Study on coagulation profile of patients with cancer and acute kidney injury (AKI)

• Grant number: 12/00224-3
• Support Opportunities: Regular Research Grants
• Start date: September 01, 2012
• End date: August 31, 2014
• Field of knowledge: Health Sciences - Medicine - Medical Clinics
• Principal Investigator: Luis Yu
• Grantee: Luis Yu
• Host Institution: Faculdade de Medicina (FM). Universidade de São Paulo (USP). São Paulo , SP, Brazil
• Associated researchers: Elbio Antonio D'Amico ; James Hung

Abstract

Patients with cancer often have clotting disorder, which may manifest clinically as thrombosis or abnormalities in laboratory tests. The procoagulant state of cancer patients is secondary to several factors: the induction of procoagulant activity by the tumor itself; the vascular stasis due to the obstruction of blood flow by the tumor; the patient's immobility (bedridden patients); the use of chemotherapy; and presence of central venous catheter. Acute kidney injury (AKI), a term used for the sudden decline in renal function, is common in cancer patients and may occur as a result of the cancer itself (myeloma, renal obstruction), treatment (tumor lysis, drug-induced nephropathy, surgical procedures), or sepsis secondary to immunosuppression caused by chemotherapy. AKI is seen in up to 67% of ICU patients and is associated with high mortality, and result in higher cost and longer hospital length of stay. Bleeding caused by uremia is a complication that can occur in patients with renal failure. The result of the interaction of AKI in the coagulation of cancer patients has not been elucidated. Objective: To study the coagulation profile of cancer patients with severe sepsis or septic shock and evaluate the effect of AKI in these patients clotting system. Method: From July 2012 to June 2013, patients admitted to the Intensive Care Unit of the ICESP with severe sepsis or septic shock will be studied. Blood samples will be collected at the following times, according to clinical evaluation: 1. The first sample at the time of ICU admission; 2. The second sample will be collected if in the first 48 hours the patient develops AKI-AKIN1. If the patient develops AKI-AKIN2, the third sample will be collected. If the patient develops AKI-AKIN3, the fourth sample will be collected. 3. The second sample will be collected if in the first 48 hours the patient develops AKI-AKIN2. If the patient develops AKI-AKIN3, the third sample will be collected. 4. The second sample will be collected in the first 48 hours if the patient develops AKI-AKIN3.5.If the patient does not develop AKI within 48 hours, a second sample will be collected at the 48th hour. The coagulation profile to be studied includes: PT, aPTT, D-dimer, fibrinogen, fator VIII, evaluation of platelet adhesion and agregation with Impact-R, thromboelastography (to assess the complete coagulation profile) and evaluation of thrombin generation. Clinical and epidemiological data will be obtained from medical records. Unlike what is done currently in clinical practice, where only specific steps of the coagulation cascade are studied, the results of this project will provide comprehensive information of the entire coagulation cascade. Inclusion criteria: Patients older than 18 years old with hematologic or solid tumor, admitted to the ICU of the Instituto do Câncer do Estado de São Paulo with severe sepsis or septic shock will be eligible. Exclusion criteria: Patients with chronic renal failure in dialysis; patient with prior history of coagulopathy or family history of coagulopathy. (AU)