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Singh G, Bamba H, Inban P, Chandrasekaran SH, Priyatha V, John J, Prajjwal P. The prognostic significance of pro-BNP and heart failure in acute pulmonary embolism: A systematic review. Dis Mon 2024:101783. [PMID: 38955637 DOI: 10.1016/j.disamonth.2024.101783] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/04/2024]
Abstract
Pulmonary embolism (PE) is the third most common type of cardiovascular disease and carries a high mortality rate of 30% if left untreated. Although it is commonly known that individuals who suffer heart failure (HF) are more likely to experience a pulmonary embolism, little is known concerning the prognostic relationship between acute PE and HF. This study aims to evaluate the prognostic usefulness of heart failure and pro-BNP in pulmonary embolism cases. A scientific literature search, including PubMed, Medline, and Cochrane reviews, was used to assess and evaluate the most pertinent research that has been published. The findings showed that increased N-terminal brain natriuretic peptide (NT-proBNP) levels could potentially identify pulmonary embolism patients with worse immediate prognoses and were highly predictive of all-cause death. Important prognostic information can be obtained from NT-proBNP and Heart-type Fatty Acid Binding Proteins (H-FABP) when examining individuals with PE. The heart, distal tubular cells of the renal system, and skeletal muscle are where H-FABP is primarily found, with myocardial cells having the highest concentration. Recent studies have indicated that these biomarkers may also help assess the severity of PE and its long-term risk.
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Affiliation(s)
- Gurmehar Singh
- Government Medical College and Hospital, Chandigarh, India
| | - Hyma Bamba
- Government Medical College and Hospital, Chandigarh, India
| | - Pugazhendi Inban
- Internal Medicine, St. Mary's General Hospital and Saint Clare's Health, NY, USA.
| | | | | | - Jobby John
- Dr. Somervell Memorial CSI Medical College and Hospital Karakonam, Trivandrum, India
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2
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Schupp T, Rusnak J, Forner J, Weidner K, Ruka M, Egner-Walter S, Dudda J, Bertsch T, Kittel M, Behnes M, Akin I. Cardiac Troponin I but Not N-Terminal Pro-B-Type Natriuretic Peptide Predicts Outcomes in Cardiogenic Shock. J Pers Med 2023; 13:1348. [PMID: 37763116 PMCID: PMC10532680 DOI: 10.3390/jpm13091348] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2023] [Revised: 08/16/2023] [Accepted: 08/29/2023] [Indexed: 09/29/2023] Open
Abstract
This study investigates the prognostic value of cardiac troponin I (cTNI) and N-terminal pro-B-type natriuretic peptide (NT-proBNP) levels in patients with cardiogenic shock (CS). Data regarding the prognostic value of cardiac biomarkers in CS is scarce, furthermore, most studies were restricted to CS patients with acute myocardial infarction (AMI). Therefore, consecutive patients with CS from 2019 to 2021 were included. Blood samples were retrieved from day of disease onset (day 1) and on days 2, 3 and 4 thereafter. The prognostic value of cTNI and NT-proBNP levels was tested for 30-day all-cause mortality. Statistical analyses included univariable t-tests, Spearman's correlations, Kaplan-Meier analyses and multivariable Cox proportional regression analyses. A total of 217 CS patients were included with an overall rate of all-cause mortality of 56% at 30 days. CTNI was able to discriminate 30-day non-survivors (area under the curve (AUC) = 0.669; p = 0.001), whereas NT-proBNP (AUC = 0.585; p = 0.152) was not. The risk of 30-day all-cause mortality was higher in patients with cTNI levels above the median (70% vs. 43%; log rank p = 0.001; HR = 2.175; 95% CI 1.510-3.132; p = 0.001), which was observed both in patients with (71% vs. 49%; log rank p = 0.012) and without AMI-related CS (69% vs. 40%; log rank p = 0.005). The prognostic impact of cTNI was confirmed after multivariable adjustment (HR = 1.915; 95% CI 1.298-2.824; p = 0.001). In conclusion, cTNI-but not NT-proBNP-levels discriminated 30-day all-cause mortality in CS patients.
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Affiliation(s)
- Tobias Schupp
- Department of Cardiology, Angiology, Haemastaseology and Medical Intensive Care, University Medical Centre Mannheim, Medical Faculty Mannheim, Heidelberg University, 69117 Heidelberg, Germany (M.B.)
- European Center for AngioScience (ECAS) and German Center for Cardiovascular Research (DZHK) Partner Site Heidelberg/Mannheim, 68167 Mannheim, Germany
| | - Jonas Rusnak
- Department of Cardiology, Angiology, Haemastaseology and Medical Intensive Care, University Medical Centre Mannheim, Medical Faculty Mannheim, Heidelberg University, 69117 Heidelberg, Germany (M.B.)
- European Center for AngioScience (ECAS) and German Center for Cardiovascular Research (DZHK) Partner Site Heidelberg/Mannheim, 68167 Mannheim, Germany
| | - Jan Forner
- Department of Cardiology, Angiology, Haemastaseology and Medical Intensive Care, University Medical Centre Mannheim, Medical Faculty Mannheim, Heidelberg University, 69117 Heidelberg, Germany (M.B.)
- European Center for AngioScience (ECAS) and German Center for Cardiovascular Research (DZHK) Partner Site Heidelberg/Mannheim, 68167 Mannheim, Germany
| | - Kathrin Weidner
- Department of Cardiology, Angiology, Haemastaseology and Medical Intensive Care, University Medical Centre Mannheim, Medical Faculty Mannheim, Heidelberg University, 69117 Heidelberg, Germany (M.B.)
