Ghada Araji , Ahmad Mustafa , Muhammad Niazi , Chapman Wei , Rubal Sharma , Saif Abu-Baker , Georges Khattar , Suzanne El-Sayegh , Marcel Odaimi
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引用次数: 0
Abstract
Background
Disseminated intravascular coagulation (DIC) is a common complication of all leukemia subtypes, but it is an especially prominent feature of Acute Myeloid Leukemias (AML). DIC complicating AML can lead to a variety of complications, however, its association with acute cardiovascular complications has not been reported before.
Methods
National Inpatient Sample Database was used to procure individuals with AML, and baseline demographics and comorbidities were collected using ICD-10-DM codes. Patients were stratified into those with and without DIC. Greedy propensity matching using R was performed to match the two cohorts in 1:1 ratio on age, gender, and fifteen other baseline comorbidities. Univariate analysis pre and post-match along with binary logistic regression analysis post-match were used to analyze outcomes.
Results
Out of a total of 37,344 patients with AML, 996 had DIC. DIC patients were younger, predominantly males, and had lower prevalence of baseline cardiovascular comorbidities. DIC patients had statistically significant higher mortality (30.2 % vs 7.8 %), acute myocardial infarction (5.1 % vs 1.8 %), acute pulmonary edema (2.3 % vs 0.7 %), cardiac arrest (6.4 % vs 0.9 %), and acute DVT/PE (6.6 % vs 2.7 %). Logistic regression model after matching showed similar outcomes along with significantly higher rates of acute heart failure in DIC patients.
Conclusion
These findings highlight the importance of close cardiovascular monitoring and prompt recognition of complications in AML patients with DIC. The underlying mechanisms involve a complex interplay of procoagulant factors, cytokine release, and endothelial dysfunction. Further studies are needed to develop targeted interventions for prevention and management of these complications.
背景弥散性血管内凝血(DIC)是所有白血病亚型的常见并发症,但在急性髓性白血病(AML)中尤为突出。方法利用全国住院病人抽样数据库收集急性髓细胞白血病患者,并使用 ICD-10-DM 编码收集基线人口统计学资料和合并症。将患者分为有 DIC 和无 DIC 两类。使用 R 进行贪婪倾向匹配,以 1:1 的比例匹配年龄、性别和其他 15 项基线合并症。结果 在总共 37,344 名 AML 患者中,996 人患有 DIC。DIC患者更年轻,以男性为主,基线心血管合并症发生率较低。据统计,DIC 患者的死亡率(30.2% vs 7.8%)、急性心肌梗死(5.1% vs 1.8%)、急性肺水肿(2.3% vs 0.7%)、心脏骤停(6.4% vs 0.9%)和急性深静脉血栓/脑栓塞(6.6% vs 2.7%)均显著高于其他患者。匹配后的逻辑回归模型显示,DIC 患者的结果相似,但急性心力衰竭的发生率明显更高。其潜在机制涉及促凝血因子、细胞因子释放和内皮功能障碍的复杂相互作用。还需要进一步研究,以制定有针对性的干预措施,预防和处理这些并发症。
期刊介绍:
Thrombosis Research is an international journal dedicated to the swift dissemination of new information on thrombosis, hemostasis, and vascular biology, aimed at advancing both science and clinical care. The journal publishes peer-reviewed original research, reviews, editorials, opinions, and critiques, covering both basic and clinical studies. Priority is given to research that promises novel approaches in the diagnosis, therapy, prognosis, and prevention of thrombotic and hemorrhagic diseases.