Thrombocyte Count Research Articles

Prognostic Accuracy of VITRO Score in Predicting the Mortality in patient with Decompensated Liver Cirrhosis

Background: Cirrhosis of the liver is a widespread chronic illness that kills more people from non-malignant diseases than any other condition. In the case of cirrhosis, the liver has sustained long-term damage and is unable to operate normally. The VITRO score is a noninvasive instrument that can forecast whether cirrhotic patients would experience problems. Objective: To determine the prognostic accuracy of VITRO score in predicting the mortality in patient with decompensated liver cirrhosis Material & Methods: Study Design: Descriptive Study Setting: Liver Clinic, Services Hospital, Lahore Duration: 06 months January 2022 to June 2022. One Hundred Ninety cirrhotic patients were recruited after meeting the inclusion criteria. Both informed consent and demographic data were collected. Blood samples were drawn and were sent to a certain facility in order to test for VWF-Ag and thrombocyte count. The VITRO-score was estimated by dividing the VWF-Ag to thrombocyte count. Patient followed for 3 months after which it was determined whether patients survived or died of cirrhosis complications. Results: The mean age of the patients was 51.42±9.98 years, 103(54.50%) were male. The mean VITRO score of the patients was 6.15±6.08. The VITRO scores the prediction of mortality was noted in 148(77.9%) patients. The sensitivity was 96.08%, specificity was 28.78%, and diagnostic accuracy of VITRO score was 46.84% for assessment of mortality taking mortality occurred within 3 months as gold standard. Practical implication: The prognosis of patients could be improved by using accurate prognostic scoring systems to assist clinicians in earlier diagnosis and therapy selection. Conclusion: According to this study the prognostic accuracy of VITRO score in predicting the mortality is approximately 50% in patient with decompensated liver cirrhosis, however the sensitivity of it is very high Keywords: Prognostic Accuracy, VITRO score, Mortality, Cirrhosis, decompensated liver disease

The effect of aquous extract of johar leaves (Senna siamea) injection on survival rate and blood profile of snakehead fish (Channa striata)

Aqueous extract of johar leaf contains metabolite compounds such as flavonoids, sponins, tannins, phenols, anthraquinones, anthocyanins, and cardiac glycosides which can be used to substitute commercial antibiotics. The use of aqueous extract of johar leaf has been known to have antibacterial activity in vitro. This study aims to determine the effect of aqueous extract of johar leaves (Senna siamea) injection on survival and blood profile of snakehead fish (Channa striata) in vivo. This research was a laboratory study using a completely randomized design (CRD) with 5 treatments and 3 replications with a total sample of 75 snakehead fish. The fish in KA, KB, KC and KD groups were injected with aqueous extract of johar leaves with concentrations of 10%, 20%, 40%, and 60% respectively, while in KE group the fish was injected with distilled water (control). The parameters of this study were the survival rate and blood profile of snakehead fish. Blood hematology examination included calculation of erythrocyte count, hemoglobin level, and hematocrit percentage, leukocyte count, and thrombocyte count. The research data obtained were analyzed using one-way analysis of variance and followed by Duncan's Multiple Distance test. Injection of aqueous extract of johar leaf did not affect the survival rate of snakehead fish. However, hemoglobin and platelet levels significant decrease in the group given 60% concentration of aqueous extract of johar leaf. It can be concluded that aqueous extract of johar leaf at a concentration of 10%, 20%, 40% is safe to use in snakehead fish.Keywords:Johar leaves extractSnakehead fishBlood profileSurvival rate

A Comparative Analysis of Effectiveness of Recombinant Interleukin-11 Versus Papaya Leaf Extract for Treatment of Thrombocytopenia: A Review.

Platelets or thrombocytes play an important role in thrombosis and maintaining hemostasis. Thrombocytes help in forming blood clots at the site of the wound. When the level of platelets decreases, uncontrolled bleeding occurs which can result in mortality. A decrease in the blood platelet level is known as thrombocytopenia which can be caused due to various reasons. A variety of treatment options are available for thrombocytopenia like platelet transfusion, splenectomy, platelet management with various types of corticosteroids, and recombinant interleukin-11 (rhIL-11). The use of rhIL-11 is approved by FDA for the treatment of thrombocytopenia. rhIL-11 is a recombinant cytokine that is administered to patients suffering from chemotherapy-induced thrombocytopenia as it enhances megakaryocytic proliferation which aids in platelet production. But this treatment has various side effects and is costly. Hence, there is a crucial need to identify cost-effective alternative strategies that present no side effects. The majority of the population in low-income countries requires a functional and cost-effective treatment for low thrombocyte count. Carica papaya is a tropical herbaceous plant that has been reported in recovering low platelet count during dengue virus infection. Even though multiple benefits of the Carica papaya leaf extract (CPLE) are popular, the active compound present in it, which mediates these benefits, remains to be identified. This review aims to highlight the different aspects of rhIL-11 and CPLE-induced platelet counts and their limitations and benefits in the treatment of thrombocytopenia. The literature related to the treatment of thrombocytopenia using rhIL-11 and CPLE from 1970 to 2022 was searched using PubMed and Google Scholar databases with the keywords Recombinant Interleukin-11, Papaya Leaf Extract, Thrombocytopenia, and Platelets.

