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Keller K, Schmitt VH, Hahad O, Espinola-Klein C, Münzel T, Lurz P, Konstantinides S, Hobohm L. Categorization of Patients With Pulmonary Embolism by Charlson Comorbidity Index. Am J Med 2024; 137:727-735. [PMID: 38663792 DOI: 10.1016/j.amjmed.2024.04.025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/02/2024] [Revised: 04/11/2024] [Accepted: 04/11/2024] [Indexed: 07/27/2024]
Abstract
BACKGROUND Short-term outcomes of pulmonary embolism are closely related to right ventricular dysfunction and patient's hemodynamic status, but also to individual comorbidity profile. However, the impact of patients' comorbidities on survival during pulmonary embolism might be underrated. Although the Charlson Comorbidity Index (CCI) is the most extensively studied comorbidity index for detecting comorbidity burden, studies analyzing the impact of CCI on pulmonary embolism patients' survival are limited. METHODS We used the German nationwide inpatient sample to analyze all hospitalized patients with pulmonary embolism in Germany 2005-2020 and calculated CCI for each patient, compared the CCI classes (very low: CCI = 0 points, mild: CCI = 1-2 points, moderate: CCI = 3-4, high severity: CCI >4 points) and impact of CCI class on outcomes. RESULTS Overall, 1,373,145 hospitalizations of patients with acute pulmonary embolism (53.0% females, 55.9% aged ≥70 years) were recorded in Germany between 2005 and 2020; the CCI class stratified them. Among these, 100,156 (7.3%) were categorized as very low; 221,545 (16.1%) as mild; 394,965 (28.8%) as moderate; and 656,479 (47.8%) as patients with a high comorbidity burden according to CCI class. In-hospital case fatality increased depending on the CCI class: 3.6% in very low, 6.5% in mild, 12.1% in moderate, and 22.1% in high CCI class (P < .001). CCI class was associated with increased in-hospital case fatality (odds ratio 2.014; 95% confidence interval, 2.000-2.027; P < .001). CONCLUSION Our study results may help practitioners to better understand and measure the association between an aggravated comorbidity profile and increased in-hospital case fatality in patients with pulmonary embolism.
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Affiliation(s)
- Karsten Keller
- Department of Cardiology, University Medical Center of the Johannes Gutenberg-University Mainz, Germany; Center for Thrombosis and Hemostasis (CTH), University Medical Center of the Johannes Gutenberg-University Mainz, Germany; Medical Clinic VII, Department of Sports Medicine, University Hospital Heidelberg, Germany.
| | - Volker H Schmitt
- Department of Cardiology, University Medical Center of the Johannes Gutenberg-University Mainz, Germany; German Center for Cardiovascular Research (DZHK), Partner Site Rhine Main, Mainz, Germany
| | - Omar Hahad
- Department of Cardiology, University Medical Center of the Johannes Gutenberg-University Mainz, Germany; German Center for Cardiovascular Research (DZHK), Partner Site Rhine Main, Mainz, Germany
| | - Christine Espinola-Klein
- Department of Cardiology, University Medical Center of the Johannes Gutenberg-University Mainz, Germany; Center for Thrombosis and Hemostasis (CTH), University Medical Center of the Johannes Gutenberg-University Mainz, Germany
| | - Thomas Münzel
- Department of Cardiology, University Medical Center of the Johannes Gutenberg-University Mainz, Germany; German Center for Cardiovascular Research (DZHK), Partner Site Rhine Main, Mainz, Germany
| | - Philipp Lurz
- Department of Cardiology, University Medical Center of the Johannes Gutenberg-University Mainz, Germany; German Center for Cardiovascular Research (DZHK), Partner Site Rhine Main, Mainz, Germany
| | - Stavros Konstantinides
- Center for Thrombosis and Hemostasis (CTH), University Medical Center of the Johannes Gutenberg-University Mainz, Germany; Department of Cardiology, Democritus University of Thrace, Alexandroupolis, Greece
| | - Lukas Hobohm
- Department of Cardiology, University Medical Center of the Johannes Gutenberg-University Mainz, Germany; Center for Thrombosis and Hemostasis (CTH), University Medical Center of the Johannes Gutenberg-University Mainz, Germany
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Mohammed AQI, Berman L, Staroselsky M, Wenn P, Hai O, Makaryus AN, Zeltser R. Clinical Presentation and Risk Stratification of Pulmonary Embolism. Int J Angiol 2024; 33:82-88. [PMID: 38846996 PMCID: PMC11152639 DOI: 10.1055/s-0044-1786878] [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: 06/09/2024] Open
Abstract
Pulmonary embolism (PE) presents with a spectrum of symptoms, ranging from asymptomatic cases to life-threatening events. Common symptoms include sudden dyspnea, chest pain, limb swelling, syncope, and hemoptysis. Clinical presentation varies based on thrombus burden, demographics, and time to presentation. Diagnostic evaluation involves assessing symptoms, physical examination findings, and utilizing laboratory tests, including D-dimer. Risk stratification using tools like Wells score, Pulmonary Embolism Severity Index, and Hestia criteria aids in determining the severity of PE. PE is categorized based on hemodynamic status, temporal patterns, and anatomic locations of emboli to guide in making treatment decisions. Risk stratification plays a crucial role in directing management strategies, with elderly and comorbid individuals at higher risk. Early identification and appropriate risk stratification are essential for effective management of PE. As we delve into this review article, we aim to enhance the knowledge base surrounding PE, contributing to improved patient outcomes through informed decision-making in clinical practice.
