Altered coagulation profile of patients with high-grade glioma: clinical study with control group.

Natalia Jeanette Quispe-Pastor; Ana Paula Gorritti-Rubio; Lissett Jeanette Fernández-Rodríguez

doi:10.12688/f1000research.154700.1

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Brief Report

Altered coagulation profile of patients with high-grade glioma: clinical study with control group.

[version 1; peer review: 2 approved with reservations]

Natalia Jeanette Quispe-Pastor¹, Ana Paula Gorritti-Rubio^1,2, Lissett Jeanette Fernández-Rodríguez ^1,3

PUBLISHED 29 Aug 2024

Author details Author details

¹ Medical School, Universidad Privada Antenor Orrego, Trujillo, La Libertad, 13008, Peru
² Medical Oncology Service, Hospital de Alta Complejidad Virgen de la Puerta - EsSalud, La Esperanza, La Libertad, 13013, Peru
³ Oncology Unit, Hospital Regional Lambayeque – Ministerio de Salud, Chiclayo, Lambayeque, 14012, Peru

Natalia Jeanette Quispe-Pastor
Roles: Investigation, Writing – Original Draft Preparation

Ana Paula Gorritti-Rubio
Roles: Project Administration, Supervision

Lissett Jeanette Fernández-Rodríguez
Roles: Conceptualization, Writing – Review & Editing

OPEN PEER REVIEW

REVIEWER STATUS

Abstract

Background

Activation of coagulation is a common phenomenon in patients with high-grade glioma, a primary malignant brain tumor.

Objective

Identify if there is an alteration in the coagulation profile in patients with high-grade glioma compared to other patients with benign brain tumors.

Methods

Sociodemographic and clinical characteristics, ECOG at admission, prothrombin time, activated partial thromboplastin time, international normalized ratio, platelet count, and blood panel results of 21 high-grade glioma patients (cases) and 42 meningioma patients (controls) from northern Peru were reviewed. Bivariate and multivariate analysis with logistic regression were performed to determine which factors are associated with glioma.

Results

Both groups had high proportions of high blood pressure (29%) and diabetes mellitus (14%). According to multivariate analysis, altered values for prothrombin time, platelet count, and ECOG score were associated with glioma (p=0.01). Furthermore, alterations in the blood panel were observed in both cases and controls but failed to reach statistical significance.

Conclusion

Patients with high-grade glioma seem to suffer more from hypercoagulable states than other patients with benign brain tumors, suggesting careful vigilance and anticoagulant treatment for these patients.

Keywords

blood coagulation, glioma, platelet count, prothrombin time, meningioma

Corresponding author: Lissett Jeanette Fernández-Rodríguez

Competing interests: No competing interests were disclosed.

Grant information: The author(s) declared that no grants were involved in supporting this work.

Copyright: © 2024 Quispe-Pastor NJ et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

How to cite: Quispe-Pastor NJ, Gorritti-Rubio AP and Fernández-Rodríguez LJ. Altered coagulation profile of patients with high-grade glioma: clinical study with control group. [version 1; peer review: 2 approved with reservations]. F1000Research 2024, 13:980 (https://doi.org/10.12688/f1000research.154700.1) First published: 29 Aug 2024, 13:980 (https://doi.org/10.12688/f1000research.154700.1) Latest published: 31 Oct 2024, 13:980 (https://doi.org/10.12688/f1000research.154700.2)

Background

Gliomas are a class of primary brain tumors that arise from glial cells and generally have a poor prognosis.¹ The malignancy of these tumors is classified into four grades, with grade four being the most malignant. High-grade gliomas (grades 3 and 4) are characterized by high mitotic activity, angiogenesis, as well as a predisposition to central necrosis, peripheral edema, rapid disease evolution, and mean survival between 12 and 17 months.¹^–³ Of these high-grade gliomas, the most common in adults are glioblastoma (grade 4), anaplastic astrocytoma, and anaplastic oligodendroglioma (both grade 3).⁴ The most common complication of high-grade gliomas is venous thromboembolism (VTE), with an incidence of approximately 30%.⁵

VTE is a common complication found in many cancers that can be triggered directly by the tumor, such as overexpression of tissue factor (TF), or indirectly through host secretion of cytokines or physical alteration of blood vessels.⁶^,⁷ Approximately 50% of patients with glioblastoma have background activation of the coagulation system.⁸ From this information, it is likely that understanding the clotting profiles of presurgical patients would be helpful in informing treatment with anticoagulants or determining prognosis based on coagulation profile. However, the judicious use of anticoagulants is important to not increase the risk of spontaneous intracerebral hemorrhage.

Due to the aggressive nature of high-grade glioma and the risk of VTE, we set out to evaluate how the coagulation profile of these patients differs from other patients with brain cancer using a clinical study with a control group.

Methods

Study design

This is an observational, descriptive, clinical study with a control group of a convenience sample of medical records.

Sample size

Medical records of both sexes were included if they were over 18 years old and diagnosed with high-grade glioma or meningioma and treated in the Virgen de la Puerta High Complexity Hospital Oncology Service (La Esperanza, Trujillo, Peru) between 2019 and 2023. Patients with an incomplete or absent anatomopathological study, and those with autoimmune or viral diseases, a history of coagulation disorders or diseases that affect blood circulation, brain metastases, or other primary tumors as well as patients receiving treatment with anticoagulant medications, were excluded from the study.

Data collection

The medical records were reviewed to evaluate the presurgical hematological results of both controls and cases. These included hemogram (leukocytes, neutrophiles, band neutrophiles, lymphocytes, monocytes, eosinophiles, basophiles, red blood cell count, hemoglobin, and hematocrit) as well as coagulation profile (prothrombin time (PT), activated partial thromboplastin time (aPTT), international normalized ratio (INR), and platelet count (PC)). Each blood parameter was recorded as normal or abnormal.⁹ Additional sociodemographic and clinical characteristics were also recorded: age, sex, address, Eastern Cooperative Oncology Group (ECOG) performance status upon admission, and whether the patient had diabetes and/or high blood pressure.

Data analysis

IBM SPSS V26.0 statistical software (https://www.ibm.com/es-es/products/spss-statistics) was used for data processing. An open-source alternative to this program is PSPP (https://www.gnu.org/software/pspp/). Qualitative variables were expressed in proportions and percentages of patients. Bivariate analysis was performed to determine the relationship of the variables. The crude odds ratio (ORc) and the adjusted odds ratio (ORa) were calculated with a 95% confidence interval (CI) for each variable in its association with the presence of high-grade glioma. Those variables that showed a significant association (p < 0.05) were subjected to multivariate analysis with logistic regression.