DIFFERENCES PLATELET INDICES IN HYPOPROLIFERATIVE AND HYPERDESTRUCTIVE THROMBOCYTOPENIA

Thrombocytopenia can increase the risk of bleeding. Determination of the type of thrombocytopenia is important because it will affect patients treatment. The gold standard for distinguishing types of thrombocytopenia is bone marrow examination. This examination is invasive and carries risk of bleeding. Platelet indices are simple and less invasive and reliable in distinguishing the types of thrombocytopenia. The aim of this study is to evaluate the value of the platelet indices in differentiating types of thrombocytopenia.This study used retrospective cross sectional study. Subjects with leukemia, aplastic anemia, MDS for hypoproliferative thrombocytopenia (group 1), dengue fever, ITP, Evans syndrome, sepsis, pneumonia, and typhoid fever for hyperdestructive thrombocytopenia (group 2). Inclusion criteria were the subjects data with a platelet count <100,000 with data with name, age, sex, diagnosis and platelet count, PCT, MPV, PDW. Group 1 consisted of 103/150 (68.67%) subjects and group 2 47/150 31.33%) subjects. Platelet indices in group 1 vs group 2, MPV 10,02  0,85 vs 11,72  1,11 (p = 0,017) PDW 10,0 (7 – 15,70) vs 14,5 (10,40 – 19,40) (p <0,001) dan PCT 0,04 (0,01 – 0,19) vs 0.06 (0,01 – 0,10) (p = 0,208) Thrombocyte count 41 (11-97) vs 50 (8-90) (p = 0,380). MPV, PDW values were higher in hyperdestructive thrombocytopenia, because there was no thrombopoiesis abnormality in bone marrow to produce young platelets. PCT difference was not significant because platelet count was not significantly different and MPV was little significant. MPV and PDW values can differentiate types of thrombocytopenia.

Bleedings in Cancer Patients Treated with Apixaban for Venous Thromboembolism

Background: Recently, direct oral anticoagulants (DOACs) have been investigated as an alternative to low-molecular-weight heparin (LMWH) for the treatment of cancer-associated venous thromboembolism (VTE). Apixaban, edoxaban, and rivaroxaban showed non-inferiority in preventing recurrent VTE compared with the dalteparin. However, it was reported higher risk of bleeding in gastrointestinal (GI) cancers in patients treated with edoxaban and rivaroxaban compared with dalteparin, but not with apixaban. It has been suggested that non-resected GI cancers have higher risk of bleeding than resected ones. The CAP study investigated apixaban as a treatment for cancer associated VTE (1). In this subanalysis, we aimed to investigate risk factors for bleedings and to find out if reducing the dose of apixaban influenced bleedings. Methods: The CAP study was a prospective, single-arm, interventional study conducted in Norway to assess the efficacy and safety of apixaban as a treatment for cancer-associated VTE. Patients received initially 7 days with 10 mg apixaban twice daily followed by 5 mg twice daily ("full dose") from baseline to 6 months, and 2.5 mg twice daily ("low dose") from 7 to 36 months. Bleedings were categorized as major bleedings or clinically relevant non-major bleedings (CRNMB). The combination of major bleedings and CRNMB is referred to as "clinically relevant bleedings” (CRBs). We investigated the following risk factors for bleeding: age, gender, low BMI, metastasis, unresected tumor, low thrombocyte count, cancer type, low hemoglobin, and concomitant use of anti-platelet therapy. Odds ratios (OR) and 95% confidence intervals (CI) were calculated to assess the association between risk factors and bleedings. Results: Patient characteristics and bleeding events by type of cancer are shown in table 1. We found that CRBs were associated with high age (above 74 years old, OR 2.0, 95% CI 1.0-4.1), low BMI (below 21.7, OR 2.3, 95% CI 1.1-4.8), and low hemoglobin (below 10.5 for females, OR 2.8, 95% CI 1.1-7.3 and 11.1 for males, OR 3.3, 95% CI 1.3-8.4), during full dose apixaban treatment period. Having GI or urogenital cancer were not associated with CRB compared with other cancers. In general, patients with unresected cancers did not have more bleedings than resected cancers. However, unresected GI cancer had increased risk of bleeding (OR 3.4, 95% CI 1.0-11.6) compared with resected GI cancer. Within the group of urogenital cancer, resected cancers were apparently associated with bleeding (OR 11.1, 95% CI 1.3-94.0), although with a large confidence interval. We did not find any risk factors associated with CRB from 7-36 months except for having breast cancer (OR 3.2, 95% CI 1.0-10.0). The frequency of major bleeding events was higher in full-dose period compared to the low-dose period but the frequency of CRNMB was not influenced by the reduction in apixaban dose (figure 1). There was one fatal bleeding in the full-dose period. Conclusion: Risk factors for bleeding in treatment with full dose apixaban were high age, low BMI, low hemoglobin. Low dose apixaban apparently reduced major bleeding events, but not CRNMB. Reference: 1. Larsen TL, Garresori H, Brekke J, Enden T, Frøen H, Jacobsen EM, et al. Low dose apixaban as secondary prophylaxis of venous thromboembolism in cancer patients - 30 months follow-up. J Thromb Haemost. 2022;20(5):1166-81. Figure 1View largeDownload PPTFigure 1View largeDownload PPT Close modal