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Affiliation(s)
| | - Lorin Berman
- Department of Cardiology, Nassau University Medical Center, East Meadow, NY
| | - Mark Staroselsky
- Department of Cardiology, Nassau University Medical Center, East Meadow, NY
| | - Peter Wenn
- Department of Cardiology, Nassau University Medical Center, East Meadow, NY
| | - Ofek Hai
- Department of Cardiology, Nassau University Medical Center, East Meadow, NY
| | - Amgad N. Makaryus
- Department of Cardiology, Nassau University Medical Center, East Meadow, NY
- Department of Cardiology, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY
| | - Roman Zeltser
- Department of Cardiology, Nassau University Medical Center, East Meadow, NY
- Department of Cardiology, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY
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Birrenkott DA, Kabrhel C, Dudzinski DM. Intermediate-Risk and High-Risk Pulmonary Embolism: Recognition and Management: Cardiology Clinics: Cardiac Emergencies. Cardiol Clin 2024; 42:215-235. [PMID: 38631791 DOI: 10.1016/j.ccl.2024.02.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/19/2024]
Abstract
Pulmonary embolism (PE) is the third most common cause of cardiovascular death. Every specialty of medical practitioner will encounter PE in their patients, and should be prepared to employ contemporary strategies for diagnosis and initial risk-stratification. Treatment of PE is based on risk-stratification, with anticoagulation for all patients, and advanced modalities including systemic thrombolysis, catheter-directed therapies, and mechanical circulatory supports utilized in a manner paralleling PE severity and clinical context.
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Affiliation(s)
- Drew A Birrenkott
- Department of Emergency Medicine, Massachusetts General Hospital, 55 Fruit Street, Boston, MA 02114, USA; Center for Vascular Emergencies, Massachusetts General Hospital, 55 Fruit Street, Boston, MA 02114, USA
| | - Christopher Kabrhel
- Department of Emergency Medicine, Massachusetts General Hospital, 55 Fruit Street, Boston, MA 02114, USA; Center for Vascular Emergencies, Massachusetts General Hospital, 55 Fruit Street, Boston, MA 02114, USA
| | - David M Dudzinski
- Center for Vascular Emergencies, Massachusetts General Hospital, 55 Fruit Street, Boston, MA 02114, USA; Division of Cardiology, Massachusetts General Hospital, 55 Fruit Street, Boston, MA 02114, USA; Cardiac Intensive Care Unit, Massachusetts General Hospital, 55 Fruit Street, Boston, MA 02114, USA.
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Teodoru M, Negrea MO, Cozgarea A, Cozma D, Boicean A. Enhancing Pulmonary Embolism Mortality Risk Stratification Using Machine Learning: The Role of the Neutrophil-to-Lymphocyte Ratio. J Clin Med 2024; 13:1191. [PMID: 38592029 PMCID: PMC10931603 DOI: 10.3390/jcm13051191] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2023] [Revised: 02/11/2024] [Accepted: 02/18/2024] [Indexed: 04/10/2024] Open
Abstract
(1) Background: Acute pulmonary embolism (PE) is a significant public health concern that requires efficient risk estimation to optimize patient care and resource allocation. The purpose of this retrospective study was to show the correlation of NLR (neutrophil-to-lymphocyte ratio) and PESI (pulmonary embolism severity index)/sPESI (simplified PESI) in determining the risk of in-hospital mortality in patients with pulmonary thromboembolism. (2) Methods: A total of 160 patients admitted at the County Clinical Emergency Hospital of Sibiu from 2019 to 2022 were included and their hospital records were analyzed. (3) Results: Elevated NLR values were significantly correlated with increased in-hospital mortality. Furthermore, elevated NLR was associated with PESI and sPESI scores and their categories, as well as the individual components of these parameters, namely increasing age, hypotension, hypoxemia, and altered mental status. We leveraged the advantages of machine learning algorithms to integrate elevated NLR into PE risk stratification. Utilizing two-step cluster analysis and CART (classification and regression trees), several distinct patient subgroups emerged with varying in-hospital mortality rates based on combinations of previously validated score categories or their defining elements and elevated NLR, WBC (white blood cell) count, or the presence COVID-19 infection. (4) Conclusion: The findings suggest that integrating these parameters in risk stratification can aid in improving predictive accuracy of estimating the in-hospital mortality of PE patients.
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Affiliation(s)
- Minodora Teodoru
- Medical Clinical Department, Faculty of Medicine, “Lucian Blaga” University, 550024 Sibiu, Romania; (M.T.); (A.B.)
- County Clinical Emergency Hospital of Sibiu, 550245 Sibiu, Romania;
| | - Mihai Octavian Negrea
- Medical Clinical Department, Faculty of Medicine, “Lucian Blaga” University, 550024 Sibiu, Romania; (M.T.); (A.B.)
- County Clinical Emergency Hospital of Sibiu, 550245 Sibiu, Romania;
| | - Andreea Cozgarea
- County Clinical Emergency Hospital of Sibiu, 550245 Sibiu, Romania;
- Institute of Cardiovascular Diseases Timisoara, 300310 Timisoara, Romania;
- Cardiology Department, “Victor Babeș” University of Medicine and Pharmacy, 300041 Timisoara, Romania
| | - Dragoș Cozma
- Institute of Cardiovascular Diseases Timisoara, 300310 Timisoara, Romania;
- Cardiology Department, “Victor Babeș” University of Medicine and Pharmacy, 300041 Timisoara, Romania
- Research Center of the Institute of Cardiovascular Diseases Timișoara, 300310 Timisoara, Romania
| | - Adrian Boicean
- Medical Clinical Department, Faculty of Medicine, “Lucian Blaga” University, 550024 Sibiu, Romania; (M.T.); (A.B.)
