| 1. |
- Mårtensson, Thomas, et al.
(författare)
-
Choice of Endoscopic Procedure in Children With Clinically Suspected Gastrointestinal Graft-Versus-Host Disease.
- 2018
-
Ingår i: Journal of Pediatric Gastroenterology and Nutrition - JPGN. - 0277-2116 .- 1536-4801. ; 66:5, s. 744-750
-
Tidskriftsartikel (refereegranskat)abstract
- Objectives: Gastrointestinal graft-versus-host disease (GI-GVHD) is a potentially life-threatening complication after hematopoietic stem cell transplantation. Symptoms indicating GI-GVHD motivates endoscopy with biopsy sampling and histopathological confirmation. Optimal extent of endoscopy in children is, however, presently unknown. Therefore, we aimed to evaluate whether biopsies from the rectosigmoid area versus the rest of the colon/ileocolon with or without biopsies from simultaneous upper endoscopy, were equally reliable for detection of GI-GVHD and relevant differential diagnoses.Methods: Retrospective multicenter study based on histopathological re-evaluation of biopsies and hospital record data, collected from children with suspected GI-GVHD.Results: Forty-four children with 51 endoscopic occasions (81 procedures) were included. Thirty-nine of 51 (76.5%) were diagnosed as GI-GVHD, 14 (27.4%) received a differential diagnosis and 7 (13.7%) had normal histology findings. Comorbidity, that is, simultaneous detection of a differential diagnosis and GI-GVHD, was observed in 9 (23.1%) cases. Cytomegalovirus infection was the most frequent differential diagnosis, 6 of 7 were detected in biopsies from rectosigmoid and esophagogastroduodenal areas. Sensitivity for detection of GI-GVHD in biopsies collected from rectosigmoid-ileocolonic-, rectosigmoid-, or esophagogastroduodenal areas were 97.4%, 84.6%, 83.3%, respectively, and 97.4% when the latter 2 were merged. The difference, nondetected GI-GVHD in the rectosigmoid area versus detected elsewhere in the GI tract, was statistically significant (P = 0.03).Conclusions: Biopsies collected from the rectosigmoid area solely were not optimal for detection of pediatric GI-GVHD. When biopsy sampling from rectosigmoid and upper GI tract areas was combined, the sensitivity for GI-GVHD was, however, equally high as for ileocolonoscopy or full upper and lower endoscopy.
|
|
| 2. |
- Mårtensson, Thomas, et al.
(författare)
-
Diagnostic disagreement between clinical standard histopathological- and retrospective assessment of histopathology-based gastrointestinal graft-versus-host disease in children
- 2020
-
Ingår i: Pediatric Transplantation. - : WILEY. - 1397-3142 .- 1399-3046. ; 24:8
-
Tidskriftsartikel (refereegranskat)abstract
- Background: No previous paediatric study has evaluated the frequency of diagnostic disagreement between clinical standard histopathological assessment (CSHA) and retrospective, independent, histopathological assessment (RIHA) of gastrointestinal Graft-Versus-Host Disease (GI-GVHD).Methods: In a retrospective cohort study, based on gastrointestinal biopsies collected from allogeneic HSCT-treated children (<18 years) with symptom-based GI-GVHD, we evaluated; disagreement of histopathology-based GI-GVHD diagnosis in CSHA vs RIHA, and potential clinical consequences of differences between the assessments. The CSHA-based diagnoses were retrieved from histopathology reports. The RIHA was performed by one pathologist, blinded to the CSHA outcomes and based on the minimal criteria for histopathology-based GI-GVHD diagnosis by theNIH 2014.Results: Seventy children with 92 endoscopic occasions (including 22 re-endoscopies) were enrolled. GI-GVHD was observed in 73% (67/92) of the endoscopies in the RIHA and in 54% (50/92) in the CSHA (P = .014). The RIHA confirmed 94% (47/50) with GI-GVHD and 52% (22/42) with non-GI-GVHD diagnoses, established in the CSHA. Disagreement, that is endoscopic occasions with GI-GVHD solely detected in RIHA or detection of GI-GVHD in CSHA but not in RIHA, was observed in 20/42 (48%) and 3/50 (6%), respectively (McNemar's test, P = .0008). The risk of a subsequent re-endoscopy was higher in endoscopic occasions with GI-GVHD detected in RIHA but not in CSHA vs if non-GI-GVHD were detected in both readings (P = .005).Conclusion: Our results suggest that in children with symptom-based GI-GVHD without histopathological confirmation in CSHA, a second,NIH 2014based histopathological assessment should be considered before performing a re-endoscopy.