Heat shock protein-70 is elevated in childhood primary immune thrombocytopenia

BackgroundImmune thrombocytopenia (ITP) is an acquired autoimmune disorder characterized by the destruction of the platelets resulting from autoimmune recognition and subsequent attack. Heat shock proteins (HSPs) are directly associated with progression and pathogenesis in some specific autoimmune diseases. The aim of this study was to investigate the serum expression of HSP-70 in ITP children and healthy controls.Materials and methodsA total of 86 children aged 1–6 years were enrolled in the study. The participants were divided into 20 newly diagnosed ITP (ndITP), 34 chronic ITP (cITP) patients and 32 healthy children. The white blood cells and platelet counts were determined and compared between the groups. HSP-70 serum levels were analyzed by sandwich ELISA. Data analysis was done using SPSS and the data variables assessment was done through histogram, probability plots and Shapiro–Wilk tests to determine normal distribution.ResultsThe white blood cell counts were 8.9 (4.2–10.4) for new diagnosis ITP, 7.1(3.9–11.9) for the chronic ITP group and 7.0 (4.3–9.5) for the healthy controls. The platelet counts were significantly increased in the chronic ITP group, 83.5(31.7–297) compared to the ndITP group 27.4 (3.7–63.7), but significantly lower compared to the healthy controls 271(172–462) (P = 0.0009). There were significantly increased HSP-70 serum levels in cITP patients compared to the ndITP and the healthy group. In addition, there was a positive correlation between the serum HSP-70 level and the thrombocyte counts among the ITP children.ConclusionsHSP-70 has a role in the progression of childhood ITP. Increased HSP-70 level is associated with the severity of childhood primary ITP.

Immune thrombocytopenia in a small cell lung cancer patient treated with atezolizumab: a case report

Immune checkpoint inhibitors (ICIs), an enormous oncological breakthrough in the last 10 years, have become the standard treatments for several types of solid cancers. Although ICIs are generally well tolerated and result in favorable outcomes, they also cause unique immune-related adverse events (irAEs) across bodily systems and organs. Compared to most common irAEs, which occur in the endocrine, skin, pulmonary system, and gastrointestinal tract, haematological irAEs (haem-irAEs) are relatively rare but potentially life-threatening events that are occasionally irreversible and refractory. Currently, haem-irAEs are not sufficiently understood, management, and lack consensus, while other common irAEs have well been characterized and managed. The reports of ICI-related thrombocytopenia in small cell lung cancer (SCLC) are rarely seen. Hence, we reported a rare case of severe steriod-resistant ICI-related thrombocytopenia after received chemotherapy plus anti-PD-L1 inhibitor in SCLC patient. Our case exemplifies the diagnosis, diagnosis of exclusion, treatment, and prognosis of thrombocytopenia in the pattern of combination therapy, meanwhile, the subject of diagnosis, therapies, therapeutic strategies for refractory type and incidence, potential biomarkers, mechanisms and prognosis in ICI-related thrombocytopenia have been fully discussed. Herein, we present a 64-year-old man diagnosed advanced SCLC developed refractory immune-related severe thrombocytopenia, who achieved favorable outcomes of cancer following chemotherapy combined with atezolizumab administrated. Routine blood re-examination on the third day of 6th therapy showed a thrombocyte count of 11×109/L. Combined the medical history and the results of laboratory tests, the diagnosis of ICI-induced thrombocytopenia was confirmed. Despite large doses of methylprednisolone, immunoglobulin, and rituximab, intermittent platelet transfusion, thrombopoietin being administrated to the patient, there were no signs of platelet count and hemoglobin improvement. Currently, this is the first case about atezolizumab induced thrombocytopenia in SCLC patient, while there is extremely rare haem-irAEs reported in SCLC. Although ICI-related severe thrombocytopenia is rare, it may persist or even be fatal. Clinicians should pay more attention to its diagnosis and prompt treatment. Once developed thrombocytopenia, large doses of methylprednisolone, ntermittent platelet transfusion, thrombopoietin should be timely administrated, also plasma exchange or rilzabrutinib, other immunosuppressive drugs, or IL-6 inhibitor warrant apply if steriod-resistant.

Transarterial Chemoembolization with Drug-Eluting Beads vs. Stereotactic Body Radiation Therapy for Hepatocellular Carcinoma: Outcomes from a Multicenter Randomized Phase II Trial