Ethical considerations

This study was reviewed and approved by the Research Bioethics Committee of Universidad Privada Antenor Orrego (Resolution N°0563-2023-UPAO), approval date 3rd August 2023. This study complied with the 2016 Council for International Organizations of Medical Sciences (CIOMS) guidelines. Given that this study was a review of medical records routinely collected during treatment, ensured patient privacy, and did not influence treatment trajectory, the requirement for informed consent was waived by ethical approval committee. Information that personally identifies patients was eliminated from the data presented here and underlying data to protect anonymity.

Results

The sample consisted of 21 patients with high-grade glioma (cases) and 42 patients with meningiomas (controls) that met acceptance criteria. Patients with meningiomas were chosen as the control group as these tumors are benign, allowing for a close comparison of patients that had similar conditions – with the only difference being malignancy. All patients came from the Peruvian regions of La Libertad, Ancash, and Cajamarca. The demographic characteristics of both groups are summarized in Table 1. Ages were similar, but the gender ratio was reversed between cases and controls. ECOG scores were also distributed differently between cases and controls. Furthermore, both groups had high proportions of diabetes (14%) and high blood pressure (29%).

Table 1. Sociodemographic and clinical parameters of cases (high-grade glioma) and controls (meningioma).

Characteristics	Tumor type
Characteristics	Cases: High-grade glioma (n = 21)	Controls: Meningioma (n = 42)
Age, y	53.91 (±14.45)	56.64 (±12.44)
Male (%)	12 (57.1%)	17 (40.5%)
Comorbidities
Diabetes	6 (28.6%)	3 (7.1%)
High Blood Pressure	7 (33.3%)	11 (26.2%)
ECOG
ECOG 1	6 (28.6%)	36 (85.7%)
ECOG 2	13 (61.9%)	6 (14.3%)
ECOG 3	2 (9.5%)	0 (0.0%)

Table 2 records the proportions of cases and controls with presurgical abnormal blood count and coagulation results. High proportions of abnormal results were found for aPTT, INR, lymphocytes, and neutrophiles.

Table 2. Blood panel results of cases and controls, presenting the number and proportion of abnormal results.

Blood parameter (abnormal)	Tumor type
Blood parameter (abnormal)	Cases: High-grade glioma (n = 21)	Controls: Meningioma (n = 42)
PT	3 (14.3%)	0 (0.0%)
aPTT	16 (76.2%)	32 (76.2%)
INR	9 (42.9%)	9 (21.4%)
PC	4 (19.0%)	0 (0.0%)
Leukocytes	5 (23.8%)	3 (7.1%)
Neutrophiles	13 (61.9%)	10 (23.8%)
Lymphocytes	17 (81.0%)	15 (35.7%)
Eosinophiles	1 (4.8%)	4 (9.5%)
Basophiles	0 (0.0%)	1 (2.4%)
Erythrocytes	5 (23.8%)	11 (26.2%)
Hemoglobin	7 (33.3%)	16 (38.1%)
Hematocrit	7 (33.3%)	14 (33.3%)
Band neutrophiles	0 (0.0%)	0 (0.0%)
Monocytes	0 (0.0%)	0 (0.0%)

Multivariate analysis showed that PT (aOR = 1.45; 95% CI = 1.13 – 2.28; p = 0.01), PC (aOR = 1.43; 95% CI = 1.06 – 2.25; p = 0.01) and ECOG 2 or 3 (aOR = 14.78; 95% CI = 3.71 – 58.86; p = 0.01) were associated with said high-grade glioma (Table 3). Other components of the blood profile did not show significant differences between groups.

Table 3. Bivariate and multivariate analysis of variables associated with the presence of high-grade glioma.

Factor	Bivariate Analysis				Multivariate Analysis
	ORc	CI 95%		p	ORa	CI 95%		p
	ORc	Low	High	p	ORa	Low	High	p
Age (≥ 60 y vs. < 60 y)	0.91	0.32	2.61	0.86	0.82	0.27	2.47	0.94
Sex	1.96	0.68	5.67	0.21	1.65	0.58	4.65	0.49
Diabetes	5.20	1.15	23.50	0.02	6.47	0.85	49.20	0.21
High blood pressure	1.41	0.45	4.40	0.55	0.54	0.12	2.57	0.69
ECOG (2 or 3 vs. 1)	15.00	4.16	54.05	0.01	14.78	3.71	58.86	0.01
PT	3.33	2.27	4.91	0.01	1.45	1.13	2.28	0.01
aPTT	1.00	0.29	3.42	1.00	0.89	0.24	3.23	0.87
INR	2.75	0.88	8.56	0.08	1.29	0.35	4.71	0.97
PC	3.47	2.32	5.18	0.01	1.43	1.06	2.25	0.01
Leukocytes	4.06	0.87	19.05	0.06	4.64	0.67	32.28	0.31
Neutrophiles	5.20	1.68	16.12	0.01	1.04	0.22	4.94	0.74
Lymphocytes	7.65	2.17	26.94	0.01	3.73	0.73	19.03	0.23
Eosinophiles	0.48	0.05	4.54	0.51	0.89	0.06	12.55	0.60
Erythrocytes	0.88	0.26	2.98	0.84	0.81	0.19	3.45	0.94
Hemoglobin	0.81	0.27	2.44	0.71	0.73	0.31	2.75	0.83
Hematocrit	1.00	0.33	3.04	1.00	0.92	0.21	2.86	0.72

Discussion

We observe that PT was shortened in the cases compared to the controls. This result is consistent with two published studies using 58 cases and 22 meningioma controls⁸ and 172 cases and 47 healthy controls.¹⁰ The PT test evaluates the extrinsic coagulation pathway, which is initiated at the site of injury in response to the release of TF, which is often overexpressed in tumor cells. These results suggest that high-grade glioma is more likely to overexpress TF than other related cancers.⁸ Another parameter calculated from PT that evaluates the extrinsic coagulation pathway is INR. The difference in INR between cases and controls came close to (p=0.08), but did not reach statistical significance. This difference is likely a result of the use of different cutoff values for normal values, as INR is a ratio with PT in the numerator and a control PT in the denominator. Because PT was significantly shortened, INR also decreased, and another study comparing patients with healthy controls also found a statistically significant difference in these parameters,¹¹ it would be reasonable to affirm that glioma patients have a more altered extrinsic clotting pathway compared to other patients with benign brain tumors and even more so when considering healthy controls.

Another parameter that was significantly associated with high-grade glioma was PC – no members of the control group had abnormal PC, while 4 patients in the case group had abnormal PC (Tables 2 and 3). Furthermore, cases of thrombocytosis and thrombocytopenia were observed in the case group. This result differs from previous investigations⁸^,¹⁰ in which no statistically significant differences were found in PC between cases and controls were found (p>0.05). Small study size as well as differences in the timing of blood sample collection may explain the differences in these results with other studies.

