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Background: Critically ill cirrhotic patients have a high mortality, particularly with concomitant respiratory failure on admission. There are no specific models in use for mortality risk assessment in critically ill cirrhotic patients with acute respiratory failure (CICRF). The aim is to develop a risk prediction model specific to CICRF in order to quantify the severity of illness.Methods: We analyzed 949 CICRF patients extracted from the MIMIC-III database. The novel model (ARF-CLIF-SOFA) was developed from the CLIF-SOFA score. Cox regression analysis and AUROC were implemented to test the predictive accuracy, compared with existing scores including the CLIF-SOFA score and MELD-related scores.Results: ARF-CLIF-SOFA contains PaO2/FiO2 ratio, lactate, MAP, vasopressor therapy, bilirubin and creatinine (1 point each; score range: 0–6). Based on our patient cohort, the ARF-CLIF-SOFA score had good predictive accuracy for predicting the 30-, 90-day and 1-year mortality (AUROC = 0.767 at 30-day, 0.768...

Background. The present study is undertaken to investigate the fibrinogen levels in type 2 diabetes mellitus (T2DM) and its relation to peripheral artery disease (PAD) based on a more accurate and applied noninvasive measurements of duplex ultrasonography. Methods. We performed a cross-sectional study including 1096 T2DM patients (474 males and 622 females). The odds ratios (ORs) and 95% confidence intervals (CIs) were presented to show the association between PAD and fibrinogen in the subjects divided by fibrinogen levels quarterly. Furthermore, the univariate and multiple logistic analyses were performed to explore the correlation between PAD and fibrinogen levels, individual components in the cross-sectional study. Results. Finally, 887 (80.9%) T2DM patients meet the diagnostic criteria of PAD and these patients had considerably higher serum fibrinogen concentration than non-PAD group (P<0.001). Multiple logistic analyses revealed that higher fibrinogen quartiles were positively related with the development of PAD in the adjusted model. After adjusting for known confounding parameters, the ORs for PAD were 1.993 (95% CI: 1.322-3.005, P<0.001), 2.469 (95% CI: 1.591-3.831, P<0.001), and 2.942 (95% CI, 1.838-4.711, P<0.001) for Q2, Q3, and Q4, respectively (all P values Conclusions. Our results suggest that serum fibrinogen concentration can be considered as an independent risk factor for PAD in T2DM patients.

Objective The role of sLOX‐1 in acute ischemic stroke still remains unclear. This study aims to demonstrate the value of sLOX‐1 in evaluating degrees of intracranial artery stenosis and to predict prognosis in stroke. Methods Two hundred and seventy‐two patients were included in this study and basic data were collected within 72 hr on admission. We assessed the association between sLOX‐1 levels and stroke conditions in one‐year duration. After adjusting for potential confounders, regression analyses were performed. Results We found that sLOX‐1 levels were increased significantly in severe patients compared to the mild stroke group (p = .011). After adjusting confounders, sLOX‐1 was associated with a poor functional outcome in patients with an adjusted OR of 2. 946 (95% CI, 1.788–4.856, p

Serum creatinine measurement demonstrates a poor specificity and sensitivity for the early diagnosis of acute kidney injury (AKI) in patients with cirrhosis. The existing model for end-stage liver disease (MELD) score reveals multiple pitfalls in critically ill patients with cirrhosis and acute kidney injury (CAKI). The aim of this study was to re-evaluate the role of creatinine values in the existing MELD score and to develop a novel score for CAKI, named the "acute kidney injury-model for end-stage liver disease score" (AKI-MELD score). We extracted 651 CAKI from the Multiparameter Intelligent Monitoring in Intensive Care database. A time-dependent Cox regression analysis was performed for developing remodeled MELD scores (Reweight-MELD score, Del-Cr-MELD score, and AKI-MELD score). The area under the receiver operating characteristic curve provided the discriminative power of scoring models related to outcome. The hazard ratio of creatinine was 1.104 (95% confidence interval [CI], 0.945-1.290; P = 0.211). Reweight-MELD score and Del-Cr-MELD score (decreasing the weight of creatinine) were superior to the original MELD score (all P < 0.001). The new AKI-MELD score consists of bilirubin, the international normalized ratio, and the ratio of creatinine in 48 hours to creatinine at admission. It had competitive discriminative ability for predicting mortality (area under the receiver operating characteristic curve, 0.720 [95% CI, 0.653-0.762] at 30 days, 0.688 [95% CI, 0.630-0.742] at 90 days, and 0.671 [95% CI, 0.612-0.725] at 1 year). Further, AKI-MELD score had significantly higher predictive ability in comparison with MELD score, MELD-Na score, and Updated MELD score (all P < 0.001). Conclusion: The predictive value of creatinine for CAKI should be re-evaluated. AKI-MELD score is a potentially reliable tool to determine the prognosis for mortality of CAKI. (Hepatology Communications 2017;1:748-756).

