Calvin Lukas Kienbacher , Christian Schoergenhofer , Gerhard Ruzicka , Jürgen Grafeneder , Christine Hufnagl , Bernd Jilma , Michael Schwameis , Harald Herkner
{"title":"急性免疫反应中的血栓弹性成像:一项前瞻性试验研究","authors":"Calvin Lukas Kienbacher , Christian Schoergenhofer , Gerhard Ruzicka , Jürgen Grafeneder , Christine Hufnagl , Bernd Jilma , Michael Schwameis , Harald Herkner","doi":"10.1016/j.rpth.2024.102425","DOIUrl":null,"url":null,"abstract":"<div><h3>Background</h3><p>Biomarkers of fibrinolysis are elevated during acute immunologic reactions (allergic reactions and angioedema), although it is unclear whether fibrinolysis is associated with disease severity.</p></div><div><h3>Objectives</h3><p>We investigated a possible association between maximum lysis (ML) measured by thromboelastography and the severity of acute immunologic reactions.</p></div><div><h3>Methods</h3><p>We recruited patients with acute immunologic reactions at a high-volume emergency department. Clinical disease severity at presentation and at the end of the emergency department stay was assessed using a 5-grade scale, ranging from local symptoms to cardiac arrest. We determined ML on admission by thromboelastography (ROTEM's extrinsic [EXTEM], and aprotinin [APTEM] tests), expressed as ML%. Hyperfibrinolysis was defined as an ML of >15% in EXTEM, which was reversed by adding aprotinin (APTEM). We used exact logistic regression to investigate an association between ML% and disease severity (grades 1 and 2 [mild] vs 3-5 [severe]) and between hyperfibrinolysis and disease severity.</p></div><div><h3>Results</h3><p>We included 31 patients (71% female; median age, 52 [IQR, 35-58] years; 10 [32%] with a severe reaction). ML% was higher in patients with severe symptoms (21 [IQR, 12-100] vs 10 [IQR, 4-17]). Logistic regression found a significant association between ML% and symptom severity (odds ratio, 1.07; 95% CI, 1.01-1.21; <em>P</em> = .003). Hyperfibrinolysis was detected in 6 patients and found to be associated with severe symptoms (odds ratio, 17.59; 95% CI, 1.52-991.09; <em>P</em> = .02). D-dimer, tryptase, and immunoglobulin E concentrations increased with the severity of immunologic reactions.</p></div><div><h3>Conclusion</h3><p>ML, quantified by thromboelastography, is associated with the severity of acute immunologic reactions.</p></div>","PeriodicalId":20893,"journal":{"name":"Research and Practice in Thrombosis and Haemostasis","volume":null,"pages":null},"PeriodicalIF":3.4000,"publicationDate":"2024-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2475037924001146/pdfft?md5=b50c38456127610b619c7e7444ece76b&pid=1-s2.0-S2475037924001146-main.pdf","citationCount":"0","resultStr":"{\"title\":\"Thromboelastography in acute immunologic reactions: a prospective pilot study\",\"authors\":\"Calvin Lukas Kienbacher , Christian Schoergenhofer , Gerhard Ruzicka , Jürgen Grafeneder , Christine Hufnagl , Bernd Jilma , Michael Schwameis , Harald Herkner\",\"doi\":\"10.1016/j.rpth.2024.102425\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<div><h3>Background</h3><p>Biomarkers of fibrinolysis are elevated during acute immunologic reactions (allergic reactions and angioedema), although it is unclear whether fibrinolysis is associated with disease severity.</p></div><div><h3>Objectives</h3><p>We investigated a possible association between maximum lysis (ML) measured by thromboelastography and the severity of acute immunologic reactions.</p></div><div><h3>Methods</h3><p>We recruited patients with acute immunologic reactions at a high-volume emergency department. Clinical disease severity at presentation and at the end of the emergency department stay was assessed using a 5-grade scale, ranging from local symptoms to cardiac arrest. We determined ML on admission by thromboelastography (ROTEM's extrinsic [EXTEM], and aprotinin [APTEM] tests), expressed as ML%. Hyperfibrinolysis was defined as an ML of >15% in EXTEM, which was reversed by adding aprotinin (APTEM). We used exact logistic regression to investigate an association between ML% and disease severity (grades 1 and 2 [mild] vs 3-5 [severe]) and between hyperfibrinolysis and disease severity.