The aPTT test is mainly used to evaluate the intrinsic coagulation pathway. In this study, no statistical significance was found between aPTT and the presence of glioma, with proportions of altered aPTT equal between cases and controls (Tables 2 and 3). This result differs from the findings of a study in which aPTT was shown to be significantly reduced in glioma cases, suggesting a hypercoagulable state.⁸

Blood count can be used to assess general condition, detect disease-related complications, and, in some cases, predict survival in patients with high-grade glioma. In this study, alterations were observed in leukocytes, erythrocytes, hemoglobin, and hematocrit; however, no significant association with high-grade glioma was found in the multivariate analysis (Table 3). Navone et al. observed a significant increase in leukocyte count in glioblastoma patients compared to meningioma patients (p < 0.001), while hemoglobin did not show significant differences between the two study groups.⁸ On the other hand, Kim et al. assessed the clinical importance of lymphopenia in patients with glioblastoma and reported that 42.0% (92 patients) showed decreased levels of lymphocytes, concluding that lymphopenia is a frequent event during progression and disease treatment.¹² In turn, Serban et al., when studying the preoperative immunoinflammatory status of patients with glioblastoma, found elevated leukocyte counts, suggesting that this could predict reduced overall survival.¹³

Finally, multivariate analysis also identified that a preoperative ECOG score of 2 or 3 was significantly associated with high-grade glioma. However, no studies have been found to determine whether the ECOG value is related to glioma, so more research would be needed to determine the relationship between the two. However, in cancer patients, an ECOG 3-4 is associated with a higher risk of in-hospital mortality.¹⁴^,¹⁵

This study presented certain limitations, such as limited sample size and scope since patients were not subjected to additional tests. Furthermore, it was not determined when the parameters of the coagulation profile were altered, so the study could not determine when a blood analysis would produce meaningful results.

Conclusions

Taken together, it appears that high-grade glioma patients have hypercoagulability to a greater degree than patients with benign brain tumors and are more likely to be diagnosed when the disease interferes more strongly with their self-care and work activities. This suggests a more careful treatment of coagulation among these patients.

CrediT author statement

NJQP: Investigation, Writing – Original Draft

APGR: Supervision, Project administration

LJFR: Conceptualization, Writing – Review & Editing

Data availability statement

Figshare. Underlying Data for article “Altered coagulation profile of patients with high-grade glioma: clinical study with control group”. https://doi.org/10.6084/m9.figshare.26391244.¹⁶

This project contains following dataset:

• Data File 1: Coagulacion-raw-data-eng.xlsx
• Data File 2: STROBE checklist for ‘Altered coagulation profile of patients with high-grade glioma: case-control study’

Data are available under the terms of the Creative Commons Attribution 4.0 International license (CC-BY 4.0).

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4. Méndez-Aguilar P, Vera-Ponce VJ, Méndez-Aguilar P, et al.: Factores pronóstico de supervivencia en adultos por gliomas de alto grado en un Hospital de Lima, Perú. Revista de la Facultad de Medicina Humana. 2020 Jul [cited 2024 Mar 16]; 20(3): 460–471. Publisher Full Text Reference Source
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13. Serban GM, Tamas CI, Tamas F, et al.: Preoperative Immune-Inflammatory Status of the Patients With Newly-Diagnosed Glioblastoma - Could It Genuinely Predict Their Survival? Cureus. 2023 Aug; 15(8): e43802. PubMed Abstract | Publisher Full Text
14. Pérez Cruz P, Acevedo Claros FN: Escalas de Estado Funcional (o performance satus) en Cáncer. Gastroenterología Latinoamericana. 2014 [cited 2024 Mar 16]; 25(3): 219–226. Reference Source
15. Díaz-Díaz D, Villanova Martínez M, Palencia Herrejón E: Pacientes oncológicos ingresados en Unidad de Cuidados Intensivos. Análisis de factores predictivos de mortalidad. Med. Intensiva. 2018 Aug 1 [cited 2024 Mar 16]; 42(6): 346–353. PubMed Abstract | Publisher Full Text Reference Source
16. Quispe-Pastor NJ, Gorritti-Rubio AP, Fernandez L: Underlying Data for article “Altered coagulation profile of patients with high-grade glioma: clinical study with control group”. figshare. 2024, 28 Temmuz. Publisher Full Text

Comments on this article Comments (0)

Version 2

VERSION 2 PUBLISHED 29 Aug 2024

Author details Author details

Natalia Jeanette Quispe-Pastor
Roles: Investigation, Writing – Original Draft Preparation

Ana Paula Gorritti-Rubio
Roles: Project Administration, Supervision

Lissett Jeanette Fernández-Rodríguez
Roles: Conceptualization, Writing – Review & Editing

Competing interests

No competing interests were disclosed.

Grant information

The author(s) declared that no grants were involved in supporting this work.

Article Versions (2)

version 2

Revised

Published: 31 Oct 2024, 13:980

https://doi.org/10.12688/f1000research.154700.2

version 1

Published: 29 Aug 2024, 13:980

https://doi.org/10.12688/f1000research.154700.1

© 2024 Quispe-Pastor NJ et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

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Quispe-Pastor NJ, Gorritti-Rubio AP and Fernández-Rodríguez LJ. Altered coagulation profile of patients with high-grade glioma: clinical study with control group. [version 1; peer review: 2 approved with reservations]. F1000Research 2024, 13:980 (https://doi.org/10.12688/f1000research.154700.1)

NOTE: If applicable, it is important to ensure the information in square brackets after the title is included in all citations of this article.

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Open Peer Review

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Reviewer Report 24 Sep 2024

Joab Chapman, Department of Neurology and Neurosurgery, Tel Aviv University, Tel-Aviv, Israel

Approved with Reservations

https://doi.org/10.5256/f1000research.169759.r324060

This is a solid addition to the data associating high grade glioma with systemic coagulation changes.

Major comments
Introduction: Secretion of thrombin and other active coagulation factors by gliomas is well known and excess thrombin may thus reach venous blood in the brain and cause venous thrombosis. This central mechanism should be added to the Introduction and perhaps Discussion. This mechanism seems highly relevant to the coagulation measures described in the manuscript.
Methods and Results: The statistical methods used to compare the groups are not clear to me. Some of the measures are quantitative (PT, aPTT etc) and though they are categorized into normal and pathological in tables 1 and 2, it is not clear if the analysis presented in table 3 was performed on continuous or categorical data. It would probably be more informative if performed on the continuous quantitative data. Analysis of INR would perhaps be significant in such and analysis. Bivariate analysis is usually performed on continuous data. It is also not clear (to me) what the OR represent.
The authors state in the opening of the Discussion that " We observe that PT was shortened in the cases compared to the controls" but it is difficult to understand if the values were higher or lower in the Results. Using the values of tests such as PC would enable us to assess if the pathology associated with glioma are high or low values, so presenting the data as mean + error would be more informative.

