Risk of Infection and Death Among Post-splenectomy Patients

Bisharat, Naiel; Omari, Hussam; Lavi, Idit; Raz, Raul

doi:10.1053/jinf.2001.0904

Cited by 410 publications

(308 citation statements)

References 41 publications

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“…Other studies have demonstrated an increased risk of postsplenectomy bacteremia and infection, 43 with reported rates of 2.3% to 3.2%. 15,16 The present study also demonstrates that patients with ITP who underwent splenectomy were at higher risk for both early and late sepsis compared with nonsplenectomized ITP patients.…”

Section: Discussionsupporting

confidence: 61%

“…[15][16][17] In examining the risk of infection after splenectomy in ITP patients, most studies are small series and have demonstrated either no or minimal increased risk of infection. 6,[18][19][20][21][22][23][24][25] The aim of this study was to better define the incidence and risks factors associated with AbVTE, VTE, and sepsis in adult patients with ITP after splenectomy compared with patients with ITP who did not undergo splenectomy.…”

Section: Introductionmentioning

confidence: 99%

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Splenectomy and the incidence of venous thromboembolism and sepsis in patients with immune thrombocytopenia

Boyle¹,

White

Brunson³

et al. 2013

Blood

182

148

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• After splenectomy, patients with ITP have a higher risk of venous thrombosis and sepsis than patients with ITP who do not undergo splenectomy.Patients with immune thrombocytopenia (ITP) who relapse after an initial trial of corticosteroid treatment present a therapeutic challenge. Current guidelines recommend consideration of splenectomy, despite the known risks associated with surgery and the postsplenectomy state. To better define these risks, we identified a cohort of 9976 patients with ITP, 1762 of whom underwent splenectomy. The cumulative incidence of abdominal venous thromboembolism (AbVTE) was 1.6% compared with 1% in patients who did not undergo splenectomy; venous thromboembolism (VTE) (deep venous thrombosis and pulmonary embolus) after splenectomy was 4.3% compared with 1.7% in patients who did not undergo splenectomy. There was increased risk of AbVTE early (<90 days; hazard ratio [HR] 5.4 [confidence interval (CI), 2.3-12.5]), but not late ( ‡90 days; HR 1.5 [CI, 0.9-2.6]) after splenectomy. There was increased risk of VTE both early (HR 5.2 [CI, 3.2-8.5]) and late (HR 2.7 [CI, 1.9-3.8]) after splenectomy. The cumulative incidence of sepsis was 11.1% among the ITP patients who underwent splenectomy and 10.1% among the patients who did not. Splenectomy was associated with a higher adjusted risk of sepsis, both early (HR 3.3 [CI, 2.4-4.6]) and late (HR 1.6 or 3.1, depending on comorbidities). We conclude that ITP patients post splenectomy are at increased risk for AbVTE, VTE, and sepsis. (Blood. 2013;121(23):4782-4790)

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Section: Discussionsupporting

confidence: 61%

Section: Introductionmentioning

confidence: 99%

Splenectomy and the incidence of venous thromboembolism and sepsis in patients with immune thrombocytopenia

Boyle¹,

White

Brunson³

et al. 2013

Blood

182

148

View full text Add to dashboard Cite

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“…Because of the high fatality rate (46%) associated with OPSI, asplenic individuals need to be vaccinated against encapsulated bacteria, which are most frequently responsible for the infection (i.e. pneumococcus, meningococcus and Haemophilus influenzae type b) (9,10). Some authors also recommend annual vaccination against influenza virus, because influenza predisposes to sepsis and pneumonia (11,12).…”