- European Center for AngioScience (ECAS) and German Center for Cardiovascular Research (DZHK) Partner Site Heidelberg/Mannheim, 68167 Mannheim, Germany
| | - Marinela Ruka
- Department of Cardiology, Angiology, Haemastaseology and Medical Intensive Care, University Medical Centre Mannheim, Medical Faculty Mannheim, Heidelberg University, 69117 Heidelberg, Germany (M.B.)
- European Center for AngioScience (ECAS) and German Center for Cardiovascular Research (DZHK) Partner Site Heidelberg/Mannheim, 68167 Mannheim, Germany
| | - Sascha Egner-Walter
- Department of Cardiology, Angiology, Haemastaseology and Medical Intensive Care, University Medical Centre Mannheim, Medical Faculty Mannheim, Heidelberg University, 69117 Heidelberg, Germany (M.B.)
- European Center for AngioScience (ECAS) and German Center for Cardiovascular Research (DZHK) Partner Site Heidelberg/Mannheim, 68167 Mannheim, Germany
| | - Jonas Dudda
- Department of Cardiology, Angiology, Haemastaseology and Medical Intensive Care, University Medical Centre Mannheim, Medical Faculty Mannheim, Heidelberg University, 69117 Heidelberg, Germany (M.B.)
- European Center for AngioScience (ECAS) and German Center for Cardiovascular Research (DZHK) Partner Site Heidelberg/Mannheim, 68167 Mannheim, Germany
| | - Thomas Bertsch
- Institute of Clinical Chemistry, Laboratory Medicine and Transfusion Medicine, Nuremberg General Hospital, Paracelsus Medical University, 90419 Nuremberg, Germany
| | - Maximilian Kittel
- Institute for Clinical Chemistry, Faculty of Medicine Mannheim, Heidelberg University, 68167 Mannheim, Germany
| | - Michael Behnes
- Department of Cardiology, Angiology, Haemastaseology and Medical Intensive Care, University Medical Centre Mannheim, Medical Faculty Mannheim, Heidelberg University, 69117 Heidelberg, Germany (M.B.)
- European Center for AngioScience (ECAS) and German Center for Cardiovascular Research (DZHK) Partner Site Heidelberg/Mannheim, 68167 Mannheim, Germany
| | - Ibrahim Akin
- Department of Cardiology, Angiology, Haemastaseology and Medical Intensive Care, University Medical Centre Mannheim, Medical Faculty Mannheim, Heidelberg University, 69117 Heidelberg, Germany (M.B.)
- European Center for AngioScience (ECAS) and German Center for Cardiovascular Research (DZHK) Partner Site Heidelberg/Mannheim, 68167 Mannheim, Germany
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Zhang J, Ali A, Liu Y, Peng L, Pu J, Yi Q, Zhou H. Derivation and Validation of a Prognostic Model for Mortality in Chinese Patients with Acute Pulmonary Embolism. Clin Appl Thromb Hemost 2022; 28:10760296221129597. [PMID: 36484273 PMCID: PMC9742928 DOI: 10.1177/10760296221129597] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
INTRODUCTION We aim to explore the risk factors for in-hospital mortality and to derive a prognostic model for patients with APE in China. MATERIALS AND METHODS Inpatients with APE were enrolled from West China Hospital between January 2016 and December 2019. Logistic regression analyses were used to explore risk factors for in-hospital mortality and develop a prognostic model. RESULTS A total of 813 subjects with APE were included in this study, of whom 542 were in the training set and 271 were in the test set. Multivariable regression analyses indicated that age, male, heart rate, systolic blood pressure, elevated NT-proBNP or troponin T, malignancy, chronic renal insufficiency, and respiratory failure were independent risk factors for in-hospital mortality. For the training set, the area under the curve (AUC) of the ROC curve was 0.899, with a sensitivity and specificity of 89.7% and 77.7%, respectively. The model had higher prediction accuracy than the PESI and sPESI. CONCLUSIONS The prediction model has proven excellent discrimination and calibration, which may be a useful tool to help physicians make decisions regarding the best treatment strategy.
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Affiliation(s)
- Jiarui Zhang
- Department of Respiratory and Critical Care Medicine,
West China
Hospital of Sichuan University, Chengdu,
China
| | - Adila Ali
- Department of Respiratory and Critical Care Medicine,
West China
Hospital of Sichuan University, Chengdu,
China
| | - Yu Liu
- Department of Respiratory and Critical Care Medicine,
West China
Hospital of Sichuan University, Chengdu,
China
| | - Lige Peng
- Department of Respiratory and Critical Care Medicine,
West China
Hospital of Sichuan University, Chengdu,
China
| | - Jiaqi Pu
- Department of Respiratory and Critical Care Medicine,
West China
Hospital of Sichuan University, Chengdu,
China
| | - Qun Yi
- Department of Respiratory and Critical Care Medicine,
West China
Hospital of Sichuan University, Chengdu,
China,Sichuan Cancer Hospital and Institution, Sichuan Cancer Center,
Cancer Hospital Affiliate to School of Medicine, UESTC, Chengdu, Sichuan Province,
China
| | - Haixia Zhou
- Department of Respiratory and Critical Care Medicine,
West China
Hospital of Sichuan University, Chengdu,
China,Haixia Zhou, MD, PhD, Qun Yi, MD, PhD,
Department of Respiratory and Critical Care Medicine, West China Hospital,
Sichuan University, Guo-xue-xiang 37#, Wuhou district, Chengdu 610041, Sichuan
Province, China.