Acute circulatory failure (ACF) is associated with high mortality rates in critically ill cirrhotic patients. Only a few accurate scoring models exist specific to critically ill cirrhotic patients with acute circulatory failure (CICCF) for mortality risk assessment. The aim was to develop and evaluate a novel model specific to CICCF. This study collected and analyzed the data on CICCF from the Multiparameter Intelligent Monitoring in Intensive Care-III database. The acute circulatory failure–chronic liver failure–sequential organ failure assessment (ACF–CLIF–SOFA) score was derived by Cox’s proportional hazards regression. Performance analysis of ACF–CLIF–SOFA against CLIF–SOFA and model for end-stage liver disease systems was completed using area under the receiver operating characteristic curve. ACF–CLIF–SOFA identified six independent factors: mean arterial pressure [hazard ratio (HR)=0.984, 95% confidence interval (CI): 0.978–0.990, P

Abstract 4196 Objective Retrospective analysis of acute transfusion reactions occurred in our hospital in recent years. Methods Investigate all hospitalized patients who transfused various blood components from November 2006 to July 2009. Results During study period, there were 27,672 times transfusion with 80,112 units various blood components, mainly red blood cells(RBCs), frozen plasma(FP) and leukocyte-depleted platelets(PLTs). Acute transfusion reactions occured in 143 patients of 159 times transfusion, including febrile nonhemolytic transfusion reactions(FNHTR), allergic transfusion reactions(ATR), transfusion-related acute lung injury(TRALI), transfusion-associated circulatory overload(TACO) and hemorrhagic tendency. The 143 enrolled patients, 87male and 56female, were between the age of 16 and 94. The incidence rate of acute transfusion reaction was 0.57%, FNHTR and ATR accounted for 96.23%. Of all blood components, the incidence rates of acute reaction were 0.35%, 0.50% and 1.82% respectively in RBCs, FP and PLTs transfusions. In 159 times of acute transfusion reactions, the constituent ratios of 0∼3 times and more than 3 times transfusion were 23.27%, 18.87%, 7.55%, 4.40% and 45.91%, respectively. Conclusion Most of acute transfusion reactions were FNHTR and ATR. The highest incidence rate was in platelets transfusion, and the most constituent ratio was in patients who have received more than 3 times transfusion. Disclosures: No relevant conflicts of interest to declare.

Abstract 4189 Objective To determine the efficacy between apheresis platelet concentrates(APCs) and platelets (PLTs) derived from whole blood(WBD) transfusion in acute leukemia patients receiving chemotherapy without remission. Methods All patients received same ABO group and leukocyte depletion PLTs. According to the platelet count before and after transfusion, we used percent platelet recovery(PPR) and corrected count increment(CCI) at 24 hours post-transfusion to analysis the outcomes. Results A total of 130 patients between the ages of 14 and 80 received 771 times PLTs transfusion. 85 patients were males, and 45 were females. There were 596 times APCs and 175 times WBD. In APCs, the platelet counts were 11.97±10.43×109/L and 24.68±18.63×109/L pre- and post-transfusion(P Conclusion For the patients of acute leukemia without remission, the incidence rate of PTR was high, even if they received same ABO group and leukocyte depletion products. The efficacy was not significant difference between APCs and WBD transfusions. Disclosures: No relevant conflicts of interest to declare.