|
|
| 3. |
- Jonmarker, Sandra, et al.
(författare)
-
A retrospective multicenter cohort study of the association between anti-Factor Xa values and death, thromboembolism, and bleeding in patients with critical COVID-19
- 2023
-
Ingår i: Thrombosis Journal. - 1477-9560. ; 21, s. 1-11
-
Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: Patients with critical COVID-19 have a high risk of thromboembolism, but intensified thromboprophylaxis has not been proven beneficial. The activity of low-molecular-weight heparins can be monitored by measuring anti-Factor Xa. We aimed to study the association between anti-Factor Xa values and death, thromboembolism, and bleeding in patients with critical COVID-19.METHOD: This retrospective cohort study included adult patients with critical COVID-19 admitted to an intensive care unit at three Swedish hospitals between March 2020 and May 2021 with at least one valid peak and/or trough anti-Factor Xa value. Within the peak and trough categories, patients' minimum, median, and maximum values were determined. Logistic regressions with splines were used to assess associations.RESULTS: In total, 408 patients had at least one valid peak and/or trough anti-Factor Xa measurement, resulting in 153 patients with peak values and 300 patients with trough values. Lower peak values were associated with thromboembolism for patients' minimum (p = 0.01), median (p = 0.005) and maximum (p = 0.001) values. No association was seen between peak values and death or bleeding. Higher trough values were associated with death for median (p = 0.03) and maximum (p = 0.002) values and with both bleeding (p = 0.01) and major bleeding (p = 0.02) for maximum values, but there were no associations with thromboembolism.CONCLUSIONS: Measuring anti-Factor Xa activity may be relevant for administrating low-molecular-weight heparin to patients with critical COVID-19. Lower peak values were associated with an increased risk of thromboembolism, and higher trough values were associated with an increased risk of death and bleeding. Prospective studies are needed to confirm the results.TRIAL REGISTRATION: The study was retrospectively registered at Clinicaltrials.gov, NCT05256524, February 24, 2022.
|
|
| 4. |
- Mellgren, Karin, 1962, et al.
(författare)
-
A retrospective case-control study of gastrostomy use in children undergoing hematopoietic cell transplantation
- 2023
-
Ingår i: Pediatric Transplantation. - : John Wiley & Sons. - 1397-3142 .- 1399-3046. ; 27:4
-
Tidskriftsartikel (refereegranskat)abstract
- BackgroundMaintaining a good nutritional status during the hematopoietic cell transplantation (HCT) procedure is challenging in the pediatric population. MethodsIn a multicentric retrospective study, we compared the outcome of nutritional status and HCT-related parameters in 227 pediatric patients during and after HCT between 2005 and 2015. 112 patients received a gastrostomy before the start of HCT (GS group), and 115 did not receive a gastrostomy (NGS). Data collection was performed at HCT, 3, 6, and 12 months post-HCT. ResultsAt time point of HCT the Standard Deviation Score (SDS) of weight was 0.17 in the NGS group, and 0.71 in the GS group (p = .01) Patients in the NGS group lost more weight during the first 3 months after HCT than patients in the GS group. At 12 months, patients in the NGS remained at a lower weight, while patients in the GS group slightly increased their weight.There were no differences between the groups in the incidence of acute graft-versus-host-disease (GvHD), overall survival, and non-relapse mortality. However, the number of febrile episodes requiring intravenous treatment with antibiotics, was higher in the GS group as compared to the NGS group, during the first 3 months post-HCT (p < .001). ConclusionsOur results indicate that gastrostomy can be utilized in children undergoing HCT without any negative effects on mortality. Therefore, the use of a gastrostomy appears to be a safe option to maintain a good nutritional status during the HCT procedure.