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Wang J, Wang L, Jin L, Rong X, Tang X, Guo H, Liu X, Shi L, Tao G. Predictive Value of MPV and Plasma NT-ProBNP Combined with the Simplified Geneva Scale for the Prognosis of Acute Pulmonary Embolism. EVIDENCE-BASED COMPLEMENTARY AND ALTERNATIVE MEDICINE : ECAM 2021; 2021:1292921. [PMID: 34712339 PMCID: PMC8548102 DOI: 10.1155/2021/1292921] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/05/2021] [Accepted: 09/14/2021] [Indexed: 11/18/2022]
Abstract
OBJECTIVE To explore the predictive value of mean platelet volume (MPV) and plasma N-terminal probrain natriuretic peptide (NT-ProBNP) combined with a simplified Geneva scale for the prognosis of acute pulmonary embolism (APE). METHODS The clinical data of 68 patients with APE admitted to our hospital from October 2017 to October 2019 were collected. According to the prognosis, the patients were divided into a good prognosis group (n = 45) and a poor prognosis group (n = 23). The clinical data, laboratory clinical indexes, and simplified Geneva scale scores were recorded for the two groups. The risk factors of poor prognosis were analyzed by binary multivariate logistic regression analysis; the predictive ability of each index on the prognosis of patients with APE was analyzed by the ROC curve. RESULTS The incidences of deep vein thrombosis, diabetes, and hyperlipidemia in the poor prognosis group were higher than those in the good prognosis group (P < 0.05). PLT, platelet distribution width (PDW), MPV, and plasma NT-ProBNP in the poor prognosis group were higher than those in the good prognosis group (P < 0.05). The simplified Geneva scale score of the poor prognosis group was higher than that of the good prognosis group (P < 0.05). PDW, MPV, plasma NT-ProBNP, and simplified Geneva scale were all independent risk factors for the poor prognosis of APE patients (P < 0.05). The AUC of MPV in predicting the prognosis of APE patients was 0.818 (95% CI: 0.712-0.925). When the optimal cutoff value was 0.571, the sensitivity was 77.1%, and the specificity was 80.0%. The AUC of plasma NT-ProBNP in predicting the prognosis of APE patients was 0.762 (95% CI: 0.634-0.891). When the optimal cutoff value was 0.475, the sensitivity was 71.5%, and the specificity was 76.0%. The AUC of the simplified Geneva scale in predicting the prognosis of APE patients was 0.749 (95% CI: 0.618-0.879). When the optimal cutoff value was 0.469, the sensitivity was 82.9%, and the specificity was 64.0%. The AUC of MPV and plasma NT-ProBNP combined with the simplified Geneva scale in predicting the prognosis of APE patients was 0.907 (95% CI: 0.826-0.988). When the optimal cutoff value was 0.726, the sensitivity was 88.6%, and the specificity was 84.0%. CONCLUSION MPV, plasma NT-ProBNP, and simplified Geneva scale have a certain predictive value for the prognosis of APE. Compared with a single index, the combination of the three indexes has a significant improvement in predicting the prognosis of APE and has better clinical value.
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Affiliation(s)
- Jing Wang
- Department of Wound Repairment and Intervention, The Second Affiliated Hospital of Dalian Medical University, Dalian, Liaoning 116000, China
| | - Lu Wang
- Department of Internal Medicine, The Second Affiliated Hospital of Dalian Medical University, Dalian, Liaoning 116000, China
| | - Ling Jin
- Department of Wound Repairment and Intervention, The Second Affiliated Hospital of Dalian Medical University, Dalian, Liaoning 116000, China
| | - Xiaolei Rong
- Department of Wound Repairment and Intervention, The Second Affiliated Hospital of Dalian Medical University, Dalian, Liaoning 116000, China
| | - Xueshuang Tang
- Department of Wound Repairment and Intervention, The Second Affiliated Hospital of Dalian Medical University, Dalian, Liaoning 116000, China
| | - Haina Guo
- Department of Wound Repairment and Intervention, The Second Affiliated Hospital of Dalian Medical University, Dalian, Liaoning 116000, China
| | - Xiaochuan Liu
- Department of Wound Repairment and Intervention, The Second Affiliated Hospital of Dalian Medical University, Dalian, Liaoning 116000, China
| | - Lei Shi
- Department of General Surgery, The Second Affiliated Hospital of Dalian Medical University, Dalian, Liaoning 116000, China
| | - Guilu Tao
- Department of Wound Repairment and Intervention, The Second Affiliated Hospital of Dalian Medical University, Dalian, Liaoning 116000, China
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Joint analysis of D-dimer, N-terminal pro b-type natriuretic peptide, and cardiac troponin I on predicting acute pulmonary embolism relapse and mortality. Sci Rep 2021; 11:14909. [PMID: 34290322 PMCID: PMC8295248 DOI: 10.1038/s41598-021-94346-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2021] [Accepted: 06/30/2021] [Indexed: 11/09/2022] Open
Abstract
Previous studies on the adverse events of acute pulmonary embolism (APE) were mostly limited to single marker, and short follow-up duration, from hospitalization to up to 30 days. We aimed to predict the long-term prognosis of patients with APE by joint assessment of D-dimer, N-Terminal Pro-Brain Natriuretic Peptide (NT-ProBNP), and troponin I (cTnI). Newly diagnosed patients of APE from January 2011 to December 2015 were recruited from three hospitals. Medical information of the patients was collected retrospectively by reviewing medical records. Adverse events (APE recurrence and all-cause mortality) of all enrolled patients were followed up via telephone. D-dimer > 0.50 mg/L, NT-ProBNP > 500 pg/mL, and cTnI > 0.40 ng/mL were defined as the abnormal. Kaplan–Meier curve was used to compare the cumulative survival rate between patients with different numbers of abnormal markers. Cox proportional hazard regression model was used to further test the association between numbers of abnormal markers and long-term prognosis of patients with APE after adjusting for potential confounding. During follow-up, APE recurrence and all-cause mortality happened in 78 (30.1%) patients. The proportion of APE recurrence and death in one abnormal marker, two abnormal markers, and three abnormal markers groups were 7.69%, 28.21%, and 64.10% respectively. Patients with three abnormal markers had the lowest survival rate than those with one or two abnormal markers (Log-rank test, P < 0.001). After adjustment, patients with two or three abnormal markers had a significantly higher risk of the total adverse event compared to those with one abnormal marker. The hazard ratios (95% confidence interval) were 6.27 (3.24, 12.12) and 10.7 (4.1, 28.0), respectively. Separate analyses for APE recurrence and all-cause death found similar results. A joint test of abnormal D-dimer, NT-ProBNP, and cTnI in APE patients could better predict the long-term risk of APE recurrence and all-cause mortality.
