Effect of hyperparathyroidism on coagulation: a global assessment by modified rotation thromboelastogram (ROTEM)

Yorulmaz, Göknur; Kalkan, Ahmet Toygar; Akalın, Ayşen; Alagüney, Elif Sevil; Gündüz, Eren; Badak, Bartu; Buyruk, Betul Aydin; Kebapçı, Medine Nur; Efe, Fatma Belgin; Bilgin, Muzaffer; Akay, Olga Meltem

doi:10.3906/sag-2012-247

Cited by 5 publications

(5 citation statements)

References 20 publications

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“…As a thrombotic disease, the coagulation function of patients with ACI has been a research hotspot for neurology/emergency scholars, and a comprehensive and systematic reflection of the coagulation function and fibrinolytic function of the body after acute cerebral infarction is important for predicting the occurrence of END, precise clinical medication guidance, improving the clinical treatment effect, and improving the long-term prognosis of ACI patients [ 11 , 12 ]. Thromboelastography (TEG) monitors the coagulation process from the whole dynamic process of platelet aggregation, coagulation, and fibrinolysis, which can dynamically reflect coagulation factors, fibrinogen, platelet function, and fibrinolysis, and is a sensitive test for overall evaluation of coagulation, which can provide strong evidence for the existence of the hypercoagulable state in thrombotic diseases [ 13 , 14 ]. The literature [ 15 ] reported that changes in TEG were sensitive predictors of the risk of progression to cerebral infarction in patients with cerebral ischemia and that several of its indicators were positively correlated with the occurrence of cerebral infarction.…”

Section: Prefacementioning

confidence: 99%

Study on the Predictive Value of Thromboelastography in Early Neurological Deterioration in Patients with Primary Acute Cerebral Infarction

Zhang

Jia

Chen

et al. 2022

Evidence-Based Complementary and Alternative Medicine

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Objective. To investigate the predictive value of thromboelastography for the occurrence of early neurological deterioration (END) in patients with primary acute cerebral infarction (ACI). Methods. 150 patients who were hospitalized in the department of neurology of our hospital from September 2020 to September 2021 and were clearly diagnosed with primary ACI by head CT and head magnetic resonance imaging (MRI) were selected and divided into END and non-END groups according to the change in National Institute of Health Stroke Scale (NIHSS) score within 72 h of admission. The general baseline data and laboratory indexes of the first examination at admission were compared between the two groups, and the factors that may affect the occurrence of END were determined by univariate analysis and multivariate logistic regression analysis, and the predictive value of thromboelastography on the occurrence of END after ACI was analyzed by applying the receiver operating characteristic (ROC) curve. Results. Time to onset, baseline NIHSS score, percentage of diabetes, white blood cell (WBC) levels, C-reactive protein (CRP), and apolipoprotein B (Apo B) levels were higher in the END group than in the non-END group ( P < 0.05 ); coagulation reaction time (RT) (3.97 ± 1.16 vs. 5.49 ± 1.03) and kinetic time (KT) (1.32 ± 0.67 vs. 1.82 ± 0.58) were lower in the END group than in the non-END group ( P < 0.05 ). Inthe END group ( P < 0.05 ) diabetes, baseline NHISS score, CRP level, Apo B level, and RT were independent risk factors for the development of END in patients with ACI ( P < 0.05 ). The AUC of RT to predict the occurrence of END in patients with ACI was 0.855 (95% CI: 0784 to 0925, P = 0.001 ), with a sensitivity of 81.70% and specificity of 78.00% when the optimal cut-off value was 0.597. Conclusion. NIHSS score at admission, CRP, apolipoprotein B, RT shortening, and diabetes mellitus were independent risk factors for the development of END in ACI patients; RT shortening in TEG was predictive of END in ACI patients.

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Section: Prefacementioning

confidence: 99%

Study on the Predictive Value of Thromboelastography in Early Neurological Deterioration in Patients with Primary Acute Cerebral Infarction

Zhang

Jia

Chen

et al. 2022

Evidence-Based Complementary and Alternative Medicine

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“…Elevated iCa can lead to increased cardiac load, causing arrhythmias, elevated blood pressure, or increased myocardial contractility, which can further disrupt cardiovascular function in patients with sepsis [32][33][34] . (2) Thrombosis formation: Elevated calcium levels enhance coagulation factor activity and increase blood viscosity, thereby increasing the risk of thrombosis [35][36][37] . (3) Immune dysregulation: Hypercalcemia impairs immune cell function and disrupts immune system regulation, which increases the severity of infection, exacerbates sepsis, and increases the risk of death [38,39] .…”

Section: Discussionmentioning

confidence: 99%

Nonlinear relationship between ionized calcium and 28-day mortality in patients with sepsis: A retrospective cohort study from MIMIC-IV database