- County Clinical Emergency Hospital of Sibiu, 550245 Sibiu, Romania;
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Korosoglou G, Mouselimis D, Koenig E, Konstantinides S. Ultrasound-assisted catheter-directed thrombolysis in a patient with COVID-19 infection and bilateral intermediate-to-high-risk pulmonary embolism: a case report. Eur Heart J Case Rep 2024; 8:ytad628. [PMID: 38223512 PMCID: PMC10787366 DOI: 10.1093/ehjcr/ytad628] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2023] [Revised: 09/28/2023] [Accepted: 12/13/2023] [Indexed: 01/16/2024]
Abstract
Background Acute pulmonary embolism (PE) is a common cardiovascular disorder, potentially associated with high morbidity and mortality rates. Case summary Herein, we report on a patient with COVID-19 infection and bilateral PE, who presented after cardiovascular resuscitation with return of spontaneous circulation. Initially, an acute coronary syndrome was suspected but bedside echocardiography showed dilatation of the right ventricle (RV) and RV dysfunction, helping to establish the diagnosis of acute intermediate-to-high-risk PE, which was subsequently confirmed by contrast-enhanced computed tomography pulmonary angiography. The patient was successfully treated using low-dose (12 mg of tissue plasminogen) ultrasound-assisted catheter-directed thrombolysis, which resulted in prompt clinical improvement and reversal of RV dysfunction without bleeding complications. Discussion This case demonstrates the importance of echocardiography for the differential diagnosis of PE and of catheter-directed thrombolysis for its treatment in patients with intermediate-to-high-risk and high-risk PEs.
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Affiliation(s)
- Grigorios Korosoglou
- Department of Cardiology, GRN Hospital Weinheim, Vascular Medicine & Pneumology, Röntgenstrasse 1, 69469 Weinheim, Germany
- Weinheim Imaging Center, Hector Foundation, Röntgenstrasse 1, 69469 Weinheim, Germany
| | - Dimitrios Mouselimis
- Department of Cardiology, GRN Hospital Weinheim, Vascular Medicine & Pneumology, Röntgenstrasse 1, 69469 Weinheim, Germany
- Weinheim Imaging Center, Hector Foundation, Röntgenstrasse 1, 69469 Weinheim, Germany
| | - Elke Koenig
- Department of Anesthesiology and Intensive Care Medicine, GRN Hospital Weinheim, Weinheim, Germany
| | - Stavros Konstantinides
- Center for Thrombosis and Hemostasis, University Medical Center Mainz, Mainz, Germany
- Department of Cardiology, Democritus University of Thrace, Alexandroupolis, Greece
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Gerardo F, Faria D, Silvério António P, Baltazar Ferreira J, Beringuilho M, Ferreira H, Fialho I, Miranda I, Sá Pereira Y, Nunes-Ferreira A, Roque D, Santos MB, Morais C, Bravo Baptista S, Augusto JB. PrOgnosis in Pulmonary Embolism (PoPE): 30-Day mortality risk score based on five admission parameters. Rev Port Cardiol 2024; 43:1-8. [PMID: 37423312 DOI: 10.1016/j.repc.2023.04.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2022] [Revised: 03/12/2023] [Accepted: 04/13/2023] [Indexed: 07/11/2023] Open
Abstract
INTRODUCTION AND OBJECTIVE Several scoring systems have been developed for risk stratification in patients with acute pulmonary embolism (PE). The Pulmonary Embolism Severity Index (PESI) and its simplified version (sPESI) are among the most used, however the high number of variables hinder its application. Our aim was to derive an easy-to-perform score based on simple parameters obtained at admission to predict 30-day mortality in acute PE patients. METHODS Retrospective study in 1115 patients with acute PE from two institutions (derivation cohort n=835, validation cohort n=280). The primary endpoint was all-cause mortality at 30 days. Statistically and clinically relevant variables were selected for multivariable Cox regression analysis. We derived and validated a multivariable risk score model and compared to other established scores. RESULTS The primary endpoint occurred in 207 patients (18.6%). Our model included five variables weighted as follows: modified shock index ≥1.1 (hazard ratio [HR] 2.57, 1.68-3.92, p<0.001), active cancer (HR 2.27, 1.45-3.56, p<0.001), altered mental state (HR 3.82, 2.50-5.83, p<0.001), serum lactate concentration ≥2.50 mmol/L (HR 5.01, 3.25-7.72, p<0.001), and age ≥80 years (HR 1.95, 1.26-3.03, p=0.003). The prognostic ability was superior to other scores (area under curve [AUC] 0.83 [0.79-0.87] vs 0.72 [0.67-0.79] in PESI and 0.70 [0.62-0.75] in sPESI, p<0.001) and its performance in the validation cohort was deemed good (73 events in 280 patients, 26.1%, AUC=0.76, 0.71-0.82, p<0.0001) and superior to other scores (p<0.05). CONCLUSIONS The PoPE score (https://tinyurl.com/ybsnka8s) is an easy tool with superior performance to predict early mortality in patients admitted for PE with non-high-risk PE.
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Affiliation(s)
- Filipa Gerardo
- Cardiology Department, Hospital Prof. Doutor Fernando Fonseca, Amadora, Portugal
| | - Daniel Faria
- Cardiology Department, Hospital Prof. Doutor Fernando Fonseca, Amadora, Portugal
| | - Pedro Silvério António
- Cardiology Department, Centro Hospitalar Universitário de Lisboa Norte EPE, Hospital de Santa Maria, Lisboa, Portugal
| | | | - Marco Beringuilho
- Cardiology Department, Hospital Prof. Doutor Fernando Fonseca, Amadora, Portugal
| | - Hilaryano Ferreira
- Cardiology Department, Hospital Prof. Doutor Fernando Fonseca, Amadora, Portugal
| | - Inês Fialho
- Cardiology Department, Hospital Prof. Doutor Fernando Fonseca, Amadora, Portugal
| | - Inês Miranda
- Cardiology Department, Hospital Prof. Doutor Fernando Fonseca, Amadora, Portugal
| | - Yolanda Sá Pereira
- Internal Medicine Department, Centro Hospitalar Universitário de Lisboa Norte EPE, Hospital de Santa Maria, Lisboa, Portugal
| | - Afonso Nunes-Ferreira
- Cardiology Department, Centro Hospitalar Universitário de Lisboa Norte EPE, Hospital de Santa Maria, Lisboa, Portugal
| | - David Roque
- Cardiology Department, Hospital Prof. Doutor Fernando Fonseca, Amadora, Portugal
| | - Miguel B Santos
- Cardiology Department, Hospital Prof. Doutor Fernando Fonseca, Amadora, Portugal
| | - Carlos Morais
- Cardiology Department, Hospital Prof. Doutor Fernando Fonseca, Amadora, Portugal
| | - Sérgio Bravo Baptista
- Cardiology Department, Hospital Prof. Doutor Fernando Fonseca, Amadora, Portugal; University Clinic of Cardiology - Faculty of Medicine at University of Lisbon, Lisbon, Portugal
| | - João B Augusto
- Cardiology Department, Hospital Prof. Doutor Fernando Fonseca, Amadora, Portugal; Advanced Cardiac Imaging Department, Barts Heart Centre, St Bartholomew's Hospital, London, UK; Institute of Cardiovascular Science, University College London, London, UK.