<h3>Purpose/Objective(s)</h3> Transarterial chemoembolization (TACE) is the most widely used local treatment option for patients with hepatocellular carcinoma (HCC) who are not eligible for surgery or ablation and whose disease is confined to the liver. However, local control after TACE is limited. Although stereotactic body radiation therapy (SBRT) has demonstrated high local tumor control, there have been no randomized comparisons of the two techniques. TACE delivered with drug eluting beads (TACE-DEB) was therefore compared with SBRT in a multicenter randomized trial. <h3>Materials/Methods</h3> Patients were potential candidates for the study if they were eligible for TACE but ineligible for surgery or ablation. They could also be recruited if they required treatment prior to liver transplantation. Other inclusion criteria were ECOG 0-1, cirrhosis Child Pugh A, and 1-3 tumors up to a cumulative diameter of ≤6cm. Exclusion criteria were macrovascular invasion, ascites, and untreated esophageal varices grade 3-4. A maximum of 4 TACE-DEB procedures and ablation after incomplete TACE were both allowed. SBRT was delivered in 6 fractions of 8-9Gy. Primary end point was time to progression (TTP). Secondary endpoints were local control (LC) (mRECIST); overall survival (OS); response rate (RR) (mRECIST); toxicity (CTCAE v4.03); and quality of life (QoL) (EORTC QLQ-C30, EORTC QLQ-HCC 18 and EuroQoL-5D). The calculated sample size was 100 patients. <h3>Results</h3> Between May 2015 and April 2020, 30 patients were randomized to the study. Due to slow accrual the trial was prematurely closed. Two patients in the SBRT arm were considered ineligible (low thrombocyte count, >3 tumors in the liver), leaving 16 patients in the TACE arm and 12 in the SBRT arm. One patient randomized for SBRT was subsequently treated with TACE (implanted fiducials used for SBRT tumor tracking not detectable on the Linac). Median follow-up was 28.1 months. In the intention-to-treat analyses, median TTP was 12 months for TACE and 19 months for SBRT (p=0.15). Median LC was 12 months for TACE and >40 months (not reached) for SBRT (p=0.056). Median OS was 36.8 months for TACE and 44.1 months for SBRT (p=0.36). Post-hoc analyses per protocol showed 100% for SBRT 1- and 2-year LC, and 54.4% and 43.6% for TACE (p=0.02). Both treatments resulted in RR>80%. Three episodes of possibly related toxicity grade ≥3 were observed after TACE. No episodes were observed after SBRT. QoL remained stable after both treatment arms. <h3>Conclusion</h3> SBRT showed higher local antitumoral activity than TACE-DEB in this small group of HCC patients, and no detrimental effects on TTP, OS, toxicity and QoL. But, to overcome poor accrual in randomized trials including SBRT, to validate our results, and to generate the evidence needed to include SBRT in HCC treatment guidelines, international cooperation is needed.

Cardiovascular Outcomes in Children with Multisystem Inflammatory Syndrome Treated with Therapeutic Plasma Exchange.

Multisystem inflammatory syndrome in children is a new, rare, post-infectious complication of SARS-CoV-2 infection in children. The aim of this study was to display the role of therapeutic plasma exchange on cardiovascular outcomes in children with multisystem inflammatory syndrome. This study included children who met the diagnostic criteria for multisystem inflammatory syndrome and who were admitted to the intensive care unit. This is a prospective single-center study conducted between August 2020 and September 2021. Subjects had cardiac involvement which was defined as elevated troponin I, abnormal electrocardiographic and echocardiographic findings. Patients were followed by a pediatric cardiologist throughout the intensive care unit stay and after discharge for 12 months. Patients were divided into two groups which received therapeutic plasma exchange and which did not. 38 children were included in this study. There were 16 patients in the no plasma exchange group and 22 patients in the plasma exchange group. The two groups were similar in age, sex, leucocyte, thrombocyte count, neutrophil percentage, hemoglobin, C-reactive protein, erythrocyte sedimentation rate, alanine aminotransferase, albumin, ferritin, fibrinogen, D-dimer, IL-6, troponin I, number of electrocardiographic abnormalities and patients with mitral valve regurgitation detected at admission (p &gt; 0.05). There was no significant difference between the two groups in terms of duration of normalization of electrocardiographic abnormalities and disappearance of mitral valve regurgitation (p &gt; 0.05). Duration of normalization of troponin I (2, IQR 1-4, versus 5, IQR 3-9 days; p = 0.044) and length of hospital stay (7, IQR 6-10, versus 13, 8-20 days; p = 0.001) was longer in the plasma exchange group. We did not observe any significant improvement in children having undergone plasma exchange as compared to children who did not. On the opposite, their length of hospital stay and time to troponin I normalisation were even longer. Some baseline differences in cardiac attainment severity may partly explain this finding.

Higher Risk of Recurrence in Patients Treated for Head and Neck Cancer with Low BMI and Elevated Levels of C-Reactive Protein.

Simple SummaryHead and neck cancer (HNC) treatment poses several challenges in clinical practice, and treatment side effects can be debilitating due to the close proximity of important anatomical structures. Cancer recurrence post-treatment presents some of the most challenging HNC management issues. This prospective study identifies high-risk groups for recurrence of head and neck cancer, based on commonly accessible clinical parameters. In this study with 272 HNC patients, elevated pre- and post-treatment CRP levels, low BMI and advanced stage at admission indicate higher risk for recurrence of disease. Using these parameters, a risk model is proposed which may be useful for estimating the probability of cancer recurrence and allow the identification of high and low-risk patients.This prospective study identifies high-risk groups for recurrence of head and neck cancer by BMI and circulating inflammatory response markers. Head and neck cancer patients from three Swedish hospitals were included (n = 272). Leukocyte and thrombocyte counts, CRP levels, and BMI were measured pre-treatment and post-treatment. Associations between the four factors and treatment failure (residual tumor, loco-regional failure, general failure/distant metastasis) were assessed using a Cox proportional hazards model adjusted for sex, age at the initial visit, smoking status, cancer stage, and hemoglobin count. CRP level was the only significant single variable, with an average increase in risk of recurrence of 74% (p = 0.018) for every doubling. The predictive power of a combined model using all variables was highest during the initial months after treatment, with AUC under the ROC curve 0.75 at the 0–3 month timepoints. Patients with elevated pre- and post-treatment CRP levels are at higher risk for recurrence of disease. Male patients with low post-treatment BMI, advanced stage, and high CRP at any time post treatment are at high risk for recurrence. The combined model may be useful for stratifying post-treatment patients into low and high-risk groups, to enable more detailed follow-up or additional treatment regimens.