Minor comments
ECOG not defined in the abstract (Eastern Cooperative Oncology Group performance status).
Study design: not clear what "convenience sample" means.

Is the work clearly and accurately presented and does it cite the current literature?

Yes
Is the study design appropriate and is the work technically sound?

Partly
Are sufficient details of methods and analysis provided to allow replication by others?

Partly
If applicable, is the statistical analysis and its interpretation appropriate?

Partly
Are all the source data underlying the results available to ensure full reproducibility?

Yes
Are the conclusions drawn adequately supported by the results?

Yes

Competing Interests: No competing interests were disclosed.

Reviewer Expertise: Neuroimmunology, neuro-coagulation, neuroinflammation

I confirm that I have read this submission and believe that I have an appropriate level of expertise to confirm that it is of an acceptable scientific standard, however I have significant reservations, as outlined above.

CITE

Report a concern

Author Response 31 Oct 2024

Lissett Fernández, Medical School, Universidad Privada Antenor Orrego, Trujillo, 13008, Peru

31 Oct 2024

Author Response

Thank you for this review. I have replied to your comments and explained the changes to the article in a point-by-point manner. The comments are preceded by “>>”

... Continue reading Thank you for this review. I have replied to your comments and explained the changes to the article in a point-by-point manner. The comments are preceded by “>>”

This is a solid addition to the data associating high grade glioma with systemic coagulation changes.

Major comments
Introduction: Secretion of thrombin and other active coagulation factors by gliomas is well known and excess thrombin may thus reach venous blood in the brain and cause venous thrombosis. This central mechanism should be added to the Introduction and perhaps Discussion. This mechanism seems highly relevant to the coagulation measures described in the manuscript.
>> The authors added statements in the introduction and the discussion explaining the mechanism.

Methods and Results: The statistical methods used to compare the groups are not clear to me. Some of the measures are quantitative (PT, aPTT etc) and though they are categorized into normal and pathological in tables 1 and 2, it is not clear if the analysis presented in table 3 was performed on continuous or categorical data.
>> We modified the text to make it clear whether a categorical or quantitative variable was used.
It would probably be more informative if performed on the continuous quantitative data. Analysis of INR would perhaps be significant in such and analysis. Bivariate analysis is usually performed on continuous data. It is also not clear (to me) what the OR represent.
>> We dichotomized the data because most clinical practice considers values as either normal or abnormal. However, additional text was added explaining direct analysis of the continuous quantitiative data in the Results and the Discussion section.
>> A short explanation of what OR represents was added to the Methods and the Results section.

The authors state in the opening of the Discussion that " We observe that PT was shortened in the cases compared to the controls" but it is difficult to understand if the values were higher or lower in the Results. Using the values of tests such as PC would enable us to assess if the pathology associated with glioma are high or low values, so presenting the data as mean + error would be more informative.
>> The direction of the difference was added, so it is clear what parameters increased or decreased in the study group compared to the control group.
>> Additional text was added to the Results and the Discussion sections to include analysis and explanation of the direction of change as well as direct statistical analysis of the continuous results.

Minor comments
ECOG not defined in the abstract (Eastern Cooperative Oncology Group performance status).
>> The term was appropriately defined in the abstract.

Study design: not clear what "convenience sample" means.
>> The term was removed from the text.
Thank you for this review. I have replied to your comments and explained the changes to the article in a point-by-point manner. The comments are preceded by “>>”

This is a solid addition to the data associating high grade glioma with systemic coagulation changes.

Major comments
Introduction: Secretion of thrombin and other active coagulation factors by gliomas is well known and excess thrombin may thus reach venous blood in the brain and cause venous thrombosis. This central mechanism should be added to the Introduction and perhaps Discussion. This mechanism seems highly relevant to the coagulation measures described in the manuscript.
>> The authors added statements in the introduction and the discussion explaining the mechanism.

Methods and Results: The statistical methods used to compare the groups are not clear to me. Some of the measures are quantitative (PT, aPTT etc) and though they are categorized into normal and pathological in tables 1 and 2, it is not clear if the analysis presented in table 3 was performed on continuous or categorical data.
>> We modified the text to make it clear whether a categorical or quantitative variable was used.
It would probably be more informative if performed on the continuous quantitative data. Analysis of INR would perhaps be significant in such and analysis. Bivariate analysis is usually performed on continuous data. It is also not clear (to me) what the OR represent.
>> We dichotomized the data because most clinical practice considers values as either normal or abnormal. However, additional text was added explaining direct analysis of the continuous quantitiative data in the Results and the Discussion section.
>> A short explanation of what OR represents was added to the Methods and the Results section.

The authors state in the opening of the Discussion that " We observe that PT was shortened in the cases compared to the controls" but it is difficult to understand if the values were higher or lower in the Results. Using the values of tests such as PC would enable us to assess if the pathology associated with glioma are high or low values, so presenting the data as mean + error would be more informative.
>> The direction of the difference was added, so it is clear what parameters increased or decreased in the study group compared to the control group.
>> Additional text was added to the Results and the Discussion sections to include analysis and explanation of the direction of change as well as direct statistical analysis of the continuous results.

Minor comments
ECOG not defined in the abstract (Eastern Cooperative Oncology Group performance status).
>> The term was appropriately defined in the abstract.

Study design: not clear what "convenience sample" means.
>> The term was removed from the text.
Competing Interests: No competing interests were disclosed. Close
Report a concern
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COMMENTS ON THIS REPORT

Author Response 31 Oct 2024

Lissett Fernández, Medical School, Universidad Privada Antenor Orrego, Trujillo, 13008, Peru

31 Oct 2024

Author Response

Thank you for this review. I have replied to your comments and explained the changes to the article in a point-by-point manner. The comments are preceded by “>>”

... Continue reading Thank you for this review. I have replied to your comments and explained the changes to the article in a point-by-point manner. The comments are preceded by “>>”

This is a solid addition to the data associating high grade glioma with systemic coagulation changes.

Major comments
Introduction: Secretion of thrombin and other active coagulation factors by gliomas is well known and excess thrombin may thus reach venous blood in the brain and cause venous thrombosis. This central mechanism should be added to the Introduction and perhaps Discussion. This mechanism seems highly relevant to the coagulation measures described in the manuscript.
>> The authors added statements in the introduction and the discussion explaining the mechanism.

Methods and Results: The statistical methods used to compare the groups are not clear to me. Some of the measures are quantitative (PT, aPTT etc) and though they are categorized into normal and pathological in tables 1 and 2, it is not clear if the analysis presented in table 3 was performed on continuous or categorical data.
>> We modified the text to make it clear whether a categorical or quantitative variable was used.
It would probably be more informative if performed on the continuous quantitative data. Analysis of INR would perhaps be significant in such and analysis. Bivariate analysis is usually performed on continuous data. It is also not clear (to me) what the OR represent.
>> We dichotomized the data because most clinical practice considers values as either normal or abnormal. However, additional text was added explaining direct analysis of the continuous quantitiative data in the Results and the Discussion section.
>> A short explanation of what OR represents was added to the Methods and the Results section.