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7
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El-Bouri WK, Sanders A, Lip GYH. Predicting acute and long-term mortality in a cohort of pulmonary embolism patients using machine learning. Eur J Intern Med 2023; 118:42-48. [PMID: 37487827 DOI: 10.1016/j.ejim.2023.07.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2023] [Revised: 06/22/2023] [Accepted: 07/10/2023] [Indexed: 07/26/2023]
Abstract
BACKGROUND Pulmonary embolism (PE) is a severe condition that causes significant mortality and morbidity. Due to its acute nature, scores have been developed to stratify patients at high risk of 30-day mortality. Here we develop a machine-learning based score to predict 30-day, 90-day, and 365-day mortality in PE patients. METHODS The Birmingham and Black Country Venous Thromboembolism registry (BBC-VTE) of 2183 venous thromboembolism patients is used. Random forests were trained on a 70% training cohort and tested against 30% held-out set. The outcomes of interest were 30-day, 90-day, and 365-day mortality. These were compared to the pulmonary embolism severity index (PESI) and simplified pulmonary embolism severity index (sPESI). Shapley values were used to determine important predictors. Oral anticoagulation at discharge was also investigated as a predictor of mortality. RESULTS The machine learning risk score predicted 30-day mortality with AUC 0.71 [95% CI: 0.63 - 0.78] compared to the sPESI AUC of 0.65 [95% CI: 0.57 - 0.73] and PESI AUC of 0.64 [95% CI: 0.56 - 0.72]. 90-day mortality and 365-day mortality were predicted with an AUC of 0.74 and 0.73 respectively. High counts of neutrophils, white blood cell counts, and c-reactive protein and low counts of haemoglobin were important for 30-day mortality prediction but progressively lost importance with time. Older age was an important predictor of high risk throughout. CONCLUSION Machine learning algorithms have improved on standard clinical risk stratification for PE patients. External cohort validation is required before incorporation into clinical workflows.
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Affiliation(s)
- Wahbi K El-Bouri
- Liverpool Centre for Cardiovascular Science, University of Liverpool and Liverpool Heart & Chest Hospital, Liverpool, UK; Department of Cardiovascular and Metabolic Medicine, Institute of Life Course and Medical Sciences, University of Liverpool, Liverpool, UK.
| | - Alexander Sanders
- Liverpool Centre for Cardiovascular Science, University of Liverpool and Liverpool Heart & Chest Hospital, Liverpool, UK
| | - Gregory Y H Lip
- Liverpool Centre for Cardiovascular Science, University of Liverpool and Liverpool Heart & Chest Hospital, Liverpool, UK; Department of Cardiovascular and Metabolic Medicine, Institute of Life Course and Medical Sciences, University of Liverpool, Liverpool, UK
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Bumroongkit C, Limsukon A, Liwsrisakun C, Deesomchok A, Pothirat C, Theerakittikul T, Trongtrakul K, Tajarernmuang P, Niyatiwatchanchai N, Inchai J, Chaiwong W. Validation of the Pulmonary Embolism Severity Index Risk Classification and the 2019 European Society of Cardiology Risk Stratification in the Southeast Asian Population with Acute Pulmonary Embolism. J Atheroscler Thromb 2023; 30:1601-1611. [PMID: 36967130 PMCID: PMC10627767 DOI: 10.5551/jat.64094] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2022] [Accepted: 02/02/2023] [Indexed: 06/18/2023] Open
Abstract
AIM To date, no studies representing the Southeast Asian population have validated the Pulmonary Embolism Severity Index (PESI) and 2019 European Society of Cardiology (ESC) risk stratification. Therefore, this study aimed to validate the PESI score, simplified PESI (sPESI), PESI risk classification, and 2019 ESC risk stratification in Southeast Asian patients with acute pulmonary embolism (APE). METHODS The present study is a 10-year cross-sectional study. Here, risk regressions were conducted to identify the PESI risk classification, sPESI, and 2019 ESC risk stratification as predictors for 30-day all-cause and PE-related mortalities. Receiver operating characteristic (ROC) curves were constructed to determine the diagnostic ability of the PESI score, sPESI score, PESI risk classification, and 2019 ESC risk stratification to predict 30-day mortality. RESULTS A total of 696 patients (male, 286; female, 410; mean age, 57.7±15.7 years) were included in this study from 2011 to 2020. The risk of 30-day all-cause mortality progressively increased with the 2019 ESC risk stratification, being approximately 6-fold higher in the high-risk than in the low-risk class [risk ratio: 6.24 (95% confidence interval (CI), 3.12, 12.47), P<0.001]. The risk of 30-day all-cause mortality with the PESI risk classification also increased with the risk classes, being approximately 6-fold higher in class V than in class I [adjusted risk ratio: 5.91 (95% CI, 2.25, 15.51), P<0.001]. The highest area under the receiver operating characteristic curve (AuROC) of the predictive model was the PESI score [AuROC=0.733 (95% CI, 0.685, 0.782)]. CONCLUSION Our study represents a good validation of the PESI and 2019 ESC risk stratification to predict 30-day mortality after APE diagnosis in the Southeast Asian population.