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Xing X, Liu J, Deng Y, Xu S, Wei L, Yang M, He X, Cao B, Huang X, Yue Q, Yang J, Teng Z. Impact of renal function on the prognosis of acute pulmonary embolism patients: a systematic review and meta-analysis. Expert Rev Respir Med 2020; 16:91-98. [PMID: 33297795 DOI: 10.1080/17476348.2021.1862653] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
OBJECTIVES We conduct a study to explore the influence of impaired renal function on prognosis in Acute pulmonary embolism (APE) patients. METHODS A meta-analysis was performed using the EMBASE and PubMed databases for relevant publications reporting the impact of impaired renal function on the clinical outcomes in patients with APE. RESULTS Eventually, 17 articles were included in our analysis. The results suggested that renal insufficiency (RI) is a predictor of poor prognosis in APE patients(short-term mortality: pooled OR = 2.83, 95%CI: 2.20-3.63; long-term mortality: pooled OR = 2.30, 95%CI: 1.72-3.08; adverse outcomes: pooled OR = 3.02, 95%CI: 2.60-3.51). The short-term and long-term mortality rates of APE patients with RI were both higher than those in patients without RI. In addition, acute kidney injury(AKI) could serve as a predictive factor of poor prognosis (pooled OR = 2.75, 95%CI: 2.45-3.08), and it doubles the overall mortality rate in APE patients. However, chronic kidney disease (CKD) did not predict poor prognosis in APE patients (pooled OR = 1.94, 95%CI: 0.99-3.81), although it could slightly increase the overall mortality rate in APE patients. CONCLUSIONS RI and AKI could be included in the prognosis evaluation for APE, but the impact of CKD in APE patients has yet to be determined.
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Affiliation(s)
- Xiqian Xing
- Department of Respiratory Medicine, The Affiliated Hospital of Yunnan University, the Second People's Hospital of Yunnan Province, Kunming, China
| | - Jie Liu
- Department of Respiratory Medicine, The Fourth Affiliated Hospital of Kunming Medical University, Kunming, China
| | - Yishu Deng
- Department of Respiratory Medicine, The Affiliated Hospital of Yunnan University, the Second People's Hospital of Yunnan Province, Kunming, China
| | - Shuanglan Xu
- Department of Respiratory Medicine, The Affiliated Hospital of Yunnan University, the Second People's Hospital of Yunnan Province, Kunming, China
| | - Li Wei
- Department of Respiratory Medicine, The Affiliated Hospital of Yunnan University, the Second People's Hospital of Yunnan Province, Kunming, China
| | - Mei Yang
- Department of Respiratory Medicine, The Affiliated Hospital of Yunnan University, the Second People's Hospital of Yunnan Province, Kunming, China
| | - Xiaohua He
- Department of Respiratory Medicine, The Affiliated Hospital of Yunnan University, the Second People's Hospital of Yunnan Province, Kunming, China
| | - Bing Cao
- Department of Respiratory Medicine, The Affiliated Hospital of Yunnan University, the Second People's Hospital of Yunnan Province, Kunming, China
| | - Xiaoxian Huang
- Department of Respiratory Medicine, The Affiliated Hospital of Yunnan University, the Second People's Hospital of Yunnan Province, Kunming, China
| | - Qiaoning Yue
- Department of Orthopedic Surgery, The People's Hospital of Yuxi City, the Sixth Affiliated Hospital of Kunming Medical University, Yuxi, China
| | - Jiao Yang
- First Department of Respiratory Medicine, The First Affiliated Hospital of Kunming Medical University, Kunming, China
| | - Zhaowei Teng
- Department of Orthopedic Surgery, The People's Hospital of Yuxi City, the Sixth Affiliated Hospital of Kunming Medical University, Yuxi, China
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Miñana G, de la Espriella R, Mollar A, Santas E, Núñez E, Valero E, Bodí V, Chorro FJ, Fernández-Cisnal A, Martí-Cervera J, Sanchis J, Bayés-Genís A, Núñez J. Factors associated with plasma antigen carbohydrate 125 and amino-terminal pro-B-type natriuretic peptide concentrations in acute heart failure. EUROPEAN HEART JOURNAL-ACUTE CARDIOVASCULAR CARE 2020; 9:437-447. [DOI: 10.1177/2048872620908033] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Background:
Plasma amino-terminal pro-B-type natriuretic peptide and antigen carbohydrate 125 levels are positively associated with a higher risk of adverse clinical outcomes in acute heart failure. As a proxy of congestion, antigen carbohydrate 125 has also been proposed as a right-sided heart failure marker. Thus, we aimed to determine in this population the main factors – including echocardiographic right-sided heart failure parameters – associated with antigen carbohydrate 125 and amino-terminal pro-B-type natriuretic peptide.