Section: Infectious Risksmentioning

confidence: 99%

Patients After Splenectomy: Old Risks and New Perspectives

Dragomir¹,

Petrescu²,

Manga³

et al. 2016

chr

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Rezumat Pacienåii post-splenectomie: complicaåii cunoscute aei perspective noiComplicaåiile care survin în urma splenectomiei pot fi împãråite în infecåioase aei non-infecåioase. Legãtura dintre splenectomie aei aceste riscuri este doar paråial înåeleasã. Rãspunsul imun al gazdei împotriva infecåiei este profund modificat post-splenectomie, iar aceaeti indivizi sunt mai susceptibili sã dezvolte sepsis aei infecåia are o evoluåie fulminantã. Splenectomia este de asemenea un potenåial factor de risc pentru numeroase complicaåii vasculare care rezultã în urma obstrucåiei paråiale sau totale ale unei artere sau vene. În plus, hipertensiunea pulmonarã poate fi o complicaåie severã aei uneori fatalã a splenectomiei. Unii autori includ aei neoplaziile, diabetul zaharat aei pancreatita acutã în categoria complicaåiilor non-infecåioase post-splenectomie. Cea mai de temut complicaåie pentru pacienåii splenectomizaåi rãmâne sepsisul. Fiziopatologia sepsisului încã este controversatã. Decesul în sepsis poate surveni fie în urma hiperinflamaåiei, fie în urma imunosupresiei. Multiple dovezi experimentale au dovedit implicarea microRNA-urilor celulare aei virale în sepsis. Considerãm faptul cã microRNA-urile sunt de asemenea asociate cu imunosupresia pacientului asplenic, ceea ce determinã o creaetere a riscului de sepsis fatal. Studierea nivelului expresiei plasmatice a microRNA-urilor circulante la pacienåii asplenici, ar putea conduce la o mai bunã înåelegere a imunosupresiei post-splenectomie aei la dezvoltarea unor noi metode diagnostice aei terapeutice.Cuvinte cheie: splenectomie, microRNA, sepsis, microRNA-uri virale, OPSI AbstractThe risks that arise after splenectomy can be divided in infectious and non-infectious. The link between splenectomy and these hazards remains partially unknown. Host defense against infection is altered after splenectomy and such individuals develop sepsis more easily and the infection has a fulminant course. Splenectomy is also a potential risk factor for several vascular complications that result from partial or total obstruction of an arterial or venous blood vessel. Furthermore, pulmonary hypertensioncan be a severe and sometimes fatal complication following splenectomy. Some authors also consider that malignancies, diabetes mellitus and acute pancreatitis are non-infectious complications after splenectomy. The most feared complication for splenectomized patients remains sepsis. The pathophysiology of sepsis is still controversial. Death in sepsis can occur due to either hyper-inflammation or "immune paralysis". Multiple experimental evidences link cellular and viral microRNAs with sepsis. We presume that General ReportChirurgia (2016)

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“…Splenectomised patients have an increased long-term risk of infection. Splenectomy is rarely performed in children given both the increased likelihood of spontaneous and/or therapyinduced remission and the increased infection-related morbidity and mortality [23]. Rituximab, a monoclonal anti-CD20 antibody, is an effective immunotherapeutic agent increasingly used to treat refractory ITP; however, its use is associated with infusion-related side effects [24,25], increased risk of the development of progressive multifocal leukoencephalopathy [26] and a greater incidence of infections [27].…”

Section: Treatment For Immune Thrombocytopeniamentioning

confidence: 99%

Eltrombopag: an update on the novel, non-peptide thrombopoietin receptor agonist for the treatment of immune thrombocytopenia

Kühne

Imbach

2010

Ann Hematol

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Immune thrombocytopenia (ITP) is characterised by a transient or persistent decrease in platelets accompanied by an increased risk of bleeding, which can have a significant negative impact on patients' health-related quality of life. The condition has long been associated with an increased rate of immune-mediated platelet destruction, and traditional treatments have targeted the reduction in platelet destruction; however, some interventional drugs are limited by transient efficacy and side effects. Recent advances in our understanding of ITP pathogenesis have highlighted the role of impaired platelet production, which has led to the advent of a new generation of thrombopoietin (TPO)-receptor agonist therapies, including eltrombopag and romiplostim. The oral, non-peptide TPO-receptor agonist eltrombopag has shown considerable promise in both preclinical and clinical trials. Eltrombopag has a unique mechanism of action and binds to a transmembrane region of the TPO receptor that is distant from the TPO binding site. As such, eltrombopag may confer synergistic effects with endogenous TPO rather than competing for binding. Eltrombopag also induces activation of the TPO receptor and downstream signalling in a distinct manner to TPO and does not have a significant impact on platelet function. Clinical evidence demonstrates that eltrombopag produces a rapid and sustainable increase in platelet counts that significantly reduces bleeding and is well tolerated in patients with ITP. Eltrombopag therefore represents an important addition to the therapeutic armamentarium for ITP.

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Risk of Infection and Death Among Post-splenectomy Patients

Cited by 410 publications

References 41 publications

Splenectomy and the incidence of venous thromboembolism and sepsis in patients with immune thrombocytopenia

Splenectomy and the incidence of venous thromboembolism and sepsis in patients with immune thrombocytopenia

Patients After Splenectomy: Old Risks and New Perspectives

Eltrombopag: an update on the novel, non-peptide thrombopoietin receptor agonist for the treatment of immune thrombocytopenia

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