Sex-Related Differences in Metastatic Melanoma Patients Treated with Immune Checkpoint Inhibition.

Simple SummaryImmune checkpoint inhibitors, ICI, have revolutionized the treatment of advanced melanoma. However, given the small number of patients responding to immunotherapy and the high risk for immune-related adverse events, there has been a rising interest in recent publications to identify factors that influence response to immunotherapies, including sex. We aimed at investigating sex-related differences in patients with advanced melanoma treated with ICI by linking the assessment of inflammatory response in peripheral blood, onset of IRAEs during therapy and treatment response in short- and long-term. Men with advanced melanoma showed a significantly better response to immunotherapy in short- and long-term than women. Higher immune activation in peripheral blood before and after initiation ICI might be linked to favorable treatment response during and after ICI in favor of men and decoupled from the onset of IRAEs. Given the significantly higher immunotoxicity and worse outcome experienced by women compared to men the use of ICI should be chosen carefully in women with advanced melanoma.Objectives: We aimed to investigate sex-related differences in patients with advanced melanoma treated with ICI by linking the assessment of inflammatory response in peripheral blood, onset of immune-related adverse events IRAEs during therapy and treatment response in short- and long-term. Methods: For the purpose of this single-center retrospective study metastatic melanoma patients treated with ICI were included. Baseline patient characteristics, blood sample tests and the onset of immune-related adverse events IRAEs were documented based on clinical records. The short-term treatment response was assessed with 18F-2-Fluor-2-desoxy-D-glucose Positron Emission Tomography/Computed Tomography FDG-PET/CT scans performed six months after initiation of ICI. The overall survival OS and progression-free survival PFS were used as endpoints to assess the long-term response to immunotherapy. Results: In total, 103 patients with advanced melanoma (mean age 68 ± 13.83 years) were included, 29 women (mean age 60.41 ± 14.57 years) and 74 men (mean age 65.66 ± 13.34 years). The primary tumor was located on a lower extremity in one out of three women and on the head/neck in one out of three men (p < 0.001). While the superficial spreading (41%) and nodular (36%) melanoma subtypes represented together 77% of the cases in male population, women showed a more heterogenous distribution of melanoma subtypes with the superficial spreading (35%), nodular (23%), acral lentiginous (19%) and mucosal (12%) melanoma subtypes being most frequent in female population (p < 0.001). Most differences between women and men with regards to inflammatory parameters were observed six months after initiation of ICI with a higher median NLR (p = 0.038), lower counts of lymphocytes (p = 0.004) and thrombocytes (p = 0.089) in addition to lower counts of erythrocytes (p < 0.001) and monocytes (p < 0.001) in women towards men. IRAEs were more frequent in women towards men (p = 0.013). Women were more likely to display endocrinological IRAEs, such as thyroiditis being the most frequent adverse event in women. Interestingly IRAEs of the gastrointestinal tract were the most frequent ones in men. Finally, men with advanced melanoma showed a significantly better response to immunotherapy in short- (p = 0.015) and long-term (OS p = 0.015 and PFS p < 0.001) than women. In fact, every fourth man died during the course of the disease, while every second woman did not survive. (p = 0.001). Conclusion: Men with advanced melanoma showed a significantly better response to immunotherapy in short- and long-term than women. Higher immune activation in peripheral blood before and after initiation ICI might be linked to favorable treatment response during and after ICI in favor of men and decoupled from the onset of IRAEs. Given the significantly higher immunotoxicity and worse outcome experienced by women compared to men the use of ICI should be chosen carefully in women with advanced melanoma.

Healthcare-Associated COVID-19 across Five Pandemic Waves: Prediction Models and Genomic Analyses.

Background: Healthcare-associated SARS-CoV-2 infections need to be explored further. Our study is an analysis of hospital-acquired infections (HAIs) and ambulatory healthcare workers (aHCWs) with SARS-CoV-2 across the pandemic in a Belgian university hospital. Methods: We compared HAIs with community-associated infections (CAIs) to identify the factors associated with having an HAI. We then performed a genomic cluster analysis of HAIs and aHCWs. We used this alongside the European Centre for Disease Control (ECDC) case source classifications of an HAI. Results: Between March 2020 and March 2022, 269 patients had an HAI. A lower BMI, a worse frailty index, lower C-reactive protein (CRP), and a higher thrombocyte count as well as death and length of stay were significantly associated with having an HAI. Using those variables to predict HAIs versus CAIs, we obtained a positive predictive value (PPV) of 83.6% and a negative predictive value (NPV) of 82.2%; the area under the ROC was 0.89. Genomic cluster analyses and representations on epicurves and minimal spanning trees delivered further insights into HAI dynamics across different pandemic waves. The genomic data were also compared with the clinical ECDC definitions for HAIs; we found that 90.0% of the ‘definite’, 87.8% of the ‘probable’, and 70.3% of the ‘indeterminate’ HAIs belonged to one of the twenty-two COVID-19 genomic clusters we identified. Conclusions: We propose a novel prediction model for HAIs. In addition, we show that the management of nosocomial outbreaks will benefit from genome sequencing analyses.