</p></div><div><h3>Results</h3><p>We included 31 patients (71% female; median age, 52 [IQR, 35-58] years; 10 [32%] with a severe reaction). ML% was higher in patients with severe symptoms (21 [IQR, 12-100] vs 10 [IQR, 4-17]). Logistic regression found a significant association between ML% and symptom severity (odds ratio, 1.07; 95% CI, 1.01-1.21; <em>P</em> = .003). Hyperfibrinolysis was detected in 6 patients and found to be associated with severe symptoms (odds ratio, 17.59; 95% CI, 1.52-991.09; <em>P</em> = .02). D-dimer, tryptase, and immunoglobulin E concentrations increased with the severity of immunologic reactions.</p></div><div><h3>Conclusion</h3><p>ML, quantified by thromboelastography, is associated with the severity of acute immunologic reactions.</p></div>\",\"PeriodicalId\":20893,\"journal\":{\"name\":\"Research and Practice in Thrombosis and Haemostasis\",\"volume\":null,\"pages\":null},\"PeriodicalIF\":3.4000,\"publicationDate\":\"2024-05-01\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"https://www.sciencedirect.com/science/article/pii/S2475037924001146/pdfft?md5=b50c38456127610b619c7e7444ece76b&pid=1-s2.0-S2475037924001146-main.pdf\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Research and Practice in Thrombosis and Haemostasis\",\"FirstCategoryId\":\"3\",\"ListUrlMain\":\"https://www.sciencedirect.com/science/article/pii/S2475037924001146\",\"RegionNum\":3,\"RegionCategory\":\"医学\",\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"Q2\",\"JCRName\":\"HEMATOLOGY\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Research and Practice in Thrombosis and Haemostasis","FirstCategoryId":"3","ListUrlMain":"https://www.sciencedirect.com/science/article/pii/S2475037924001146","RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q2","JCRName":"HEMATOLOGY","Score":null,"Total":0}
Thromboelastography in acute immunologic reactions: a prospective pilot study
Background
Biomarkers of fibrinolysis are elevated during acute immunologic reactions (allergic reactions and angioedema), although it is unclear whether fibrinolysis is associated with disease severity.
Objectives
We investigated a possible association between maximum lysis (ML) measured by thromboelastography and the severity of acute immunologic reactions.
Methods
We recruited patients with acute immunologic reactions at a high-volume emergency department. Clinical disease severity at presentation and at the end of the emergency department stay was assessed using a 5-grade scale, ranging from local symptoms to cardiac arrest. We determined ML on admission by thromboelastography (ROTEM's extrinsic [EXTEM], and aprotinin [APTEM] tests), expressed as ML%. Hyperfibrinolysis was defined as an ML of >15% in EXTEM, which was reversed by adding aprotinin (APTEM). We used exact logistic regression to investigate an association between ML% and disease severity (grades 1 and 2 [mild] vs 3-5 [severe]) and between hyperfibrinolysis and disease severity.
Results
We included 31 patients (71% female; median age, 52 [IQR, 35-58] years; 10 [32%] with a severe reaction). ML% was higher in patients with severe symptoms (21 [IQR, 12-100] vs 10 [IQR, 4-17]). Logistic regression found a significant association between ML% and symptom severity (odds ratio, 1.07; 95% CI, 1.01-1.21; P = .003). Hyperfibrinolysis was detected in 6 patients and found to be associated with severe symptoms (odds ratio, 17.59; 95% CI, 1.52-991.09; P = .02). D-dimer, tryptase, and immunoglobulin E concentrations increased with the severity of immunologic reactions.
Conclusion
ML, quantified by thromboelastography, is associated with the severity of acute immunologic reactions.