Endothelial dysfunction and hypercoagulability in severe sickle-cell acute chest syndrome
| Autor: | Laurent Savale, Etienne-Marie Jutant, Muriel Fartoukh, Vincent Labbé, Guillaume Voiriot, Patrick Van Dreden, Grigorios T. Gerotziafas, Hayat Mokrani |
|---|---|
| Přispěvatelé: | Service de Réanimation et USC Médico-Chirurgicale [CHU Tenon], CHU Tenon [AP-HP], Sorbonne Université (SU)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP), Département Médico-Universitaire APPROCHES, Sorbonne Université - Faculté de Médecine (SU FM), Sorbonne Université (SU), Centre de Référence de l’Hypertension Pulmonaire Sévère [CHU Le Kremlin Bicêtre], AP-HP Hôpital Bicêtre (Le Kremlin-Bicêtre)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP), Centre de Recherche Saint-Antoine (CR Saint-Antoine), Sorbonne Université (SU)-Institut National de la Santé et de la Recherche Médicale (INSERM)-CHU Saint-Antoine [AP-HP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU), Institut Universitaire de Cancérologie [Paris] (IUC), Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Sorbonne Université (SU)-Centre National de la Recherche Scientifique (CNRS), Service d'Hématologie biologique [CHU Tenon], Diagnostica Stago, Gestionnaire, Hal Sorbonne Université, Service de Réanimation et USC Médico-Chirurgicale = Médecine intensive réanimation [CHU Tenon], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-AP-HP Hôpital Bicêtre (Le Kremlin-Bicêtre), Centre de Recherche Saint-Antoine (CRSA), Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Sorbonne Université (SU) |
| Jazyk: | angličtina |
| Rok vydání: | 2021 |
| Předmět: |
Pulmonary and Respiratory Medicine
medicine.medical_specialty 030204 cardiovascular system & hematology [SDV.MHEP.PSR]Life Sciences [q-bio]/Human health and pathology/Pulmonology and respiratory tract law.invention Endothelial activation 03 medical and health sciences 0302 clinical medicine law Internal medicine Original Research Articles medicine Platelet Endothelial dysfunction Pulmonary Vascular Disease business.industry medicine.disease Intensive care unit Pulmonary hypertension Acute chest syndrome 3. Good health Pneumonia Cohort Cardiology [SDV.MHEP.PSR] Life Sciences [q-bio]/Human health and pathology/Pulmonology and respiratory tract Medicine business 030215 immunology |
| Zdroj: | ERJ Open Research article-version (VoR) Version of Record ERJ Open Research, European Respiratory Society, 2021, 7 (4), pp.00496-2021. ⟨10.1183/23120541.00496-2021⟩ ERJ Open Research, Vol 7, Iss 4 (2021) ERJ Open Research, 2021, 7 (4), pp.00496-2021. ⟨10.1183/23120541.00496-2021⟩ |
| ISSN: | 2312-0541 |
| DOI: | 10.1183/23120541.00496-2021⟩ |
| Popis: | Rationale Acute pulmonary hypertension (PH) may develop during sickle-cell acute chest syndrome (ACS), and is associated with an increased mortality. Its mechanisms remain poorly known. We questioned whether there is endothelial dysfunction and hypercoagulability in severe ACS, with and without acute PH. Methods In a prospective monocentre cohort follow-up study, all sickle-cell adult patients with ACS admitted to the intensive care unit underwent transthoracic echocardiography and measurement of biomarkers of coagulation, endothelial activation and platelet and erythrocyte activation. Acute PH was defined as a high echocardiographic probability of PH. The biological profiles of sickle-cell patients were analysed at the time of ACS, contrasting with the existence of acute PH, and compared with steady-state and with non-sickle-cell controls (healthy subjects and community-acquired pneumonia). Results Most patients (36 patients with 39 ACS episodes; 23 males; median age 27 years) had thoracic pain, dyspnoea and computed tomography scan lung consolidation. Acute PH was diagnosed in seven (19%) patients. Erythrocyte- and platelet-derived microparticles and the pro-coagulant activity of microparticles were higher in ACS patients with acute PH, compared with their counterparts. Compared with healthy controls, ACS patients had higher levels of tissue factor, fibrin monomers, D-dimer, release of pro-coagulant microparticles and erythrocyte- and platelet-derived microparticles. Compared with community-acquired pneumonia patients, ACS patients had increased levels of fibrin monomers and erythrocyte- and platelet-derived microparticles. Conclusions Severe ACS is characterised by endothelial dysfunction and hypercoagulability, with a marked pro-coagulant profile in cases of associated PH. Severe sickle-cell acute chest syndrome is associated with an activation of the pulmonary vascular endothelium and of coagulation, with higher levels of pro-coagulant microparticles in cases of associated acute pulmonary hypertension https://bit.ly/3sjkaYy |
| Databáze: | OpenAIRE |
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