Hematology profile analysis in coronavirus disease 2019 (COVID-19) patients.

Some hematological parameters were reported as markers to assess severity of COVID-19 patients. Comorbidities were risk factors for severe COVID-19. Differences in hematology profile based on severity and comorbidity, and correlation between hematology profile and Ct value were never studied at Makassar, Indonesia. The aim of this study were to know the differences of hematology profile based onseverity and comorbidity, and the correlation between hematology profile and Ct value in COVID-19 patients. This study was retrospective, cross-sectional of confirmed COVID-19 patients who had been hospitalized at Dr. Wahidin Sudirohusodo hospital, Makassar, since June to August 2020. Hematology profile, Ct value, comorbidity, and severity of COVID-19 patients were obtained from Hospital Information System Data. From 217 patients, subjects were 102 (47%) male dan 115 (53%) female, 127 mild-moderate patients (58.5%) and 90 severe patients (41.5%), 143 patients (65%) without comorbidity, 74 patients (35%) with comorbidity. White blood cells (WBC), red cell distribution width (RDW), neutrophil and monocyte count, and neutrophil lymphocyte ratio (NLR) were significantly higher in severe patients than mild-moderate patients (p<0.05), besides RBC, hemoglobin, hematocrit, lymphocyte and thrombocyte count were significantly lower in severe patients than mild-moderate patients (p<0.05). Hematology profile was not different significantly based on comorbidity and was not correlated significantly with Ct value, except eosinophil count (r=0.161; p=0.018). We suggest that hematology profile could predict the severity of COVID-19 patients. Moreover, eosinophil count could be considered to predict the infectivity of patient with COVID-19.

The LIPL study lipid panels and platelet activity in coronary heart disease

Abstract Introduction Measuring lipid panel in the fasting state can be inconvenient for patients and may aggravate their compliance. Moreover, people spend most of the day in the nonfasting state. Hence, it suggests that the changes in the process of atherosclerosis happen mainly under the influence of nonfasting lipids. Up to date, the studies in the postprandial state were primarily performed in healthy subjects. Aim This exploratory study investigates the change in lipid profile and platelet activity in patients with different cardiovascular risk profiles in the postprandial state. Methods The studied population consists of 66 patients with different cardiovascular risks: patients with coronary artery disease (CAD) and diabetes mellitus type 2 (DM2) (n=20), CAD without DM2 (n=25), and a healthy control group (n=21). Lipid variables and markers of platelet function were assessed during the fasting state and 3 and 5 hours after a standardized fat meal using a standardized oral fat tolerance test (OFTT), a milkshake with 90g of fat. The platelet activity was measured with a Multiplate test using ADP, ASPI and TRAP reagents. Results Patients with CAD and DM2 were significantly older and had the highest BMI. All patients with CAD were on acetylsalicylic acid, and 95% of CAD patients were on high-dose statins. Total cholesterol, LDL-c, Apolipoprotein A1, and Apolipoprotein B did not change during the OFTT, irrespective of the group. However, HDL-c decreased statistically significantly three and five hours after the fat loading with a peak after five hours (3.46±0.4 mg/dL, p&amp;lt;0.001). The lowest HDL-c was in the CAD and DM2 group (p=0.006). Triglycerides (TG) increased significantly during the OFTT, with a peak after 5 hours (130.2±14.5 mg/dL, p&amp;lt;0.001) irrespective of the group. There was no difference in TG concentration between the groups. Differences stayed statistically significant even after adjustment for age and BMI. Platelet activity increased after fat loading, as shown by a significantly increased thrombocyte count after three hours (p&amp;lt;0.001). Platelet activity measured by multiplate test with ADP (7.16±2.17 AU, p=0.005), ASPI (4.60±1.40 AU, p=0.005), and TRAP (11.41±3.10 AU, p=0.001) reagents increased statistically significant three hours after the fat loading. The platelet activity measured by all three reagents remained increased even after the adjustment for age and BMI (ADP: 7.14±2.10 AU, p=0.004, ASPI: 4.60±1.40 AU, p=0.006, TRAP: 11.40±3.10 AU, p=0.002). Moreover, the platelet activity measured by ADP (−13.12±4.93, p=0.030), and TRAP (−14.6±15.51, p=0.031) reagents was lower in the control group. When adjusted for age and BMI, there was no difference in the platelet activity between the three groups. Conclusion This study showed that fatty meal causes worsening of lipid profile and leads to increased platelet activity in subjects irrespective of cardiovascular risk profile. Funding Acknowledgement Type of funding sources: None.

Predictors of pulmonary involvement in children with COVID-19: How strongly associated is viral load?