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Affiliation(s)
- Chaiwat Bumroongkit
- Division of Pulmonary, Critical Care and Allergy, Department of Internal Medicine, Faculty of Medicine, Chiangmai University, Chiang Mai, Thailand
| | - Atikun Limsukon
- Division of Pulmonary, Critical Care and Allergy, Department of Internal Medicine, Faculty of Medicine, Chiangmai University, Chiang Mai, Thailand
| | - Chalerm Liwsrisakun
- Division of Pulmonary, Critical Care and Allergy, Department of Internal Medicine, Faculty of Medicine, Chiangmai University, Chiang Mai, Thailand
| | - Athavudh Deesomchok
- Division of Pulmonary, Critical Care and Allergy, Department of Internal Medicine, Faculty of Medicine, Chiangmai University, Chiang Mai, Thailand
| | - Chaicharn Pothirat
- Division of Pulmonary, Critical Care and Allergy, Department of Internal Medicine, Faculty of Medicine, Chiangmai University, Chiang Mai, Thailand
| | - Theerakorn Theerakittikul
- Division of Pulmonary, Critical Care and Allergy, Department of Internal Medicine, Faculty of Medicine, Chiangmai University, Chiang Mai, Thailand
| | - Konlawij Trongtrakul
- Division of Pulmonary, Critical Care and Allergy, Department of Internal Medicine, Faculty of Medicine, Chiangmai University, Chiang Mai, Thailand
| | - Pattraporn Tajarernmuang
- Division of Pulmonary, Critical Care and Allergy, Department of Internal Medicine, Faculty of Medicine, Chiangmai University, Chiang Mai, Thailand
| | - Nutchanok Niyatiwatchanchai
- Division of Pulmonary, Critical Care and Allergy, Department of Internal Medicine, Faculty of Medicine, Chiangmai University, Chiang Mai, Thailand
| | - Juthamas Inchai
- Division of Pulmonary, Critical Care and Allergy, Department of Internal Medicine, Faculty of Medicine, Chiangmai University, Chiang Mai, Thailand
| | - Warawut Chaiwong
- Division of Pulmonary, Critical Care and Allergy, Department of Internal Medicine, Faculty of Medicine, Chiangmai University, Chiang Mai, Thailand
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9
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de Wit K, D'Arsigny CL. Risk stratification of acute pulmonary embolism. J Thromb Haemost 2023; 21:3016-3023. [PMID: 37187357 DOI: 10.1016/j.jtha.2023.05.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2022] [Revised: 04/18/2023] [Accepted: 05/01/2023] [Indexed: 05/17/2023]
Abstract
Approximately 5% of pulmonary embolism (PE) cases present with persistent hypotension, obstructive shock, or cardiac arrest. Given the high short-term mortality, management of high-risk PE cases focuses on immediate reperfusion therapies. Risk stratification of normotensive PE is important to identify patients with an elevated risk of hemodynamic collapse or an elevated risk of major bleeding. Risk stratification for short-term hemodynamic collapse includes assessment of physiological parameters, right heart dysfunction, and identification of comorbidities. Validated tools such as European Society of Cardiology guidelines and Bova score can identify normotensive patients with PE and an elevated risk of subsequent hemodynamic collapse. At present, we lack high-quality evidence to recommend one treatment over another (systemic thrombolysis, catheter-directed therapy, or anticoagulation with close monitoring) for patients at elevated risk of hemodynamic collapse. Newer, less well-validated scores such as BACS and PE-CH may help identify patients at a high risk of major bleeding following systemic thrombolysis. The PE-SARD score may identify those at risk of major anticoagulant-associated bleeding. Patients at low risk of short-term adverse outcomes can be considered for outpatient management. The simplified Pulmonary Embolism Severity Index score or Hestia criteria are safe decision aids when combined with physician global assessment of the need for hospitalization following the diagnosis of PE.
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Affiliation(s)
- Kerstin de Wit
- Department of Emergency Medicine, Queen's University, Kingston, Ontario, Canada; Division of Emergency Medicine, Department of Medicine, McMaster University, Hamilton, Ontario, Canada.
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10
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Götzinger F, Lauder L, Sharp ASP, Lang IM, Rosenkranz S, Konstantinides S, Edelman ER, Böhm M, Jaber W, Mahfoud F. Interventional therapies for pulmonary embolism. Nat Rev Cardiol 2023; 20:670-684. [PMID: 37173409 PMCID: PMC10180624 DOI: 10.1038/s41569-023-00876-0] [Citation(s) in RCA: 20] [Impact Index Per Article: 20.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/30/2023] [Indexed: 05/15/2023]
Abstract
Pulmonary embolism (PE) is the leading cause of in-hospital death and the third most frequent cause of cardiovascular death. The clinical presentation of PE is variable, and choosing the appropriate treatment for individual patients can be challenging. Traditionally, treatment of PE has involved a choice of anticoagulation, thrombolysis or surgery; however, a range of percutaneous interventional technologies have been developed that are under investigation in patients with intermediate-high-risk or high-risk PE. These interventional technologies include catheter-directed thrombolysis (with or without ultrasound assistance), aspiration thrombectomy and combinations of the aforementioned principles. These interventional treatment options might lead to a more rapid improvement in right ventricular function and pulmonary and/or systemic haemodynamics in particular patients. However, evidence from randomized controlled trials on the safety and efficacy of these interventions compared with conservative therapies is lacking. In this Review, we discuss the underlying pathophysiology of PE, provide assistance with decision-making on patient selection and critically appraise the available clinical evidence on interventional, catheter-based approaches for PE treatment. Finally, we discuss future perspectives and unmet needs.