Liang,

Chen,

Zhou

et al. 2024

Preprint

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Background: This study aimed to investigate the linear and nonlinear relationships between ionized calcium levels and 28-day mortality in patients with sepsis in the intensive care unit (ICU) and to provide clinicians with a direction for laboratory index testing and a basis for a calcium supplementation program. Methods: The data of patients with sepsis were extracted from the Medical Information Mart for Intensive Care (MIMIC-IV;) database, iCa served as the exposure variable, and 28-day mortality served as the outcome variable. The relationship between iCa and 28-day mortality was investigated using multivariate binary logistic regression models, with adjustment for covariates. A generalized additive model (GAM) and smoothed curve fitting were used to investigate the non-linear relationship between iCa and 28-day mortality. A two-piecewise linear model was used to calculate the OR and 95% CI on either side of the inflection point. Results: Patients with sepsis (n = 20,417) were included in the analysis, with an overall 28-day mortality rate of 19.73%. Sepsis patients were grouped into quartiles (Q1 - Q4) according to ionized calcium levels, and after complete adjustment, the short-term mortality rate of sepsis patients in Q2 - Q4 was significantly lower than that in the Q1 group (OR:0.78, 95% CI: 0.70 - 0.87. OR: 0.74, 95% CI: 0.66 - 0.83. OR: 0.81, 95% CI: 0.72 - 0.9. iCa and 28-day mortality displayed a U-shaped relationship among patients with sepsis. When iCa levels were less than 1.14 mmol/L, each unit increase corresponded to a 79% reduction in the risk of 28-day sepsis mortality(OR: 0.21, 95% CI: 0.13 - 0.35). Conversely, when iCa exceeded 1.14 mmol/L, each unit increase was linked to an 85% increase in the 28-day mortality risk (OR: 1.85, 95% CI: 1.08 - 3.16). Conclusion: The relationship between iCa and 28-day mortality in patients with sepsis showed a U-shaped curve with an inflection point of 1.14 mmol/L, which is in the range of mild hypocalcemia.

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“…The hypercoagulable state in a patient with PHPT is not fully understood, whether secondary to hypercalcemia or primary hyperparathyroidism [7,25]. However, multiple mechanisms have been suggested, such as the effect of calcium in the vascular smooth muscle causing vasoconstriction or stimulation of multiple factors in the clotting system that boosts platelet aggregation.…”

Section: Discussionmentioning

confidence: 99%

“…Furthermore, the ability of the kidneys to reabsorb sodium and water is altered by the hypercalcemic state, and non-compensated polyuria due to nausea and anorexia can cause dehydration and lead to a hypercoagulable state. In addition, a high calcium concentration has a cytotoxic effect and results in thrombosis [7,25].…”

Section: Discussionmentioning

confidence: 99%

Pancreatitis with Intraabdominal Venous Thrombosis as an Initial Presentation of Parathyroid Adenoma: A Rare Clinical Presentation

Alalawi,

Alrashidi,

Alshahrani

2024

Am J Case Rep

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Patient: Female, 34-year-old Final Diagnosis: Acute necrotizing pancreatitis with intra abdominal veins thrombosis secondary to parathyroid adenoma Symptoms: Epigastric abdominal pain • radiated to the back• vomiting Clinical Procedure: — Specialty: Endocrinology and Metabolic • Surgery Objective: Rare disease Background: Benign parathyroid adenoma is a cause of hypercalcemia, which can lead to acute pancreatitis. Patients with acute pancreatitis are at risk for venous thrombosis. This report describes a 34-year-old woman with hypercalcemia due to parathyroid adenoma and acute pancreatitis associated with splenic vein and superior mesenteric vein thrombosis. Case Report: A previously healthy 34-year-old woman presented with severe epigastric pain that radiated to the back, associated with vomiting. Her abdominal examination was soft and lax, with epigastric and left upper quadrant tenderness. Pancreatitis with splenic and superior mesenteric veins thrombosis was diagnosed. The diagnosis was confirmed by an elevated serum lipase level and contrast-enhanced computed tomography (CT) of abdomen. Her serum calcium level was elevated. However, further workup revealed elevated parathyroid hormone (PTH) levels and radiological imaging showed parathyroid adenoma. She was diagnosed with hypercalcemia-induced pancreatitis secondary to hyperparathyroidism with intraabdominal venous thrombosis. The patient was initially treated conservatively, and later underwent parathyroidectomy after her condition was stabilized. The patient is currently in good condition, after a 2-year follow-up period. Conclusions: Acute pancreatitis and thrombosis secondary to primary hyperparathyroidism (PHPT) are rare, but can lead to potentially fatal complications, especially in patients without symptoms of PHPT. This report highlights the importance of recognizing that hypercalcemia associated with parathyroid adenoma can result in acute pancreatitis, leading to hypercoagulable states and inflammation of adjacent vessels, including the splenic and mesenteric veins. To the best of our knowledge, this is second case report of acute pancreatitis with intraabdominal venous thrombosis secondary to PHPT.

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Effect of hyperparathyroidism on coagulation: a global assessment by modified rotation thromboelastogram (ROTEM)

Cited by 5 publications

References 20 publications

Study on the Predictive Value of Thromboelastography in Early Neurological Deterioration in Patients with Primary Acute Cerebral Infarction

Study on the Predictive Value of Thromboelastography in Early Neurological Deterioration in Patients with Primary Acute Cerebral Infarction

Nonlinear relationship between ionized calcium and 28-day mortality in patients with sepsis: A retrospective cohort study from MIMIC-IV database

Pancreatitis with Intraabdominal Venous Thrombosis as an Initial Presentation of Parathyroid Adenoma: A Rare Clinical Presentation

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