The purpose of this study was to identify risk factors for pulmonary involvement by examining the demographic, clinical, and laboratory characteristics of children with COVID‐19. We performed a retrospective single‐center study of COVID‐19 in children treated at a tertiary care hospital in Turkey from December 2020 to June 2021. During the course of the study, 126 patients were evaluated, of whom 70/126 were male. The patients' ages ranged from 1 to 216 (mean, 4.73 ± 81.11) months. Fever (65.9%), cough (52.4%), and shortness of breath (18.3%) were the most common symptoms of COVID‐19. Ten patients required noninvasive mechanical ventilation. Sixty‐nine patients (54.8%) had pneumonia. Longer duration of fever, hospitalization, and the presence of cough were significantly associated with pulmonary involvement. Children with pneumonia had significantly higher levels of C‐reactive protein (CRP), procalcitonin, erythrocyte sedimentation rate (ESR), and viral load, and significantly lower counts of lymphocytes and thrombocytes. The cutoff viral load, CRP, and procalcitonin values for predicting pulmonary involvement were 26.5 cycle threshold (Ct; 95% confidence interval [CI], 0.54–0.74; sensitivity, 0.65; specificity, 0.56; area under curve [AUC]: 0.647, p = 0.005), 7.85 mg/L (95% CI, 0.56–0.75; sensitivity, 0.66; specificity, 0.64; AUC = 0.656; p = 0.003) and 0.105 ng/ml (95% CI, 0.52–0.72; sensitivity, 0.55; specificity, 0.58; AUC = 0.626; p = 0.02), respectively. High CRP, procalcitonin levels, ESR, and viral load, and low lymphocyte and thrombocyte counts can predict pulmonary involvement in children with COVID‐19, so better management may be provided for good prognosis.

Hematological parameters in workers of water supply facilities of petrochemical enterprises

Introduction. One of the major petrochemical complexes of the Republic of Bashkortostan is Limited liability company (LLC) «Gazprom Neftekhim Salavat». The normal operation of industrial enterprises requires the use of large volumes of water. Its water supply, water disposal, waste disposal, reclamation of sludge reservoirs, equipment repair, cleaning of oil sludge reservoirs is provided by LLC «PromVodoKanal». The main technological personnel are wastewater treatment operators, process plant operators, pumping plant operators, chemical analysis laboratory assistants, commodity operators. Their work is associated with exposure to harmful and / or dangerous production factors. Objective. Search and substantiation of laboratory markers of early health disorders in workers of water supply facilities of petrochemical enterprises. Materials and methods. Hygienic and clinical laboratory studies were carried out among workers of the main occupations of the «PromVodoKanal» station who have contact with various harmful derivative factors. A complex of hematological and biochemical research methods was used in the work. Results. A comparative analysis of the frequency of occurrence of deviations of hematological parameters from the norm in all examined (occupational) groups was carried out. A laboratory study showed that hematological parameters are characterized by an increased content of hemoglobin, erythrocytes, and hematocrit. Changes in the mean corpuscular hemoglobin (MCH) and mean corpuscular hemoglobin concentration (MCHC), and thrombocytes count, were detected in every fifth worker. Over the years of work, the share of workers with high levels of glucose and cholesterol increases markedly, the correlation of which reaches from 0.90 to 0.97. Limitations. The article has limitations on the scientific study of working conditions, as periodic medical examinations are carried out by occupational pathologists. Conclusions. Red blood values are specific markers of workers’ health problems and require special attention during periodic medical examinations.

Risk factors for intracardiac thrombus in peripartum cardiomyopathy: a retrospective study in China.

Peripartum cardiomyopathy (PPCM) are more vulnerable to intracardiac thrombus than other types of cardiomyopathies, although explicit anticoagulant strategy is not sure. Too aggressive anticoagulation therapy can lead to severe bleeding events. Hence, we want to construct a risk stratification model for intracardiac thrombus in PPCM patients. A total of 159 suspected PPCM cases were initially screened, whereas 123 confirmed cases were enrolled in the final analysis. The study population was randomly assigned as derivation group (N=83) and validation group (N=40). The derivation cohort was utilized to develop the model, and the validation cohort was used to internal validate the discriminatory ability of the model. Formation of intracardiac thrombus was detected in 22 patients. After adjusted by multivariable logistic regression analysis, left ventricle ejection fraction (LVEF, OR 0.772, 95% CI 0.665-0.897, P=0.001), haemoglobin levels (OR 1.050, 95% CI 1.003-1.099, P=0.038), and thrombocyte counts (OR 1.018, 95% CI 1.006-1.029, P=0.003) were identified as risk factors independently associated with intracardiac thrombus and were finally included in the tentative risk stratification model with a C-indexes of 0.916 (95% CI: 0.850-0.982, P<0.001). A score of ≤7 was regarded as low risk, 8-10 defined intermediate risk, and ≥11 defined high risk in our model. Internal validation showed good discriminatory ability of the model with a C-indexes of 0.790 (95% CI: 0.644-0.936, P=0.017). In our retrospective study, impaired LVEF, elevated haemoglobin levels, and high thrombocyte counts were regarded as independent risk factors for intracardiac thrombus in PPCM. A risk stratification model derived from these risk factors, which was economic and easily applicable in clinical practice, could rapidly and accurately identify PPCM patients with higher-risk of intracardiac thrombus.