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Affiliation(s)
- Felix Götzinger
- Clinic of Cardiology, Angiology and Intensive Care Medicine, University Hospital Homburg, Saarland University, Homburg, Germany
| | - Lucas Lauder
- Clinic of Cardiology, Angiology and Intensive Care Medicine, University Hospital Homburg, Saarland University, Homburg, Germany
| | - Andrew S P Sharp
- Department of Cardiology, University Hospital of Wales, Cardiff, UK
- Cardiff University, Cardiff, UK
| | - Irene M Lang
- Department of Cardiology, Internal Medicine II, Medical University of Vienna, Vienna, Austria
| | - Stephan Rosenkranz
- Department of Cardiology - Internal Medicine III, Cologne University Heart Center, Cologne, Germany
- Cologne Cardiovascular Research Center (CCRC), Cologne University Heart Center, Cologne, Germany
| | - Stavros Konstantinides
- Center for Thrombosis and Hemostasis, University Medical Center of the Johannes Gutenberg University, Mainz, Germany
- Department of Cardiology, Democritus University of Thrace, Alexandroupolis, Greece
| | - Elazer R Edelman
- Institute for Medical Engineering and Science, Massachusetts Institute of Technology, Cambridge, MA, USA
| | - Michael Böhm
- Clinic of Cardiology, Angiology and Intensive Care Medicine, University Hospital Homburg, Saarland University, Homburg, Germany
| | - Wissam Jaber
- Division of Cardiology, Department of Medicine, Emory University School of Medicine, Atlanta, GA, USA
| | - Felix Mahfoud
- Clinic of Cardiology, Angiology and Intensive Care Medicine, University Hospital Homburg, Saarland University, Homburg, Germany.
- Institute for Medical Engineering and Science, Massachusetts Institute of Technology, Cambridge, MA, USA.
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11
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Tunzi M, Boster J, Godar C, Yugawa C, Prichard I, Walter R, Anderson J. Standardization of Pulmonary Embolism Evaluation and Management Through Implementation of a Pulmonary Embolism Response Team: A Single-Center Experience at Brooke Army Medical Center. Mil Med 2023; 188:e1808-e1812. [PMID: 36260426 DOI: 10.1093/milmed/usac318] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2022] [Revised: 08/17/2022] [Accepted: 10/03/2022] [Indexed: 11/12/2022] Open
Abstract
INTRODUCTION Pulmonary embolism (PE) is associated with significant rates of morbidity and mortality. Management of PE is complex, and adverse patient events are not uncommon. Brooke Army Medical Center (BAMC) is among several select institutions that have implemented multidisciplinary pulmonary embolism response teams (PERTs) to improve PE outcomes. PERT structure varies among institutions and often involves specialty expertise from a variety of departments within the hospital. PE response teams aim to improve the diagnosis and treatment for patients with acute PE. Here, we report our initial experience with this intervention. MATERIALS AND METHODS We developed a multidisciplinary PERT and implemented a standardized algorithm to guide the evaluation, management, and disposition of patients with acute PE. Patients with PE were identified in the pre-PERT period (2015-2017) and the post-PERT period (2020-2021). A retrospective analysis of clinical characteristics, management strategies, and outcomes was performed for both cohorts. RESULTS A total of 68 patients with acute PE were analyzed, 38 patients before PERT adoption, and 30 patients post-PERT. Baseline characteristics between the two cohorts were similar. A statistically significant increase in the evaluation for right ventricle dysfunction was noted in the post-PERT cohort, with 80% of patients having pro-brain natriuretic peptide labs obtained compared to 47% in the pre-PERT cohort (P = .005). Furthermore, 97% of patients in the post-PERT cohort had a transthoracic echocardiogram compared to 55% in the pre-PERT cohort (P = .0001). Six patients in the pre-PERT cohort underwent catheter-directed thrombolysis, compared to zero in the post-PERT cohort (P = .006). There were no differences in other treatment modalities. There was no statistically significant difference in length of stay between the two cohorts. CONCLUSIONS To our knowledge, this is the first report describing the successful implementation of a PERT at a military treatment facility to guide the evaluation, management, and treatment of PE. The implementation of the PERT improved the appropriate diagnostic evaluation for patients with intermediate-risk PE and reduced the use of non-guideline-based catheter-directed thrombolysis. This initiative serves as an example of what could be applied across other military treatment facilities within the Defense Health Agency.
