RESUMEN
A 12-year-old girl with severe acute respiratory syndrome coronavirus 2 infection presented as phlegmasia cerulea dolens with venous gangrene. Emergent mechanical thrombectomy was complicated by a massive pulmonary embolism and cardiac arrest, for which extracorporeal cardiopulmonary resuscitation and therapeutic hypothermia were used. Staged ultrasound-assisted catheter-directed thrombolysis was used for treatment of bilateral pulmonary emboli and the extensive lower extremity deep vein thrombosis while the patient received extracorporeal membrane oxygenation support. We highlight the need for heightened suspicion for occult severe acute respiratory syndrome coronavirus 2 infection among children presenting with unusual thrombotic complications.
Asunto(s)
COVID-19/diagnóstico , Embolia Pulmonar/virología , Tromboflebitis/virología , Venas/patología , Trombosis de la Vena/virología , COVID-19/complicaciones , COVID-19/patología , COVID-19/terapia , Niño , Femenino , Gangrena/diagnóstico , Gangrena/virología , Humanos , Embolia Pulmonar/diagnóstico , Embolia Pulmonar/patología , Embolia Pulmonar/terapia , Tromboflebitis/diagnóstico , Tromboflebitis/patología , Tromboflebitis/terapia , Trombosis de la Vena/diagnóstico , Trombosis de la Vena/patología , Trombosis de la Vena/terapiaRESUMEN
BACKGROUND AND AIMS: Portal vein thrombosis (PVT) is a critical complication in cirrhotic patients. We explored the role of the activated factor VII-antithrombin (FVIIa-AT) complex and enhanced monocytic tissue factor (TF) expression in the development and prediction of non-neoplastic PVT in cirrhotic patients. MATERIAL AND METHODS: A total of 30 HCV-cirrhosis patients were included in our study. They were compared to 35 cirrhotic patients without PVT, 15 non-cirrhotic patients with PVT, and 15 healthy controls. The plasma level of the FVIIa-AT complexes was analyzed by ELISA. MIF CD142, CD86, and HLA-DR on monocytes (CD14) were determined by flow cytometry. RESULTS: Compared with cirrhotic patients without PVT, cirrhotic patients with PVT had comparable plasma values of FVIIa, AT, and the FVIIa-AT complex. However, they had significantly lower values compared to non-cirrhotic patients with PVT and healthy controls. Cirrhotic patients with PVT had increased monocytic TF expression (MIF CD142) compared to non-PVT cirrhotic patients and healthy controls [86.5 (93.5) vs. 18 (32.0) and 11.0 (6.0), respectively; p < 0.001 for each]. However, cirrhosis PVT could not be distinguished from non-cirrhosis PVT. The area under the ROC curve of MIF CD142 was 0.759 (0.641- 0.876; p = 0.000) at an optimal cut-off value of 45, which yielded a sensitivity of 60% and a specificity of 77.1%, as well as a PPV and NPV of 69.2% for each. CONCLUSION: Enhanced expression of monocytic TF may have a role in the development and prediction of non-neoplastic PVT in HCV-cirrhosis patients. Large multicenter studies are necessary to validate our results.
Asunto(s)
Antitrombinas/análisis , Coagulación Sanguínea , Factor VIIa/análisis , Hepatitis C/complicaciones , Cirrosis Hepática/sangre , Vena Porta , Tromboplastina/análisis , Trombosis de la Vena/sangre , Adulto , Área Bajo la Curva , Biomarcadores/sangre , Estudios de Casos y Controles , Distribución de Chi-Cuadrado , Femenino , Hepatitis C/sangre , Hepatitis C/diagnóstico , Hepatitis C/inmunología , Humanos , Cirrosis Hepática/diagnóstico , Cirrosis Hepática/inmunología , Cirrosis Hepática/virología , Modelos Logísticos , Masculino , Persona de Mediana Edad , Complejos Multiproteicos , Análisis Multivariante , Vena Porta/diagnóstico por imagen , Valor Predictivo de las Pruebas , Estudios Prospectivos , Curva ROC , Factores de Riesgo , Trombosis de la Vena/diagnóstico , Trombosis de la Vena/inmunología , Trombosis de la Vena/virología , Adulto JovenRESUMEN
BACKGROUND/OBJECTIVES: Hepatitis C virus (HCV) infection is one of the leading causes of cirrhosis. As a result of chronic inflammatory response to the virus, HCV-infected patients may be at a higher risk of venous thromboembolism (VTE). However, the data on this association is unclear. This systematic review and meta-analysis was conducted with the aims to summarize all available evidence. MATERIAL AND METHODS: A literature search was performed using MEDLINE and EMBASE from inception to April 2016. Studies that reported relative risks, odd ratios, or hazard ratios comparing the risk of VTE among HCV-infected patients vs. subjects without HCV infection were included. Pooled risk ratios (RR) and 95% confidence interval (CI) were calculated using a random-effect, generic inverse variance method. RESULTS: Three studies met our eligibility criteria and were included in analysis. The pooled RR of VTE in HCV-infected patients vs. subjects without HCV infection was 1.38 (95% CI, 1.08-1.77, I2 = 40%). Subgroup analysis showed that risk was increased for both pulmonary embolism (PE) and deep venous thrombosis (DVT) even though without adequate power to demonstrate statistical significance (Pooled RR of 1.34, 95% CI, 0.67-2.66 for PE and pooled RR 1.45, 95% CI, 0.93-2.77 for DVT). CONCLUSION: Our study demonstrated a significantly increased risk of VTE among HCV-infected patients. Further studies are required to clarify how this risk should be addressed in clinical practice.