PDF(Pubmed)
Abstract：
UNASSIGNED: Biomarkers of fibrinolysis are elevated during acute immunologic reactions (allergic reactions and angioedema), although it is unclear whether fibrinolysis is associated with disease severity.
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.
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.
摘要：
■纤维蛋白溶解的生物标志物在急性免疫反应（过敏反应和血管性水肿）期间升高，尽管目前尚不清楚纤维蛋白溶解是否与疾病严重程度相关。
■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。
■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。
