function, and pregnancy outcome in early-onset severe preeclampsia (EOSP). Pregnant women with EOSP were divided into the control group and the study group, each with 62 cases. Patients in the control group were treated with labetalol and magnesium sulfate, and those in the study group were treated with LMWH in combination with the control grou Blood pressure (systolic blood pressure [SBP] and diastolic blood pressure [DBP]), 24-h urine protein, coagulation indices [D-dimer (D-D), plasma fibrinogen (Fg), prothrombin time (PT), activated partial thromboplastin time (APTT), and prothrombin time (TT)], endothelial function [endothelin (ET-1) and nitric oxide (NO)], oxidative stress indices [oxidized low-density lipoproteins (ox-LDL), lipid peroxidation (LPO), superoxide dismutase (SOD), and malondialdehyde (MDA)], pregnancy outcome, and adverse effects occurred in the two groups were compared. After treatment, lower SBP, DBP, and 24-h urine protein levels; lower Fg and D-D levels; higher PT, APPT, and TT levels; higher NO levels; lower ET-1 levels; lower ox-LDL, MDA, and LPO levels; higher SOD levels; and lower incidence of adverse pregnancy and adverse reactions were noted in the study group in contrast to the control group. EOSP patients given with LMWH combined with magnesium sulfate and labetalol can effectively reduce the patient's blood pressure and urinary protein level; improve coagulation function, oxidative stress, and vascular endothelial function indices; reduce the adverse pregnancy outcomes; and improve the safety of treatment.

A Predictive Model for Disseminated Intravascular Coagulopathy in Sepsis: An Observational Study.

Sepsis remains a significant global health challenge due to its high morbidity and mortality rates. Disseminated Intravascular Coagulopathy (DIC) represents a critical complication of sepsis, contributing to increased mortality and economic burden. Despite various prognostic scoring systems, there is a lack of a specific model for DIC prediction in sepsis patients. This observational study included 336 sepsis patients. Clinical and laboratory data were collected, and prognoses were defined according to established criteria. We enrolled 336 patients, with 304 in the non-DIC group and 32 in the DIC group. Patients with DIC had notably lower platelet (PLT) and higher levels of prothrombin time (PT), lactate (LAC), and procalcitonin (PCT) compared to those without DIC. Univariate and multivariate analyses identified risk factors associated with the DIC, showing that PLT (OR = 0.985, 95% CI 0.978-0.993, p < 0.001), PT level (OR = 1.140, 95% CI 1.004-1.295, p = 0.044), and LAC (OR = 1.101, 95% CI 0.989-1.226, p = 0.078) were related factors. A risk model was established, and its sensitivity and specificity in predicting DIC among sepsis patients were assessed by comparing it to the SOFA score. The area under the ROC curve for the model was 0.850, while the SOFA score was 0.813. With a model score >-2.12, the sensitivity for predicting DIC was 84.4%, and the specificity was 75.0%. Our study introduces a predictive model for DIC detection in sepsis patients, emphasizing the need for clinicians to focus on patients with high model scores for timely intervention.

Development and validation of predictive models for mortality of cases with COVID-19 (Omicron BA.5.2.48 and B.7.14): a retrospective study

ObjectivesWith the emergence of new COVID-19 variants (Omicron BA.5.2.48 and B.7.14), predicting the mortality of infected patients has become increasingly challenging due to the continuous mutation of the virus. Existing...

Using Machine Learning and Electronic Health Records to Identify Neuropsychiatric Risk Scores for Delirium in ICU and General Hospital Settings.

Delirium is a common and acute neuropsychiatric syndrome that requires timely intervention to prevent its associated morbidity and mortality. Yet, its diagnosis and symptoms are often overlooked due to its variable clinical presentation and fluctuating nature. Thus, in this study, we address the barriers to delirium diagnosis by utilizing a machine learning-based predictive algorithm for incident delirium that relies on archived electronic health records (EHRs) data. We used the Medical Information Mart for Intensive Care (MIMIC) database to create a detailed dataset for identifying delirium in intensive care unit (ICU) patients. Our approach involved training machine learning models on this dataset to pinpoint critical clinical features for delirium detection. These features were then refined and applied to non-ICU patients using EHRs from the American University of Beirut Medical Center (AUBMC). Our study assessed machine learning models like Extreme Gradient Boosting (XGBoost), Categorical Boosting (CatBoost), Classification and Regression Trees (CART), Random Forest (RF), Neural Oblivious Decision Ensembles (NODE), and Logistic Regression (LR), highlighting superior delirium detection in diverse clinical settings. The CatBoost model excelled in ICU environments with an F1 Score of 89.2%, while XGBoost performed best in general hospital settings with a 75.4% F1 Score. Interpretations using Tabular Local Interpretable Model-agnostic Explanations (LIME) revealed critical indicators such as prothrombin time and hematocrit levels, enhancing model transparency and clinical applicability. These clinical insights help differentiate the delirium predictors between ICU patients, who are often sensitive to various factors. The proposed predictive algorithm improves delirium detection rates and streamlines efficiency in hospital electronic systems, thereby enabling prompt interventions to prevent delirium progression and associated complications. The clinical indicators for delirium that we identified in general hospital settings and ICU can greatly help healthcare professionals identify potential causes of delirium and reduce misdiagnosis.

Machine learning-based prediction model of lower extremity deep vein thrombosis after stroke.

This study aimed to apply machine learning (ML) techniques to develop and validate a risk prediction model for post-stroke lower extremity deep vein thrombosis (DVT) based on patients' limb function, activities of daily living (ADL), clinical laboratory indicators, and DVT preventive measures. We retrospectively analyzed 620 stroke patients. Eight ML models-logistic regression (LR), support vector machine (SVM), random forest (RF), decision tree (DT), neural network (NN), extreme gradient boosting (XGBoost), Bayesian (NB), and K-nearest neighbor (KNN)-were used to build the model. These models were extensively evaluated using ROC curves, AUC, PR curves, PRAUC, accuracy, sensitivity, specificity, and clinical decision curves (DCA). Shapley's additive explanation (SHAP) was used to determine feature importance. Finally, based on the optimal ML algorithm, different functional feature set models were compared with the Padua scale to select the best feature set model. Our results indicated that the RF algorithm demonstrated superior performance in various evaluation metrics, including AUC (0.74/0.73), PRAUC (0.58/0.58), accuracy (0.75/0.77), and sensitivity (0.78/0.80) in both the training set and test set. DCA analysis revealed that the RF model had the highest clinical net benefit. SHAP analysis showed that D-dimer had the most significant influence on DVT, followed by age, Brunnstrom stage (lower limb), prothrombin time (PT), and mobility ability. The RF algorithm can predict post-stroke DVT to guide clinical practice.