Methods and results:
We prospectively included 2949 patients admitted with acute heart failure. Amino-terminal pro-B-type natriuretic peptide and antigen carbohydrate 125 were used as dependent variables in a multivariable linear regression analysis. The mean age of the sample was 73.9±11.1 years; 48.9% were female, 35.8% showed ischaemic aetiology, and 51.6% exhibited heart failure with preserved ejection fraction. The median (interquartile range) for amino-terminal pro-B-type natriuretic peptide and antigen carbohydrate 125 were 4840 (2111–9204) pg/ml and 58 (26–129) U/ml, respectively. In a multivariable setting, and ranked in order of importance (R2), estimated glomerular filtration rate (43.7%), left ventricle ejection fraction (15.1%), age (12.4%) and high-sensitivity troponin T (10.9%) emerged as the most important factors associated with amino-terminal pro-B-type natriuretic peptide. The five main factors associated with antigen carbohydrate 125 were, in order of importance: the presence of pleural effusion (36.8%), tricuspid regurgitation severity (25.1%), age (11.9%), amino-terminal pro-B-type natriuretic peptide (6.5%) and peripheral oedema (4.3%).
Conclusion:
In patients with acute heart failure the main factors associated with amino-terminal pro-B-type natriuretic peptide were renal dysfunction, left ventricle ejection fraction and age. For antigen carbohydrate 125, clinical parameters of congestion and the severity of tricuspid regurgitation were the most important predictors. These results endorse the value of antigen carbohydrate 125 as a useful marker of right-sided heart failure.
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Affiliation(s)
- Gema Miñana
- Cardiology Department, Universitat de Valencia, Spain
- Centro de Investigación Biomédica en Red Cardiovascular, Spain
| | | | - Anna Mollar
- Cardiology Department, Universitat de Valencia, Spain
| | | | - Eduardo Núñez
- Cardiology Department, Universitat de Valencia, Spain
| | - Ernesto Valero
- Cardiology Department, Universitat de Valencia, Spain
- Centro de Investigación Biomédica en Red Cardiovascular, Spain
| | - Vicent Bodí
- Cardiology Department, Universitat de Valencia, Spain
- Centro de Investigación Biomédica en Red Cardiovascular, Spain
| | - Francisco J Chorro
- Cardiology Department, Universitat de Valencia, Spain
- Centro de Investigación Biomédica en Red Cardiovascular, Spain
| | | | | | - Juan Sanchis
- Cardiology Department, Universitat de Valencia, Spain
- Centro de Investigación Biomédica en Red Cardiovascular, Spain
| | - Antoni Bayés-Genís
- Centro de Investigación Biomédica en Red Cardiovascular, Spain
- Cardiology Department and Heart Failure Unit, Hospital Universitari Germans Trias i Pujol, Badalona, Autonomous University of Barcelona, Spain
| | - Julio Núñez
- Cardiology Department, Universitat de Valencia, Spain
- Centro de Investigación Biomédica en Red Cardiovascular, Spain
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CA125 outperforms NT-proBNP in acute heart failure with severe tricuspid regurgitation. Int J Cardiol 2020; 308:54-59. [DOI: 10.1016/j.ijcard.2020.03.027] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/08/2019] [Revised: 02/21/2020] [Accepted: 03/10/2020] [Indexed: 12/28/2022]
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9
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Kong T, Park YS, Lee HS, Kim S, Lee JW, Yu G, Eun C, You JS, Chung HS, Park I, Chung SP. Value of the Delta Neutrophil Index for Predicting 28-Day Mortality in Patients With Acute Pulmonary Embolism in the Emergency Department. Shock 2019; 49:649-657. [PMID: 29036031 DOI: 10.1097/shk.0000000000001027] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
PURPOSE Acute pulmonary embolism (PE), frequently seen in the emergency department (ED), is a leading cause of cardiovascular morbidity and mortality. The delta neutrophil index (DNI) reflects the fraction of circulating immature granulocytes as a component of the systemic inflammatory response syndrome criteria. The pathogenesis of acute PE is significantly associated with inflammation. The aim of the study was to investigate the clinical usefulness of the DNI as a marker of severity in patients with acute PE admitted to the ED. METHODS We retrospectively analyzed the data of patients who were diagnosed with acute PE at a single ED, admitted from January 1, 2011 to June 30, 2017. The diagnosis of acute pulmonary embolism was confirmed using clinical, laboratory, and radiological findings. The DNI was determined at presentation. The clinical outcome was all-cause mortality within 28 days of emergency department admission. RESULTS We included 447 patients in this study. The multivariate Cox regression model demonstrated that higher DNI values on ED admission were significantly associated with short-term mortality (hazard ratio, 1.107; 95% confidence interval, 1.042-1.177). The optimal cut-off DNI value, measured on ED admission, was 3.0%; this value was associated with an increased hazard of 28-day mortality following PE (HR, 7.447; 95% CI, 4.183-13.366; P < 0.001) CONCLUSION:: The DNI value, obtained as part of the complete blood count analysis, can be easily determined without additional burdens of cost or time. A high DNI is useful as a marker to predict 28-day mortality in patients with acute PE.