|
|
| 5. |
- Mårtensson, Thomas
(författare)
-
Acute gastrointestinal graft-versus-host disease in allogeneic hematopoietic stem cell transplanted children and adolescents : clinical aspects of histopathological evaluation and risk factors
- 2020
-
Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Background: Acute graft-versus-host disease (aGVHD), following allogeneic hematopoietic stem cell transplantation (HSCT), is a potentially life-threating condition. Gastrointestinal involvement of aGVHD (GI-aGVHD) affects approximately every fourth transplanted child. The diagnosis of GI-aGVHD is primarily symptom-based. However, symptoms associated with GI-aGVHD are nonspecific; thus, histopathological confirmation of the diagnosis, is recommended. The overall objectives of this thesis were: i) to evaluate the influence of two different conditioning regimens on the incidence of GI-aGVHD, and ii) to evaluate clinical aspects of the currently recommended diagnostic approach to GI-aGVHD, i.e., endoscopy-guided histopathological assessment, applied to pediatric HSCT patients. Patients and methods: Four retrospective cohort studies were included in this thesis. Paper I enrolled all children with HSCT performed during 2000–2010 at Karolinska University Hospital Huddinge who also had underlying diagnoses of juvenile myelomonocytic leukemia (JMML) or myelodysplastic syndrome (MDS). The children were conditioned with busulfan (Bu) and cyclophosphamide (Cy), with or without addition of melphalan (Mel). Paper IIIV included all children who underwent HSCT at any of the four HSCT centers in Sweden between 2000 and 2012 and with endoscopy-guided histopathological assessment performed to confirm symptom-based GI-aGVHD within one-year post-HSCT. In paper III-IV a retrospective, blinded, histopathological assessment (RIHA) was carried out based on the National Institutes of Health (NIH) 2014 criteria for histopathology-based GI-GVHD. Paper IV only included those with at least a biopsy sampling from the rectosigmoid area and the area proximal to the left colonic flexure. Results: Paper I. Twenty-five children were enrolled. Forty-seven percent (8/17) of the children that received addition of Mel to the BuCy conditioning, versus none (0/8) in the BuCy group, developed GI-aGVHD (stages 2-4) (p<0.05). Paper II. Based on 68 children with 91 endoscopic occasions, treatment changes in response to histopathology reports occurred in 48% (44/91). Paper III. Seventy children with 92 endoscopic occasions were assessed. Histopathologybased GI-GVHD diagnosis was established in 67 of 92 (73%) endoscopic occasions in the RIHA and in 50 of 92 (54%) in the clinical standard histopathological assessment (p=0.014). The risk of a subsequent re-endoscopy within one-year post-HSCT was higher in endoscopic occasions with GI-GVHD solely detected in RIHA versus non-GI-GVHD in both assessments (p=0.005). Paper IV. Forty-four children with 51 endoscopic occasions were analyzed. Biopsies from the rectosigmoid area had 85% sensitivity for RIHA-based GI-GVHD diagnosis. The corresponding figure for combined biopsy sampling from both rectosigmoid area and upper gastrointestinal tract was 97% and was similarly high compared with biopsies collected from complete lower endoscopy. Conclusions: I) Addition of Mel to the BuCy conditioning increased the incidence of symptom-based GI-aGVHD in children with JMML and MDS. II) Endoscopy-guided histopathological assessment was found to influence the treatment decisions and should therefore be considered in children with GI-aGVHD. III) In children with symptom-based GI-aGVHD, without confirmation of the diagnosis by clinical standard histopathological assessment, a second histopathological assessment based on the NIH 2014 criteria should be considered before performing a re-endoscopy. IV) Sigmoidoscopy combined with upper endoscopy, colonoscopy/ileocolonoscopy, or full upper and lower endoscopy should be considered as preferred choices for the endoscopic procedure in children with clinically suspected GI-aGVHD.
|
|