Objective: To analysis the clinical features and therapy of acquired primary fibrinolysis. Methods: The underlying diseases, clinical manifestations, laboratory findings, treatment and outcomes of 22 primary fibrinolysis were analyzed retrospectively. Results: 22 patients were enrolled, 13 were male, and 9 were female. The median age was 54.9(17–77) years. The underlying diseases were ulcer of gastric-carcinoma bleeding, colorectal polypectomy by endoscope, intracranial tumor to get worse quickly, metanephric duct galeted by holmium laser+DJ tube implantation, herniorrhaphy of abdominal incision, gaster carcinosectomy, colon carcinosectomy, cerebral trauma and operation of cranium. Patients have bleeding and hemorrhage from surgical incisions or venipuncture or catheter sites in 1 to 7 days after trauma or surgery, with a disproportionately low level of fibrinogen (Fg), high level of tissue type plasminogen activator activity (t-PA) and a relatively normal of thrombin time (PT), activated partial thromboplastin time (APTT), thrombin time(TT), normal or nearly normal of platelet count. Diagnosis of primary fibrinolysis was established clearly, the patients were treated with plasma, cryoprecipitate, fibrinogen and fibrinolytic inhibitor PAMBA. Prognosis was quite good, 18/22 patients were cured. Conclusion: Primary fibrinolysis may complicate various disorders, most of them are trauma, surgery, and malignancy. Bleeding and hemorrhage from surgical incisions or venipuncture or catheter sites is a predominant clinical feature. Low fibrinogen level with a normal or nearly normal platelet count is a predominant laboratory feature. We should differentiate primary fibrinolysis from the secondary fibrinolysis in DIC. Control of the primary disease, use fibrinolytic inhibitor, and replace depleted clotting factors with plasma, cryoprecipitate, fibrinogen, most of patients can be cured.

Objective: To estimate the appropriateness of frozen plasma (FP) transfusions in a tertiary-care teaching hospital. Methods: The medical records of all hospitalized patients transfused with FP between 1 April 2007 and 31 April 2008 were reviewed, analyzed retrospectively according to the Clinical Blood Transfusion Technical Specification from Ministry of Healthy. Results: In 5084 times 13627 units FP transfusions, departments of surgery used 77.7%, and departments of internal medicine used 22.3%. The medical records showed that the reasons of FP transfusion included supply coagulation factors, supply intraoperative blood loss, postoperative supporting therapy for enhancement of wound healing, volume expansion, plasma exchange, nutritional support and massive transfusion. Overall, the 68.5% of FP transfusions were assessed as inappropriate. The inappropriateness rate in departments of surgery was 71.7%, and that in departments of internal medicine was 22.6%. Conclusion: There is considerable inappropriate transfusion of FP in our hospital, for there has some important objective reasons. It is stated that the Technical Specification is not suitable to the condition of blood production supply and clinical practice. Clinicians should follow evidence-based transfusion guidelines for appropriate use of FP. So we suggest the Technical Specification should be renew periodly.

Objective: To inquire into the clinical features of acquired multiple coagulation factors inhibitors associated bleeding disorder. Methods: A case of acquired multiple coagulation factors inhibitors in clinical manifestations, diagnosis, treatment and result was described and related literatures were reviewed. Results: A 74-year-old man developed sustained wound bleeding after implantation of heart pacemaker. Prothrombin time (PT), activated partial thromboplastin time (APTT) were prolonged significantly. But thrombin time (TT), fibrinogen (Fg), platelet count(PLT) and liver function were normal. 3P test was negative. Further tests revealed that the activities of factor 2, 5, 7,8,9,10,11,12 were all less than 10%, and the inhibitors of these factors could be detected, with the titers ranging from 8~64 Bu. So acquired multiple coagulation factor inhibitors was diagnosed. Transfusion with frozen plasma and cryoprecipitate was ineffective, whereas the combination therapy with glucocorticoid plus plasma exchange seemed to be successful. The patient was cured. Conclusion: Acquired multiple coagulation factors inhibitors is a rare bleeding disorder. In fact, this is the first case, as far as we are aware. It may develop serious bleeding. Immunosuppressive agents, such as corticosteroids, used for suppression of autoantibodies formation and plasma exchange, used for eradication of inhibitors may have beneficial effects.