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Affiliation(s)
- Taeyoung Kong
- Department of Emergency Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Yoo Seok Park
- Department of Emergency Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Hye Sun Lee
- Department of Research Affairs, Biostatistics Collaboration Unit, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Sinae Kim
- Department of Research Affairs, Biostatistics Collaboration Unit, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Jong Wook Lee
- Department of Laboratory Medicine, Konyang University Hospital, Daejeon, Republic of Korea.,Research Institute of Bacterial Resistance, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Gina Yu
- Department of Emergency Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Claire Eun
- Department of Neurology, University of California, San Francisco, San Francisco, California.,San Francisco Veterans Affairs Medical Center, San Francisco, California
| | - Je Sung You
- Department of Emergency Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Hyun Soo Chung
- Department of Emergency Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Incheol Park
- Department of Emergency Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Sung Phil Chung
- Department of Emergency Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea
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Öz A, Çınar T, Hayıroğlu Mİ, Avşar Ş, Keskin M, Orhan AL. The predictive value of plasma osmolality for in-hospital mortality in patients with acute pulmonary embolism. CLINICAL RESPIRATORY JOURNAL 2019; 13:174-183. [PMID: 30712325 DOI: 10.1111/crj.13001] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/26/2018] [Revised: 01/21/2019] [Accepted: 01/28/2019] [Indexed: 01/21/2023]
Abstract
INTRODUCTION AND OBJECTIVES Prior studies demonstrated that plasma osmolality may have a predictive value for in-hospital mortality in patients with heart failure and acute coronary syndrome. In addition, plasma glucose and blood urea nitrogen (BUN) levels, the components of plasma osmolality, have been shown to be an important contributor for in-hospital mortality in acute pulmonary embolism (APE) patients. Hence, the objective of the current study is to evaluate the effect of plasma osmolality upon admission with in-hospital mortality in patients with APE. METHODS A total of 245 consecutive intermediate or high risk APE patients were enrolled into the study. The study population was divided into three tertile groups (T1, T2 and T3) based on the increased plasma osmolality. The in-hospital mortality was the primary end-point. RESULTS After adjusting for all risk factors, in-hospital mortality was significantly higher in the T3 group compared to T1 and T2 groups (OR: 3.6, 95% CI: 1.3 to 18.8, P < .001). In addition, the incidence of asystolia, hypotension and cardiogenic shock were significantly higher in the T3 group. An area under the receiver operating characteristic curve value of plasma osmolality for the in-hospital mortality was 0.76 with sensitivity 67.2% and specificity 74.1% 95% CI: (0.66-0.87, P < .001). CONCLUSION This is the first study to demonstrate that elevated levels of plasma osmolality may have a predictive value for in-hospital mortality in APE patients. Our findings are novel and deserve further studies whether the treatment of higher plasma osmolality may reduce the risk of in-hospital mortality in APE patients.
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Affiliation(s)
- Ahmet Öz
- Department of Cardiology, Health Sciences University, Sultan Abdülhamid Han Training and Research Hospital, Istanbul, Turkey
| | - Tufan Çınar
- Department of Cardiology, Health Sciences University, Sultan Abdülhamid Han Training and Research Hospital, Istanbul, Turkey
| | - Mert İlker Hayıroğlu
- Department of Cardiology, Health Sciences University, Sultan Abdülhamid Han Training and Research Hospital, Istanbul, Turkey
| | - Şahin Avşar
- Urla State Hospital, Department of Cardiology, Izmir, Turkey
| | - Muhammed Keskin
- Department of Cardiology, Health Sciences University, Sultan Abdülhamid Han Training and Research Hospital, Istanbul, Turkey
| | - Ahmet Lütfüllah Orhan
- Department of Cardiology, Health Sciences University, Sultan Abdülhamid Han Training and Research Hospital, Istanbul, Turkey
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Gromadziński L, Januszko-Giergielewicz B, Czarnacka K, Pruszczyk P. NT-proBNP in the Prognosis of Death or Need for Renal Replacement Therapy in Patients with Stage 3-5 Chronic Kidney Disease. Cardiorenal Med 2019; 9:125-134. [PMID: 30726840 DOI: 10.1159/000496238] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/20/2018] [Accepted: 12/12/2018] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND The risk of cardiovascular (CV) complications is much greater in patients with chronic kidney disease (CKD). The aim of this study was to assess predictors of mortality, renal failure progression, and the need for dialysis in patients with CKD. METHODS The study group consisted of 70 patients with stage 3-5 CKD, followed up on average for 33.4 ± 15.6 months. Laboratory tests and echocardiography were performed on all patients. Composite endpoints were defined as (1) all-cause mortality and (2) mortality or renal replacement therapy (RRT), defined as the initiation of dialysis therapy. RESULTS During the observation period, 13 patients died and 11 began dialysis therapy. NT-proBNP was found to be a significant predictor in receiver operating characteristic curve analysis for all study endpoints. The optimal cutoff value for NT-proBNP as a predictor of mortality was 569.8 pg/mL, with a sensitivity of 53.8% and a specificity of 89.1%. For mortality or RRT, the cutoff value for NT-proBNP was 384.9 pg/mL, with a sensitivity and specificity of 70.8 and 72.7%, respectively. In a multivariate regression analysis, NT-proBNP was an independent predictor of mortality with an OR = 7.5 (95% CI: 1.05-53.87; p = 0.044) and of mortality or RRT with an OR = 4.7 (95% CI: 1.01-22.66; p = 0.048). CONCLUSIONS NT-proBNP is an independent predictor of mortality in patients with CKD and can also be useful for CV risk stratification in this patient population.