The authors state in the opening of the Discussion that " We observe that PT was shortened in the cases compared to the controls" but it is difficult to understand if the values were higher or lower in the Results. Using the values of tests such as PC would enable us to assess if the pathology associated with glioma are high or low values, so presenting the data as mean + error would be more informative.
>> The direction of the difference was added, so it is clear what parameters increased or decreased in the study group compared to the control group.
>> Additional text was added to the Results and the Discussion sections to include analysis and explanation of the direction of change as well as direct statistical analysis of the continuous results.

Minor comments
ECOG not defined in the abstract (Eastern Cooperative Oncology Group performance status).
>> The term was appropriately defined in the abstract.

Study design: not clear what "convenience sample" means.
>> The term was removed from the text.
Thank you for this review. I have replied to your comments and explained the changes to the article in a point-by-point manner. The comments are preceded by “>>”

This is a solid addition to the data associating high grade glioma with systemic coagulation changes.

Major comments
Introduction: Secretion of thrombin and other active coagulation factors by gliomas is well known and excess thrombin may thus reach venous blood in the brain and cause venous thrombosis. This central mechanism should be added to the Introduction and perhaps Discussion. This mechanism seems highly relevant to the coagulation measures described in the manuscript.
>> The authors added statements in the introduction and the discussion explaining the mechanism.

Methods and Results: The statistical methods used to compare the groups are not clear to me. Some of the measures are quantitative (PT, aPTT etc) and though they are categorized into normal and pathological in tables 1 and 2, it is not clear if the analysis presented in table 3 was performed on continuous or categorical data.
>> We modified the text to make it clear whether a categorical or quantitative variable was used.
It would probably be more informative if performed on the continuous quantitative data. Analysis of INR would perhaps be significant in such and analysis. Bivariate analysis is usually performed on continuous data. It is also not clear (to me) what the OR represent.
>> We dichotomized the data because most clinical practice considers values as either normal or abnormal. However, additional text was added explaining direct analysis of the continuous quantitiative data in the Results and the Discussion section.
>> A short explanation of what OR represents was added to the Methods and the Results section.

The authors state in the opening of the Discussion that " We observe that PT was shortened in the cases compared to the controls" but it is difficult to understand if the values were higher or lower in the Results. Using the values of tests such as PC would enable us to assess if the pathology associated with glioma are high or low values, so presenting the data as mean + error would be more informative.
>> The direction of the difference was added, so it is clear what parameters increased or decreased in the study group compared to the control group.
>> Additional text was added to the Results and the Discussion sections to include analysis and explanation of the direction of change as well as direct statistical analysis of the continuous results.

Minor comments
ECOG not defined in the abstract (Eastern Cooperative Oncology Group performance status).
>> The term was appropriately defined in the abstract.

Study design: not clear what "convenience sample" means.
>> The term was removed from the text.
Competing Interests: No competing interests were disclosed. Close
Report a concern

Views

Reviewer Report 16 Sep 2024

Darko Orešković, Department of Neurosurgery, Clinical Hospital Dubrava, Zagreb, Croatia

Approved with Reservations

https://doi.org/10.5256/f1000research.169759.r320124

This is an important and currently overlooked issue in treating neuro-oncological patients and I applaud the authors for their work writing this brief report.

Their objective is clear and their methods are sound. Also, the discussion is relevant and important.

However I would add several suggestions.

First of all, I think the authors should acknowledge the fact that they only analyzed coagulation markers in two groups of patients with brain tumors. Both of these tumors are known to cause perturbations in the coagulation profile. A control group without a malignant disease, whose results would be compared to these two groups would be much better. I would like this fact to be emphasized more in the limitations of the study (if not changed in the study design).

Secondly, a major limitation is the fact that the authors do not know when the blood samples were taken. This is important because various conditions, diseases and therapy can also impact the coagulation profile. For example, our own previous research analyzes the connection between corticosteroid treatment and the coagulation profile in these patients (Oreskovic et al 2024.). This limitation also has to be emphasized more.

Thirdly, I would like to see additional references showing the effects of altered PT on the risk of VTE, especially in brain tumor patients. In other words, what are the clinical implications of the found results.

Lastly, it is true that the coagulation patterns of brain tumor patients are important in light of VTE risk. However, they are also very important due to the fact that parts of the coagulation cascade have a crucial role in the development and aggressiveness of glial tumors (Magnus et a. 2013). This should also be acknowledged.

Is the work clearly and accurately presented and does it cite the current literature?

Yes
Is the study design appropriate and is the work technically sound?

Yes
Are sufficient details of methods and analysis provided to allow replication by others?

Yes
If applicable, is the statistical analysis and its interpretation appropriate?

I cannot comment. A qualified statistician is required.
Are all the source data underlying the results available to ensure full reproducibility?

Yes
Are the conclusions drawn adequately supported by the results?

Yes

References

1. Orešković D, Madero Pohlen A, Cvitković I, Alen JF, et al.: Glycemia and Coagulation in Patients with Glioblastomas.World Neurosurg. 2024; 189: e999-e1005 PubMed Abstract | Publisher Full Text
2. Magnus N, D'Asti E, Garnier D, Meehan B, et al.: Brain neoplasms and coagulation.Semin Thromb Hemost. 2013; 39 (8): 881-95 PubMed Abstract | Publisher Full Text

Competing Interests: No competing interests were disclosed.

Reviewer Expertise: Neurosurgery, neuro-oncology

CITE

Report a concern

Author Response 31 Oct 2024

Lissett Fernández, Medical School, Universidad Privada Antenor Orrego, Trujillo, 13008, Peru

31 Oct 2024

Author Response

Thank you for this review. I have replied to your comments and explained the changes to the article in a point-by-point manner. The comments are preceded by “>>”

... Continue reading Thank you for this review. I have replied to your comments and explained the changes to the article in a point-by-point manner. The comments are preceded by “>>”

This is an important and currently overlooked issue in treating neuro-oncological patients and I applaud the authors for their work writing this brief report.

Their objective is clear and their methods are sound. Also, the discussion is relevant and important.

However I would add several suggestions.

First of all, I think the authors should acknowledge the fact that they only analyzed coagulation markers in two groups of patients with brain tumors. Both of these tumors are known to cause perturbations in the coagulation profile. A control group without a malignant disease, whose results would be compared to these two groups would be much better. I would like this fact to be emphasized more in the limitations of the study (if not changed in the study design).
>> The authors agree that it is important to make clear the natures of the study and control group. Therefore, additional text was added to the introduction and the limitations paragraph explaining the reason for the use of the control group. This article was designed to highlight the uniquely pro-coagulatory effects of high-grade gliomas with respect to non-malignant brain neoplasms. This means that we are likely underestimating the coagulatory dysfunction in glioblastoma patients with respect to healthy, cancer-free people.

