UNASSIGNED: We investigated a possible association between maximum lysis (ML) measured by thromboelastography and the severity of acute immunologic reactions.
UNASSIGNED: 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.
UNASSIGNED: 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.
UNASSIGNED: ML, quantified by thromboelastography, is associated with the severity of acute immunologic reactions.
■我们研究了通过血栓弹力图测量的最大溶解(ML)与急性免疫反应严重程度之间的可能关联。
■我们在一家高容量急诊科招募了急性免疫反应患者。使用5级量表评估急诊住院时和结束时的临床疾病严重程度,从局部症状到心脏骤停。我们通过血栓弹力图确定了入院时的ML(ROTEM的外在[EXTEM],和抑肽酶[APTEM]测试),表示为ML%。纤溶亢进定义为EXTEM中ML>15%,通过添加抑肽酶(APTEM)可以逆转。我们使用精确的逻辑回归来研究ML%与疾病严重程度(1级和2级[轻度]vs3-5级[严重])之间以及纤溶亢进与疾病严重程度之间的关系。
■我们包括31名患者(71%为女性;中位年龄,52[IQR,35-58]年;10[32%]有严重反应)。有严重症状的患者的ML%更高(21[IQR,12-100]vs10[IQR,4-17]).Logistic回归发现ML%和症状严重程度之间存在显著关联(比值比,1.07;95%CI,1.01-1.21;P=.003)。在6例患者中检测到纤溶亢进,并发现与严重症状有关(比值比,17.59;95%CI,1.52-991.09;P=0.02)。D-二聚体,胰蛋白酶,免疫球蛋白E浓度随免疫反应的严重程度而增加。
■ML,通过血栓弹力图量化,与急性免疫反应的严重程度有关。