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Affiliation(s)
- Leszek Gromadziński
- II Department of Cardiology and Internal Medicine, Collegium Medicum, School of Medicine, University of Warmia and Mazury, Olsztyn, Poland,
| | - Beata Januszko-Giergielewicz
- Family Medicine Unit, Collegium Medicum, School of Medicine, University of Warmia and Mazury in Olsztyn, Olsztyn, Poland
| | | | - Piotr Pruszczyk
- Department of Internal Medicine and Cardiology, Medical University of Warsaw, Warsaw, Poland
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Ģībietis V, Kigitoviča D, Vītola B, Strautmane S, Skride A. Glomerular Filtration Rate as a Prognostic Factor for Long-Term Mortality after Acute Pulmonary Embolism. Med Princ Pract 2019; 28:264-272. [PMID: 30716739 PMCID: PMC6597913 DOI: 10.1159/000497436] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/07/2018] [Accepted: 02/04/2019] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND In-hospital mortality for patients presenting with acute pulmonary embolism (PE) has been reported to be up to 7 times higher for patients with decreased estimated glomerular filtration rate (eGFR). However, few studies have assessed its effect on long-term mortality. OBJECTIVE To determine the impact of eGFR and creatinine clearance (CrCl) on long-term all-cause mortality following acute PE in association with other routine laboratory analyses and comorbidities. PATIENTS/METHODS The prospective study enrolled 141 consecutive patients presenting with objectively confirmed acute PE. Demographic, clinical data, comorbidities, and laboratory values were recorded. CrCl and GFR were estimated using the Cockcroft-Gault, MDRD, and chronic kidney disease (CKD)-EPI equations. Patients were followed up at 90 days and 1 year after the event. RESULTS In univariate analyses, age, active cancer, PE severity index (PESI), CrCl and eGFR, D-dimer value, and high-density lipoprotein level were found to be significantly associated with mortality in 90 days and 1 year. Additionally, body mass index was significant in the 1-year follow-up. CrCl by Cockcroft-Gault (90-day: area under the curve [AUC] 0.763; 1-year: AUC 0.718) demonstrated higher discriminatory power for predicting mortality than eGFR by the MDRD (AUC 0.686; AUC 0.609) and CKD-EPI (AUC 0.697; AUC 0.630) equations. In multivariate analyses, active cancer, CrCl by Cockcroft-Gault (90-day: hazard ratio [HR] 0.948, 95% CI 0.919-0.979; 1-year: HR 0.967, 95% CI 0.943-0.991), eGFR by CKD-EPI (90-day: HR 0.948, 95% CI 0.915-0.983; 1-year: HR 0.971, 95% CI 0.945-0.998) were found to be independent predictors of mortality. eGFR by MDRD, D-dimer, and PESI value were significant prognostic factors for 90-day mortality. CONCLUSION Decreased renal function is a prognostic factor for increased all-cause mortality 90 days and 1 year after acute PE.
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Affiliation(s)
- Valdis Ģībietis
- Faculty of Continuing Education, Riga Stradins University, Riga, Latvia,
- Department of Internal Medicine, Riga Stradins University, Riga, Latvia,
- Pauls Stradins Clinical University Hospital, Riga, Latvia,
| | - Dana Kigitoviča
- Faculty of Continuing Education, Riga Stradins University, Riga, Latvia
- Department of Internal Medicine, Riga Stradins University, Riga, Latvia
- Pauls Stradins Clinical University Hospital, Riga, Latvia
| | - Barbara Vītola
- Faculty of Continuing Education, Riga Stradins University, Riga, Latvia
- Pauls Stradins Clinical University Hospital, Riga, Latvia
| | | | - Andris Skride
- Department of Internal Medicine, Riga Stradins University, Riga, Latvia
- Pauls Stradins Clinical University Hospital, Riga, Latvia
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Keskin M, Güvenç TS, Hayıroğlu Mİ, Kaya A, Tatlısu MA, Avşar Ş, Öz A, Keskin T, Uzun AO, Kozan Ö. A novel prognostic indicator for in-hospital and 4-year outcomes in patients with pulmonary embolism: TIMI risk index. J Crit Care 2017; 41:183-190. [PMID: 28575813 DOI: 10.1016/j.jcrc.2017.05.018] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2016] [Revised: 04/27/2017] [Accepted: 05/20/2017] [Indexed: 10/19/2022]
Abstract
BACKGROUND Thrombolysis in Myocardial Infarction (TIMI) risk index (TRI) was recently evaluated in patients with acute myocardial infarction and found as an important prognostic index. In the current study, we evaluated the prognostic value of TRI in patients with moderate-high and high risk pulmonary embolism (PE) who were treated with thrombolytic agents. METHODS We retrospectively evaluated the in-hospital and long-term (4-year) prognostic impact of TRI in a total number of 456 patients with moderate-high and high risk PE. Patients were stratified by quartiles (Q) of admission TRI. RESULTS In-hospital analysis revealed significantly higher rates of in-hospital death for patients with TRI in Q4. After adjustment for confounding baseline variables, TRI in Q4 was associated with 2.8-fold hazard of in-hospital death. Upon multivariate analysis, admission TRI in Q4 vs. Q1-3 was associated with 3.1 fold hazard of 4-year mortality rate. CONCLUSION TRI in Q4, as compared to Q1-3, was significantly predictive of short term and long-term outcomes in PE patients who treated with thrombolytic agents. Our data suggest TRI to be an independent, feasible, and cost-effective tool for rapid risk stratification in moderate-high and high risk PE patients who treated with thrombolytic agents.