Secondly, a major limitation is the fact that the authors do not know when the blood samples were taken. This is important because various conditions, diseases and therapy can also impact the coagulation profile. For example, our own previous research analyzes the connection between corticosteroid treatment and the coagulation profile in these patients (Oreskovic et al 2024.). This limitation also has to be emphasized more.
>> We have made the text clear in the limitations paragraph that therapy could have had an impact in the coagulation profile. Patients with diseases that affect coagulation were excluded from the study as mentioned in the methods section.

Thirdly, I would like to see additional references showing the effects of altered PT on the risk of VTE, especially in brain tumor patients. In other words, what are the clinical implications of the found results.
>> A paragraph explaining the implications and the effects of altered PT on the risk of VTE was added. This additional paragraph has several references that are relevant to the topic.

Lastly, it is true that the coagulation patterns of brain tumor patients are important in light of VTE risk. However, they are also very important due to the fact that parts of the coagulation cascade have a crucial role in the development and aggressiveness of glial tumors (Magnus et a. 2013). This should also be acknowledged.
>> Additional text and references in the introduction and discussion were added to make this point in the article.
Thank you for this review. I have replied to your comments and explained the changes to the article in a point-by-point manner. The comments are preceded by “>>”

This is an important and currently overlooked issue in treating neuro-oncological patients and I applaud the authors for their work writing this brief report.

Their objective is clear and their methods are sound. Also, the discussion is relevant and important.

However I would add several suggestions.

First of all, I think the authors should acknowledge the fact that they only analyzed coagulation markers in two groups of patients with brain tumors. Both of these tumors are known to cause perturbations in the coagulation profile. A control group without a malignant disease, whose results would be compared to these two groups would be much better. I would like this fact to be emphasized more in the limitations of the study (if not changed in the study design).
>> The authors agree that it is important to make clear the natures of the study and control group. Therefore, additional text was added to the introduction and the limitations paragraph explaining the reason for the use of the control group. This article was designed to highlight the uniquely pro-coagulatory effects of high-grade gliomas with respect to non-malignant brain neoplasms. This means that we are likely underestimating the coagulatory dysfunction in glioblastoma patients with respect to healthy, cancer-free people.

Secondly, a major limitation is the fact that the authors do not know when the blood samples were taken. This is important because various conditions, diseases and therapy can also impact the coagulation profile. For example, our own previous research analyzes the connection between corticosteroid treatment and the coagulation profile in these patients (Oreskovic et al 2024.). This limitation also has to be emphasized more.
>> We have made the text clear in the limitations paragraph that therapy could have had an impact in the coagulation profile. Patients with diseases that affect coagulation were excluded from the study as mentioned in the methods section.

Thirdly, I would like to see additional references showing the effects of altered PT on the risk of VTE, especially in brain tumor patients. In other words, what are the clinical implications of the found results.
>> A paragraph explaining the implications and the effects of altered PT on the risk of VTE was added. This additional paragraph has several references that are relevant to the topic.

Lastly, it is true that the coagulation patterns of brain tumor patients are important in light of VTE risk. However, they are also very important due to the fact that parts of the coagulation cascade have a crucial role in the development and aggressiveness of glial tumors (Magnus et a. 2013). This should also be acknowledged.
>> Additional text and references in the introduction and discussion were added to make this point in the article.
Competing Interests: No competing interests were disclosed. Close
Report a concern
Respond or Comment

COMMENTS ON THIS REPORT

Author Response 31 Oct 2024

Lissett Fernández, Medical School, Universidad Privada Antenor Orrego, Trujillo, 13008, Peru

31 Oct 2024

Author Response

Thank you for this review. I have replied to your comments and explained the changes to the article in a point-by-point manner. The comments are preceded by “>>”

... Continue reading Thank you for this review. I have replied to your comments and explained the changes to the article in a point-by-point manner. The comments are preceded by “>>”

This is an important and currently overlooked issue in treating neuro-oncological patients and I applaud the authors for their work writing this brief report.

Their objective is clear and their methods are sound. Also, the discussion is relevant and important.

However I would add several suggestions.

First of all, I think the authors should acknowledge the fact that they only analyzed coagulation markers in two groups of patients with brain tumors. Both of these tumors are known to cause perturbations in the coagulation profile. A control group without a malignant disease, whose results would be compared to these two groups would be much better. I would like this fact to be emphasized more in the limitations of the study (if not changed in the study design).
>> The authors agree that it is important to make clear the natures of the study and control group. Therefore, additional text was added to the introduction and the limitations paragraph explaining the reason for the use of the control group. This article was designed to highlight the uniquely pro-coagulatory effects of high-grade gliomas with respect to non-malignant brain neoplasms. This means that we are likely underestimating the coagulatory dysfunction in glioblastoma patients with respect to healthy, cancer-free people.

Secondly, a major limitation is the fact that the authors do not know when the blood samples were taken. This is important because various conditions, diseases and therapy can also impact the coagulation profile. For example, our own previous research analyzes the connection between corticosteroid treatment and the coagulation profile in these patients (Oreskovic et al 2024.). This limitation also has to be emphasized more.
>> We have made the text clear in the limitations paragraph that therapy could have had an impact in the coagulation profile. Patients with diseases that affect coagulation were excluded from the study as mentioned in the methods section.

Thirdly, I would like to see additional references showing the effects of altered PT on the risk of VTE, especially in brain tumor patients. In other words, what are the clinical implications of the found results.
>> A paragraph explaining the implications and the effects of altered PT on the risk of VTE was added. This additional paragraph has several references that are relevant to the topic.

Lastly, it is true that the coagulation patterns of brain tumor patients are important in light of VTE risk. However, they are also very important due to the fact that parts of the coagulation cascade have a crucial role in the development and aggressiveness of glial tumors (Magnus et a. 2013). This should also be acknowledged.
>> Additional text and references in the introduction and discussion were added to make this point in the article.
Thank you for this review. I have replied to your comments and explained the changes to the article in a point-by-point manner. The comments are preceded by “>>”

This is an important and currently overlooked issue in treating neuro-oncological patients and I applaud the authors for their work writing this brief report.

Their objective is clear and their methods are sound. Also, the discussion is relevant and important.

However I would add several suggestions.