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Affiliation(s)
- Matthew Tunzi
- Department of Medicine, Brooke Army Medical Center, San Antonio, TX 78234, USA
| | - Joshua Boster
- Division of Pulmonology and Critical Care Medicine, Brooke Army Medical Center, San Antonio, TX 78234, USA
| | - Cassandra Godar
- Department of Medicine, Brooke Army Medical Center, San Antonio, TX 78234, USA
| | - Craig Yugawa
- Department of Medicine, Brooke Army Medical Center, San Antonio, TX 78234, USA
| | - Ian Prichard
- Department of Medicine, Brooke Army Medical Center, San Antonio, TX 78234, USA
| | - Robert Walter
- Division of Pulmonology and Critical Care Medicine, Brooke Army Medical Center, San Antonio, TX 78234, USA
| | - Jess Anderson
- Division of Pulmonology and Critical Care Medicine, Brooke Army Medical Center, San Antonio, TX 78234, USA
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12
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Goldschmied A, Geisler T. [Thromboembolic diseases from a cardiological point of view]. Dtsch Med Wochenschr 2023; 148:908-914. [PMID: 37493952 DOI: 10.1055/a-1825-7296] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/27/2023]
Abstract
Thromboembolic disease is associated with a high mortality. It can be divided into two groups: embolism from a venous and embolism from an arterial side. This article gives an overview on thromboembolic disease (with a focus on pulmonary embolism and ischemic stroke) from a cardiologist's perspective.The therapeutic options for acute pulmonary embolism range from anticoagulation to fibrinolysis to interventional recanalization and surgery. The deciding factor for choice of therapy is the risk of early death. Besides clinical parameters, laboratory markers like cardiac troponin and right ventricular function on echocardiography or CTPA (computed tomography pulmonary angiography) are used to determine the early mortality risk. In hemodynamically instable patients, immediate thrombolysis is required, whereas patients with intermediate and low risk can be treated with anticoagulation. Interventional recanalization is currently being studied in patients at risk for development of CTEPH (chronic thromboembolic pulmonary hypertension) or an intermediate risk of early mortality.In ischemic stroke, early interdisciplinary workup involving a cardiologist is paramount. Post stroke screening should include monitoring for arrythmias (especially atrial fibrillation) and transthoracic echocardiography as well as sonography of extra- and intracranial arteries. If no embolic source can be detected (embolic stroke of undetermined source), transesophageal echo can be helpful to detect intracardiac shunts like patent foramen ovale (PFO) or intracardiac tumors. Post stroke care includes secondary prevention measures like risk factor modification and lipid lowering therapy as well as anticoagulation. In high risk for paradoxical embolization, interventional PFO closure can be performed. Interventional closure of the left atrial appendage (LAA) can be discussed in patients with both high thromboembolic and bleeding risk.
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13
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Choudry H, Ata F, Ibrahim W, Rana MOR, Ahmad S, Mehmood A, Gill BA, Suheb MK. Saddle pulmonary embolism in the setting of COVID-19 infection: A systematic review of case reports and case series. Open Med (Wars) 2023; 18:20230724. [PMID: 37273918 PMCID: PMC10238810 DOI: 10.1515/med-2023-0724] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2023] [Revised: 05/02/2023] [Accepted: 05/02/2023] [Indexed: 06/06/2023] Open
Abstract
Saddle pulmonary embolism (SPE) is a rare type of pulmonary embolism that can lead to hemodynamic compromise causing sudden deaths. Due to a dearth of large prospective studies in this area, little is known regarding the epidemiology, and prognosis and factors affecting the latter for COVID-19-associated SPE. We aimed to describe COVID-19-associated SPE and quantify and compare mortality and factors affecting mortality among the cases. We included a total of 25 publications with a total of 35 cases. The average age was 45 ± 16.3 years with 11 females and 24 males. Dyspnoea (82.5%), orthopnoea (43.5%), and cough (43.5%) were the most common symptoms, and obstructive shock was present in five (21.7%) patients. The average reported oxygen (O2) saturation was 85.8% ± 11.9 mm Hg. Hypertension (26.1%), diabetes (21.7%), and deep vein thrombosis (21.7%) were the most commonly reported comorbidities. Right heart strain was recognized in seven (30%) patients on electroencephalogram (S1QIIITIII) and 12 (52.2%) patients on echocardiogram. Anticoagulation, thrombolysis, and percutaneous intervention were tried in 21 (91.3%), 13 (56.5%), and 6 (26.1%) cases, respectively. Despite the aggressive management, 2 of 25 (8.7%) patients died in our smaller case report cohort. We conclude that despite aggressive management modalities, the mortality of SPE remains high in COVID-19.
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Affiliation(s)
- Hassan Choudry
- Department of Respiratory Medicine, University Hospital of Leicester, LeicesterLE1, UK
| | - Fateen Ata
- Department of Endocrinology, Hamad General Hospital, Hammad Medical Corporation, PO BOX 3050, Doha, Qatar
| | - Wanis Ibrahim
- Department of Internal Medicine and Pulmonology, Hammad Medical Corporation, Doha, Qatar
| | - Mohammad Omer Rehman Rana
- Department of Adult Cardiology, Chaudhary Pervaiz Ilahi Institute of Cardiology, Wazirabad, Pakistan
| | - Shoaib Ahmad
- Department of Medicine, Punjab Medical College, Faisalabad, Pakistan
| | - Asim Mehmood
- Respiratory Department, Derriford Hospital, University Hospitals Plymouth, Plymouth, UK
| | - Basir Afzaal Gill
- Intensive Care Unit, Department of Anaesthesia, Jinnah Hospital, Lahore, Pakistan
| | - Mahammed Khan Suheb
- Critical Care Department, St. Luke’s Aurora Hospital, Milwaukee, Wisconsin, USA
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14
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Snyder DJ, Zilinyi RS, V Madhavan M, Alsaloum M, Saleem D, Buyske JJ, Healy EW, McGredy MJ, Da Silva BT, Rosenzweig EB, Takeda K, Brodie D, Agerstrand C, Eisenberger A, Kirtane AJ, Parikh SA, Sethi SS. Association between Hispanic or Latino ethnicity and pulmonary embolism severity, management, and in-hospital outcomes. Vasc Med 2023; 28:222-232. [PMID: 36946153 DOI: 10.1177/1358863x231157441] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/23/2023]
Abstract
BACKGROUND Hispanic and Latino patients are under-represented in existing healthcare disparities research in pulmonary embolism (PE). The goal of this study was to determine if differences in PE severity, treatment modality, or in-hospital outcomes exist for Hispanic or Latino patients with PE. METHODS All PE cases from 2013 to 2019 at a single institution were reviewed. Clinical characteristics, imaging findings, intervention types, and in-hospital and 30-day outcomes were collected. Two cohorts were created based on patients' self-reported ethnicity. Outcomes were compared using univariate and multivariate analysis. RESULTS A total of 1265 patients were identified with confirmed PE; 474 (37%) identified as Hispanic or Latino. Hispanic or Latino patients presented with high-risk PE significantly less often (19% vs 25%, p = 0.03). On univariate analysis, Hispanic or Latino patients had lower rates of PE-specific intervention (15% vs 19%, p = 0.03) and similar rates of inpatient mortality (6.8% vs 7.5%, p = 0.64). On ordinal regression analysis, Hispanic or Latino ethnicity was associated with lower PE severity (OR 0.69, 95% CI 0.54-0.89, p = 0.003). In subgroup analyses of intermediate and high-risk PEs, ethnicity was not a significant predictor of receipt of PE-specific intervention or in-hospital mortality. CONCLUSIONS At this institution, Hispanic or Latino patients were less likely to present with high-risk PE but had similar rates of inpatient mortality. Future research is needed to identify if disparities in in-hospital care are driving perceived differences in PE severity and what addressable systematic factors are driving higher-than-expected in-hospital mortality for Hispanic or Latino patients.