The Diagnostic Value of Platelet Count and MPV in Suspected COVID-19 Patient at Dr. Saiful Anwar Hospital

COVID-19 is a disease caused by SARS-CoV-2. Haematology alterations like lymphopenia is common, but not much study involves about thrombocyte. Incidence of thrombocytopenia in COVID-19 patient is 5-53.6%. Purpose of this study is to analyze diagnostic value of thrombocyte count and MPV in COVID-19. Cross sectional design took place at Dr. Saiful Anwar Hospital on March-June 2020. Data was taken at first admission. Confirmation test with SARS-CoV-2 gene detection with RT-PCR method. 115 patient suspected COVID-19 collected at the end of study with 69 positive and 46 negative. AUROC for thrombocyte is 0.336 (CI: 95%, 0.238 – 0.435, p= 0.01); MPV 0.488 (CI 95%, 0.378 – 0.598, p= 0.762). Thrombocyte count and MPV doesn't have good diagnostic value for COVID-19. This might be due to different conditions that patient might had at admission. Thrombocytopenia and increased MPV often caused by hyperinflammatory condition and severe infection as mentioned in other study. Thrombocyte count and MPV alone can't be used to diagnose COVID-19. Coincide use of other marker such inflammatory markers might be useful. Future study with larger sample and serial testing may needed to evaluate more about diagnostic value of thrombocyte count and MPV.

The Diagnostic Value of the Modified mSIS Score in Predicting Sentinel Axillary Lymph Node Positivity in Patients with Early-Stage Breast Cancer

Axillary lymph node metastasis is the most important prognostic factor in breast cancer. No method exists to diagnose the metastasis of the axillary lymph nodes before surgery. Sentinel lymph node biopsy is a procedure for axillary staging. Hematological parameters and systemic inflammation play a role in cancer metastasis. This study aims to evaluate the modified Systemic Inflammation Score (mSIS) score predicting sentinel axillary lymph node positivity in early breast cancer patients and to determine if there is a need to modify it. This is a retrospective study conducted in Ankara City Hospital General Surgery Department from March 2019 to July 2021. One hundred fifty-nine patients were analyzed according to age, albumin parameters, Thrombocyte, Lymphocyte and Monocyte count, histopathological type of cancer, and lymph node metastasis status. The collected information was entered into SPSS 24.0 program. Lymph node metastasis was detected in 51 of these 159 patients. Results showed no significant difference between the lymph node metastasis group and no lymph node metastasis group after applying the mSIS score to each group. This result is due to normal albumin levels in early breast cancer patients. Platalet lymphocyte ratio (PLR) is associated with lymph node metastasis in breast cancer. PLR is applied to mSIS score instead of albumin.The new modified early-stage breast cancer SIS(mebcSIS) was established as follows: Score 0: LMR ≥ 5.7 and PLR &lt; 141, Score 1: LMR &lt; 5.7 or PLR ≥ 141, Score 2: LMR &lt; 5.7 or PLR ≥ 141. The relationship between mebcSIS and LNM was statistically significant (p = 0.003). There is a positive correlation between mebcSIS score and lymph node metastasis in early breast cancer patients.

P11.27: Changes in Markers of Coagulation and Fibrinolysis Offer Insights Into Pathophysiological Aspects of Preservation Injury During Normothermic Liver Perfusion

Background: The perfusate used in normothermic machine perfusion (NMP) is mainly composed of red packed blood cells and colloid solution and is therefore free from thrombocytes and coagulation factors. Our aim was to monitor changes in composition of coagulation factors during NMP and to investigate their association with liver function during NMP and after transplantation. Methods: NMP has been performed on a heterogenous study group of 16 grafts that included 12 extended criteria donor livers. Factor V activity (FV), factor XIII activity (FXIII), van Willebrand factor activity (vWF), D-dimer, plasminogen-activator-inhibitor (PAI-1) and thrombocyte count in perfusate were assessed. Liver and bile duct biopsies were taken before and after perfusion and after reperfusion. Median follow-up after transplantation was 11 months (IQR: 6.4-12). Results: NMP and assessment of 16 livers resulted in 10 livers that were successfully transplanted. Main reasons for decline included inability to clear lactate, low bile quality, or signs of fibrosis in the frozen section. Two livers presented with increased D-dimer levels during perfusion (8.7 µg/mL and 12.3 µg/mL vs. mean peak D-dimer of 3.7 µg/mL SD: 3.1). One liver was transplanted, the histological analysis of the bile duct biopsies taken before implantation showed sclerosing cholangitis. Additionally, vWF activity during perfusion of this liver was increased (13 % vs. mean peak vWF activity of 6.4% SD: 2.5). The recipient had to be treated with a stent for an anastomotic stricture. The second liver with elevated D-dimer was severely steatotic and the only liver out of the study group that did not produce bile and was therefore declined for transplantation. The graft additionally presented with high levels of PAI-1 (299 IU/mL vs. mean peak PAI-1 of 186 IU/mL SD: 155) and increased FXIII activity in perfusate (158 % vs. mean peak FXIII activity 45% SD: 49). PAI-1 was also elevated in another three livers during perfusion, of which one was discarded due to increasing lactate after initial clearing and high grade of steatosis (peak PAI-1 605 IU/mL). Both other livers were successfully transplanted, one of the two recipients later developed an anastomotic stricture. Each of the three cases with increased PAI-1 levels coincided with peaks in either thrombocyte count, bilirubin or FV activity. Conclusion: Changes in perfusate composition of coagulation and fibrinolysis factors offer interesting new insights in pathophysiological aspects of preservation injury and might allow for additional graft assessment during longer courses of NMP. Prospective studies are needed to validate these initial findings.