First of all, I think the authors should acknowledge the fact that they only analyzed coagulation markers in two groups of patients with brain tumors. Both of these tumors are known to cause perturbations in the coagulation profile. A control group without a malignant disease, whose results would be compared to these two groups would be much better. I would like this fact to be emphasized more in the limitations of the study (if not changed in the study design).
>> The authors agree that it is important to make clear the natures of the study and control group. Therefore, additional text was added to the introduction and the limitations paragraph explaining the reason for the use of the control group. This article was designed to highlight the uniquely pro-coagulatory effects of high-grade gliomas with respect to non-malignant brain neoplasms. This means that we are likely underestimating the coagulatory dysfunction in glioblastoma patients with respect to healthy, cancer-free people.

Secondly, a major limitation is the fact that the authors do not know when the blood samples were taken. This is important because various conditions, diseases and therapy can also impact the coagulation profile. For example, our own previous research analyzes the connection between corticosteroid treatment and the coagulation profile in these patients (Oreskovic et al 2024.). This limitation also has to be emphasized more.
>> We have made the text clear in the limitations paragraph that therapy could have had an impact in the coagulation profile. Patients with diseases that affect coagulation were excluded from the study as mentioned in the methods section.

Thirdly, I would like to see additional references showing the effects of altered PT on the risk of VTE, especially in brain tumor patients. In other words, what are the clinical implications of the found results.
>> A paragraph explaining the implications and the effects of altered PT on the risk of VTE was added. This additional paragraph has several references that are relevant to the topic.

Lastly, it is true that the coagulation patterns of brain tumor patients are important in light of VTE risk. However, they are also very important due to the fact that parts of the coagulation cascade have a crucial role in the development and aggressiveness of glial tumors (Magnus et a. 2013). This should also be acknowledged.
>> Additional text and references in the introduction and discussion were added to make this point in the article.
Competing Interests: No competing interests were disclosed. Close
Report a concern

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Version 2

VERSION 2 PUBLISHED 29 Aug 2024

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Version 2 (revision) 31 Oct 24		read
Version 1 29 Aug 24	read	read

Darko Orešković, Clinical Hospital Dubrava, Zagreb, Croatia
Joab Chapman, Tel Aviv University, Tel-Aviv, Israel

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06 Dec 2024 | for Version 2

Joab Chapman, Department of Neurology and Neurosurgery, Tel Aviv University, Tel-Aviv, Israel

2 Views Cite this report Responses(0)

Approved

The authors have fully responded to all the points raised.

Competing Interests

No competing interests were disclosed.

Reviewer Expertise

Neuroimmunology, neuro-coagulation, neuroinflammation

I confirm that I have read this submission and believe that I have an appropriate level of expertise to confirm that it is of an acceptable scientific standard.

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9 Views

24 Sep 2024 | for Version 1

Joab Chapman, Department of Neurology and Neurosurgery, Tel Aviv University, Tel-Aviv, Israel

9 Views Cite this report Responses(1)

Approved With Reservations

Is the work clearly and accurately presented and does it cite the current literature?

Yes
Is the study design appropriate and is the work technically sound?

Partly
Are sufficient details of methods and analysis provided to allow replication by others?

Partly
If applicable, is the statistical analysis and its interpretation appropriate?

Partly
Are all the source data underlying the results available to ensure full reproducibility?

Yes
Are the conclusions drawn adequately supported by the results?

Yes

Competing Interests

No competing interests were disclosed.

Reviewer Expertise

Neuroimmunology, neuro-coagulation, neuroinflammation

Respond to this report

Responses (1)

Author Response

31 Oct 2024

Lissett Fernández, Medical School, Universidad Privada Antenor Orrego, Trujillo, 13008, Peru

Thank you for this review. I have replied to your comments and explained the changes to the article in a point-by-point manner. The comments are preceded by “>>”

This is a solid addition to the data associating high grade glioma with systemic coagulation changes.

Major comments
Introduction: Secretion of thrombin and other active coagulation factors by gliomas is well known and excess thrombin may thus reach venous blood in the brain and cause venous thrombosis. This central mechanism should be added to the Introduction and perhaps Discussion. This mechanism seems highly relevant to the coagulation measures described in the manuscript.
>> The authors added statements in the introduction and the discussion explaining the mechanism.

Methods and Results: The statistical methods used to compare the groups are not clear to me. Some of the measures are quantitative (PT, aPTT etc) and though they are categorized into normal and pathological in tables 1 and 2, it is not clear if the analysis presented in table 3 was performed on continuous or categorical data.
>> We modified the text to make it clear whether a categorical or quantitative variable was used.
It would probably be more informative if performed on the continuous quantitative data. Analysis of INR would perhaps be significant in such and analysis. Bivariate analysis is usually performed on continuous data. It is also not clear (to me) what the OR represent.
>> We dichotomized the data because most clinical practice considers values as either normal or abnormal. However, additional text was added explaining direct analysis of the continuous quantitiative data in the Results and the Discussion section.
>> A short explanation of what OR represents was added to the Methods and the Results section.

The authors state in the opening of the Discussion that " We observe that PT was shortened in the cases compared to the controls" but it is difficult to understand if the values were higher or lower in the Results. Using the values of tests such as PC would enable us to assess if the pathology associated with glioma are high or low values, so presenting the data as mean + error would be more informative.
>> The direction of the difference was added, so it is clear what parameters increased or decreased in the study group compared to the control group.
>> Additional text was added to the Results and the Discussion sections to include analysis and explanation of the direction of change as well as direct statistical analysis of the continuous results.

Minor comments
ECOG not defined in the abstract (Eastern Cooperative Oncology Group performance status).
>> The term was appropriately defined in the abstract.

Study design: not clear what "convenience sample" means.
>> The term was removed from the text.

View more View less

Competing Interests

No competing interests were disclosed.

Back to all reports

Reviewer Report

15 Views

16 Sep 2024 | for Version 1

Darko Orešković, Department of Neurosurgery, Clinical Hospital Dubrava, Zagreb, Croatia

15 Views Cite this report Responses(1)

Approved With Reservations

Is the work clearly and accurately presented and does it cite the current literature?

Yes
Is the study design appropriate and is the work technically sound?

Yes
Are sufficient details of methods and analysis provided to allow replication by others?

Yes
If applicable, is the statistical analysis and its interpretation appropriate?

I cannot comment. A qualified statistician is required.
Are all the source data underlying the results available to ensure full reproducibility?

Yes
Are the conclusions drawn adequately supported by the results?

Yes

References

Competing Interests

No competing interests were disclosed.

Reviewer Expertise

Neurosurgery, neuro-oncology

Respond to this report

Responses (1)

Author Response

31 Oct 2024

Lissett Fernández, Medical School, Universidad Privada Antenor Orrego, Trujillo, 13008, Peru

Thank you for this review. I have replied to your comments and explained the changes to the article in a point-by-point manner. The comments are preceded by “>>”

This is an important and currently overlooked issue in treating neuro-oncological patients and I applaud the authors for their work writing this brief report.

Their objective is clear and their methods are sound. Also, the discussion is relevant and important.

However I would add several suggestions.