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Affiliation(s)
- Muhammed Keskin
- Sultan Abdulhamid Han Training and Research Hospital, Department of Cardiology, Istanbul, Turkey.
| | - Tolga Sinan Güvenç
- Dr. Siyami Ersek Thoracic and Cardiovascular Surgery Center, Training and Research Hospital, Department of Cardiology, Istanbul, Turkey
| | - Mert İlker Hayıroğlu
- Sultan Abdulhamid Han Training and Research Hospital, Department of Cardiology, Istanbul, Turkey
| | - Adnan Kaya
- Duzce University, Department of Cardiology, Duzce, Turkey
| | | | | | - Ahmet Öz
- Sultan Abdulhamid Han Training and Research Hospital, Department of Cardiology, Istanbul, Turkey
| | - Taha Keskin
- Yeshiva University, Albert Einstein College of Medicine, Montefiore Medical Center, Department of Allergy/Immunology, Bronx, New York, USA
| | - Ahmet Okan Uzun
- Dortyol State Hospital, Department of Cardiology, Dortyol, Hatay, Turkey
| | - Ömer Kozan
- Sultan Abdulhamid Han Training and Research Hospital, Department of Cardiology, Istanbul, Turkey
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Gould PA, Ng K, Chacko Y, Doneva S, Claughton A, Korczyk D, Dimeski G. Characterisation and Comparison of Acute Haemodynamic, Cardiac Biochemical and Hormonal Response to Different Ventricular Pacing Sites in the Normal Heart. Heart Lung Circ 2016; 25:140-7. [DOI: 10.1016/j.hlc.2015.07.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2015] [Revised: 06/01/2015] [Accepted: 07/19/2015] [Indexed: 11/25/2022]
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15
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Lauque D, Maupas-Schwalm F, Bounes V, Juchet H, Bongard V, Roshdy A, Botella JM, Charpentier S. Predictive value of the heart-type fatty acid-binding protein and the Pulmonary Embolism Severity Index in patients with acute pulmonary embolism in the emergency department. Acad Emerg Med 2014; 21:1143-50. [PMID: 25308138 DOI: 10.1111/acem.12484] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2014] [Revised: 06/07/2014] [Accepted: 06/08/2014] [Indexed: 11/27/2022]
Abstract
OBJECTIVES Heart-type fatty acid-binding protein (h-FABP), sensitive troponins, natriuretic peptides, and clinical scores such as the Pulmonary Embolism Severity Index (PESI) are candidates for risk stratification of patients with acute pulmonary embolism (PE). The aim was to compare their respective prognostic values to predict an adverse outcome at 1 month. METHODS The authors prospectively included 132 consecutive patients with confirmed acute PE. On admission to the emergency department (ED), plasma concentrations of h-FABP, sensitive cardiac troponin I-Ultra (cTnI-Ultra), and brain natriuretic peptide (BNP) were measured and the PESI calculated in all patients. The combined 30-day outcomes of interest were death, cardiac arrest, mechanical ventilation, use of catecholamines, and recurrence of acute PE. RESULTS During the first 30 days, 14 (10.6%) patients suffered complications. Among the biomarkers, h-FABP above 6 μg/L was a stronger predictor of an unfavorable outcome (odds ratio [OR] = 17.5, 95% confidence interval [CI] = 4.2 to 73.3) than BNP > 100 pg/mL (OR = 5.7, 95% CI = 1.6 to 20.4) or cTnI-Ultra > 0.05 μg/L (OR = 3.4, 95% CI = 1.1 to 10.9). The PESI classified 83 of 118 patients (70.3%) with favorable outcomes and only one of 14 (7%) with adverse outcomes in low class I or II (OR = 30.8, 95% CI = 3.2 to 299.7). The areas under the receiver operating characteristic (ROC) curves (AUCs) were 0.90 (95% CI = 0.81 to 0.98) for h-FABP, 0.89 (95% CI = 0.82 to 0.96) for PESI, 0.79 (95% CI = 0.67 to 0.90) for BNP, and 0.76 (95% CI = 0.64 to 0.87) for cTnI-Ultra. The combination of h-FABP with PESI was a particularly useful prognostic indicator because none of the 79 patients (59.8%) with h-FABP < 6 ng/mL and PESI class < III had an adverse outcome. CONCLUSIONS h-FABP and the PESI are superior to BNP and cTnI-Ultra as markers for risk stratification of patients with acute PE. The high sensitivity of their combination identified a large number of low-risk patients in the ED.
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Affiliation(s)
- Dominique Lauque
- The Emergency Department; Rangueil University Hospital; Toulouse France
- University Toulouse 3; Toulouse France
| | - Françoise Maupas-Schwalm
- The Department of Biochemistry; Rangueil University Hospital; Toulouse France
- University Toulouse 3; Toulouse France
| | - Vincent Bounes
- The Emergency Department; Rangueil University Hospital; Toulouse France
| | - Henry Juchet
- The Emergency Department; Rangueil University Hospital; Toulouse France
| | - Vanina Bongard
- The Department of Epidemiology; Health Economics and Public Health University; Toulouse France
- INSERM UMR1027; Toulouse France
| | - Ashraf Roshdy
- The Cardiothoracic Intensive Therapy Unit; St. George's Hospital; London UK
| | - Jean Marie Botella
- The Department of Biochemistry; Rangueil University Hospital; Toulouse France
| | - Sandrine Charpentier
- The Emergency Department; Rangueil University Hospital; Toulouse France
- University Toulouse 3; Toulouse France
- INSERM UMR1027; Toulouse France
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