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- Benediktsson, Sigurdur
(författare)
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Aspects of platelet transfusions and the association between routine coagulation tests and outcome
- 2019
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Patients with chemotherapy-induced bone marrow aplasia often develop severe thrombocytopenia which requires platelet transfusion. However, up to 25% of the patients show a less than adequate response to the transfusion. This phenomenon is called platelet refractoriness and is associated with increased morbidity and mortality as well as longer hospital stays and increased costs.It is well documented in the critical care setting that both a low platelet count (PLC) and a decline in PLC is associated with increased mortality. However, it is unknown whether the results of routine coagulation tests on admission to ICU may predict mortality and morbidity.Study I, performed on hematological patients receiving platelet transfusions, showed that platelet increments, measured as corrected count increments (CCI), declined in a linear manner from hours 1 to 24 post-transfusion. In patients with bone marrow aplasia due to chemotherapy for either acute leukemia or stem cell transplantation, the CCI declined 2.0% 0.6% (mean 95% confidence interval) per hour. In patients who were transfused prior to an intervention, the CCI declined 2.8% 1.2% per hour. Study II, a sub-study of Study I, showed that platelet increments did not correlate with endothelial damage measured with the endothelial cell markers syndecan-1, soluble thrombomodulin and vascular endothelial growth factor. Study III, a retrospective cohort study, showed that prolonged APTT and increased PT-INR on admission to the ICU correlated with increased mortality in patients with severe sepsis or septic shock.Study IV, a retrospective study on an unselected ICU cohort, showed that prolonged APTT on admission to the ICU correlated with increased mortality and the need for vasopressors and renal replacement therapy. Increased PT-INR was, on the other hand, not associated with mortality, but was nevertheless associated with the need for vasopressors and invasive ventilation.The findings in Studies III and IV were adjusted for severity of illness by adding the simplified acute physiology score 3 (SAPS 3) to the regression models. This means that APTT and PT-INR on admission to the ICU have a prognostic value which is not accounted for in the SAPS 3 model.
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| 2. |
- Benediktsson, Sigurdur, et al.
(författare)
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Coagulation tests on admission correlate with mortality and morbidity in general ICU-patients : an observational study
- 2020
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Ingår i: Acta Anaesthesiologica Scandinavica. - : Wiley. - 0001-5172 .- 1399-6576. ; 64:5, s. 628-634
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: It is well known that low platelet count on admission to intensive care units (ICU) is associated with increased mortality. However, it is unknown whether prothrombin time (PT-INR) and activated partial thromboplastin time (APTT) on admission correlate with mortality and organ failure. Therefore, the aim of this study was to investigate if PT-INR and APTT at admission can predict outcome in the critically ill patient after adjusting for severity of illness measured with Simplified Acute Physiology Score 3 (SAPS 3).MATERIALS AND METHODS: Data were retrospectively collected. APTT and PT-INR taken on admission and SAPS 3 score, were independent variables in all regression analyses. Survival analysis was done with Cox regression. Organ failure was reported as days alive and free (DAF) of vasopressors and invasive ventilation, need of continuous renal replacement therapy (CRRT) and Acute Kidney Injury Network creatinine score (AKIN-crea).RESULTS: 3585 ICU-patients were included. Prolonged APTT correlated with mortality with 95% confidence interval (CI) of hazard ratio 1.001-1.010. Prolonged APTT also correlated with DAF vasopressor, CRRT, and AKIN-crea with 95% CI of odds ratio (OR) 1.009-1.034, 1.016-1.037 and 1.009-1.028, respectively. Increased PT-INR correlated with DAF vasopressor and DAF ventilator with 95% CI of OR 1.112-2.014 and 1.135-1.847, respectively.CONCLUSIONS: APTT prolongation was associated with mortality and all morbidity outcomes except the DAF ventilator. PT-INR increase at admission was associated with DAF vasopressor and DAF ventilator. APTT and PT-INR at admission correlate with morbidity, which is not accounted for in the SAPS 3 model.
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| 3. |
- Benediktsson, Sigurdur, et al.
(författare)
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Linear decline of corrected platelet count increment within 24 hours after platelet transfusion in haematological patients : a prospective observational study
- 2017
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Ingår i: European Journal of Haematology. - : Wiley. - 1600-0609 .- 0902-4441. ; , s. 559-568
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Tidskriftsartikel (refereegranskat)abstract
- OBJECTIVES: The aim of the present study was to prospectively explore the detailed longitudinal development of platelet increments in patients with chemotherapy-induced bone marrow aplasia during the first 24 hours after platelet transfusion.METHODS: Patients admitted to the Haematology department during 7 months and fulfilled inclusion criteria were divided into 4 groups: Group 1, patients with acute leukaemia; Group 2, patients after autologous stem cell transplantation (SCT); Group 3, patients after allogeneic SCT; Group 4, patients given platelet transfusion prior to intervention. We used frequent blood sampling within 24 hours after platelet transfusion to investigate the kinetics of platelet counts following transfusion.RESULTS AND CONCLUSIONS: 54 platelet transfusion occasions in patients with chemotherapy-induced bone marrow aplasia were included. The decrease of corrected count increment (CCI) 1-24 hours after platelet transfusions in all groups could be described as linear functions. For patients in the aggregated Groups 1-3, the decline was 2.0%± 0.6% (mean± standard deviation) per hour. For patients in Group 4, the decline of CCI was 2.8%± 1.2% per hour. We found no differences between the groups, either in the rate of platelet elimination from the bloodstream or in the mean CCI, in the first 24 hours post-transfusion. This article is protected by copyright. All rights reserved.
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