First of all, I think the authors should acknowledge the fact that they only analyzed coagulation markers in two groups of patients with brain tumors. Both of these tumors are known to cause perturbations in the coagulation profile. A control group without a malignant disease, whose results would be compared to these two groups would be much better. I would like this fact to be emphasized more in the limitations of the study (if not changed in the study design).
>> The authors agree that it is important to make clear the natures of the study and control group. Therefore, additional text was added to the introduction and the limitations paragraph explaining the reason for the use of the control group. This article was designed to highlight the uniquely pro-coagulatory effects of high-grade gliomas with respect to non-malignant brain neoplasms. This means that we are likely underestimating the coagulatory dysfunction in glioblastoma patients with respect to healthy, cancer-free people.

Secondly, a major limitation is the fact that the authors do not know when the blood samples were taken. This is important because various conditions, diseases and therapy can also impact the coagulation profile. For example, our own previous research analyzes the connection between corticosteroid treatment and the coagulation profile in these patients (Oreskovic et al 2024.). This limitation also has to be emphasized more.
>> We have made the text clear in the limitations paragraph that therapy could have had an impact in the coagulation profile. Patients with diseases that affect coagulation were excluded from the study as mentioned in the methods section.

Thirdly, I would like to see additional references showing the effects of altered PT on the risk of VTE, especially in brain tumor patients. In other words, what are the clinical implications of the found results.
>> A paragraph explaining the implications and the effects of altered PT on the risk of VTE was added. This additional paragraph has several references that are relevant to the topic.

Lastly, it is true that the coagulation patterns of brain tumor patients are important in light of VTE risk. However, they are also very important due to the fact that parts of the coagulation cascade have a crucial role in the development and aggressiveness of glial tumors (Magnus et a. 2013). This should also be acknowledged.
>> Additional text and references in the introduction and discussion were added to make this point in the article.

View more View less

Competing Interests

No competing interests were disclosed.

Alongside their report, reviewers assign a status to the article:

Approved - the paper is scientifically sound in its current form and only minor, if any, improvements are suggested

Approved with reservations - A number of small changes, sometimes more significant revisions are required to address specific details and improve the papers academic merit.

Not approved - fundamental flaws in the paper seriously undermine the findings and conclusions

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[2] 2. Morey RJR, Ramírez-Morfa CA, Rivero-Morey J: Tratamiento del glioma cerebral de alto grado en el paciente adulto. Universidad Médica Pinareña. 2020 Jan 9 [cited 2024 Mar 16]; 16(1): 389. Reference Source

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[4] 4. Méndez-Aguilar P, Vera-Ponce VJ, Méndez-Aguilar P, et al.: Factores pronóstico de supervivencia en adultos por gliomas de alto grado en un Hospital de Lima, Perú. Revista de la Facultad de Medicina Humana. 2020 Jul [cited 2024 Mar 16]; 20(3): 460–471. Publisher Full Text Reference Source

[5] 5. Eisele A, Seystahl K, Rushing EJ, et al.: Venous thromboembolic events in glioblastoma patients: An epidemiological study. Eur. J. Neurol. 2022 Aug [cited 2024 Mar 16]; 29(8): 2386–2397. PubMed Abstract | Publisher Full Text | Free Full Text

[6] 6. Sosa-Quintero LS, Carrasco-Martínez IL, Mariscal-Ramírez I, et al.: El estado protrombótico en los pacientes con cáncer. GAMO. 2021 Jun 15 [cited 2024 Mar 16]; 20(1): 5369. Publisher Full Text Reference Source

[7] 7. Ay C, Pabinger I, Cohen AT: Cancer-associated venous thromboembolism: Burden, mechanisms, and management. Thromb. Haemost. 2017 Jan 26; 117(2): 219–230. PubMed Abstract | Publisher Full Text

[8] 8. Navone SE, Guarnaccia L, Locatelli M, et al.: Significance and Prognostic Value of The Coagulation Profile in Patients with Glioblastoma: Implications for Personalized Therapy. World Neurosurg. 2019 Jan; 121: e621–e629. PubMed Abstract | Publisher Full Text

[9] 9. Hall JE: Guyton and Hall Textbook of Medical Physiology. 13th ed.Philadelphia, PA: Saunders; 2015; 1168.

[10] 10. Li W, Wang YR, Song W, et al.: The changes of plasma coagulation function in patients with glioma and its correlation with malignant grade of glioma. Zhonghua Yi Xue Za Zhi. 2018 Jan 30; 98(5): 336–339. PubMed Abstract | Publisher Full Text

[11] 11. Unsal E, Atalay F, Atikcan S, et al.: Prognostic significance of hemostatic parameters in patients with lung cancer. Respir. Med. 2004 Feb; 98(2): 93–98. PubMed Abstract | Publisher Full Text

[12] 12. Kim WJ, Dho YS, Ock CY, et al.: Clinical observation of lymphopenia in patients with newly diagnosed glioblastoma. J. Neuro-Oncol. 2019 Jun; 143(2): 321–328. PubMed Abstract | Publisher Full Text

[13] 13. Serban GM, Tamas CI, Tamas F, et al.: Preoperative Immune-Inflammatory Status of the Patients With Newly-Diagnosed Glioblastoma - Could It Genuinely Predict Their Survival? Cureus. 2023 Aug; 15(8): e43802. PubMed Abstract | Publisher Full Text

[14] 14. Pérez Cruz P, Acevedo Claros FN: Escalas de Estado Funcional (o performance satus) en Cáncer. Gastroenterología Latinoamericana. 2014 [cited 2024 Mar 16]; 25(3): 219–226. Reference Source

[15] 15. Díaz-Díaz D, Villanova Martínez M, Palencia Herrejón E: Pacientes oncológicos ingresados en Unidad de Cuidados Intensivos. Análisis de factores predictivos de mortalidad. Med. Intensiva. 2018 Aug 1 [cited 2024 Mar 16]; 42(6): 346–353. PubMed Abstract | Publisher Full Text Reference Source

[16] 16. Quispe-Pastor NJ, Gorritti-Rubio AP, Fernandez L: Underlying Data for article “Altered coagulation profile of patients with high-grade glioma: clinical study with control group”. figshare. 2024, 28 Temmuz. Publisher Full Text

Altered coagulation profile of patients with high-grade glioma: clinical study with control group.

Abstract

Background

Objective

Methods

Results

Conclusion

Keywords

Background

Methods

Study design

Sample size

Data collection

Data analysis

Ethical considerations

Results

Table 1. Sociodemographic and clinical parameters of cases (high-grade glioma) and controls (meningioma).

Table 2. Blood panel results of cases and controls, presenting the number and proportion of abnormal results.

Table 3. Bivariate and multivariate analysis of variables associated with the presence of high-grade glioma.

Discussion

Conclusions

CrediT author statement

Data availability statement

References

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