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Affiliation(s)
- Daniel J Snyder
- Department of Medicine, NewYork-Presbyterian/Columbia University Irving Medical Center, NY, USA
| | - Robert S Zilinyi
- Department of Medicine, Division of Cardiology, Columbia University Irving Medical Center, NY, USA
| | - Mahesh V Madhavan
- Department of Medicine, Division of Cardiology, Columbia University Irving Medical Center, NY, USA
| | - Marissa Alsaloum
- Department of Medicine, NewYork-Presbyterian/Columbia University Irving Medical Center, NY, USA
| | - Danial Saleem
- Department of Medicine, NewYork-Presbyterian/Columbia University Irving Medical Center, NY, USA
| | - John J Buyske
- Department of Medicine, NewYork-Presbyterian/Columbia University Irving Medical Center, NY, USA
| | - Emma W Healy
- Department of Medicine, NewYork-Presbyterian/Columbia University Irving Medical Center, NY, USA
| | - Maxine J McGredy
- Department of Medicine, NewYork-Presbyterian/Columbia University Irving Medical Center, NY, USA
| | - Bernardo T Da Silva
- Department of Medicine, NewYork-Presbyterian/Columbia University Irving Medical Center, NY, USA
| | - Erika B Rosenzweig
- Department of Pediatrics, Division of Pediatric Cardiology, Columbia University Irving Medical Center, Morgan Stanley Children's Hospital, NY, USA
| | - Koji Takeda
- Department of Surgery, Division of Cardiothoracic Surgery, Columbia University Irving Medical Center, NY, USA
| | - Daniel Brodie
- Department of Medicine, Division of Pulmonary, Allergy and Critical Care Medicine, Columbia University Irving Medical Center, NY, USA
| | - Cara Agerstrand
- Department of Medicine, Division of Pulmonary, Allergy and Critical Care Medicine, Columbia University Irving Medical Center, NY, USA
| | - Andrew Eisenberger
- Department of Medicine, Division of Hematology and Oncology, Columbia University Irving Medical Center, NY, USA
| | - Ajay J Kirtane
- Department of Medicine, Division of Cardiology, Columbia University Irving Medical Center, NY, USA
| | - Sahil A Parikh
- Department of Medicine, Division of Cardiology, Columbia University Irving Medical Center, NY, USA
| | - Sanjum S Sethi
- Department of Medicine, Division of Cardiology, Columbia University Irving Medical Center, NY, USA
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15
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Kong NW, Acosta M, Zahid A, Clarke M, Bandealy N, Teerapuncharoen K, Luchetti H, Serritella A, Shah AP, Nathan S, Kalathiya R, Blair J, Ahmed O, Bag R, Paul J. Long-Term Outcomes of Patients With Pulmonary Embolism Managed With Endovascular Therapies Compared to Medical Therapy. JOURNAL OF THE SOCIETY FOR CARDIOVASCULAR ANGIOGRAPHY & INTERVENTIONS 2023; 2:100602. [PMID: 39130707 PMCID: PMC11308074 DOI: 10.1016/j.jscai.2023.100602] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/27/2022] [Revised: 01/26/2023] [Accepted: 02/03/2023] [Indexed: 08/13/2024]
Abstract
Background Guidelines on the management of acute pulmonary embolism (PE) recommend consideration of endovascular therapies (EVT) for patients at intermediate-high risk. However, long-term data on the outcomes of patients after EVT as compared to medical therapy is lacking. This study aimed to compare outcomes of patients receiving EVT as compared to medical therapy alone at 3 to 6 months. Methods In this single-center, retrospective cohort study, 190 patients with PE underwent evaluation for presence of right ventricular (RV) dysfunction by transthoracic echocardiogram, residual perfusion defects on ventilation-perfusion scanning, and functional capacity by 6-minute walk distance (6MWD) at 3 to 6 month follow-up. Results Fifty-eight (31%) patients received EVT for the management of their acute PE. At follow-up (median 120 [97-170] days), 71% of patients who received EVT had normalization of RV function compared with only 34% of patients who received medical therapy alone (P < .001). Patients who received EVT had a significantly greater increase in their estimated glomerular filtration rate (P = .001), decrease in N-terminal proB-type natriuretic peptide (P = .003), and decrease in hemoglobin values (P = .018). Patients with intermediate-high to high risk PE who received EVT had significantly greater distance achieved on their 6MWD as compared to those who received medical therapy alone (P = .025). Conclusions Patients with acute PE who received EVT plus medical therapy were more likely to achieve normalization of RV dysfunction at 3 to 6 month follow-up compared to patients who received medical therapy alone. These data suggest that EVT is an effective therapy option for acute PE in intermediate-high and high risk patients with potential durable long-term benefits.
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Affiliation(s)
- Nathan W. Kong
- Department of Internal Medicine, University of Chicago, Chicago, Illinois
| | - Mary Acosta
- Department of Internal Medicine, University of Chicago, Chicago, Illinois
| | - Arslan Zahid
- Department of Internal Medicine, University of Chicago, Chicago, Illinois
| | - Michael Clarke
- Department of Internal Medicine, University of Chicago, Chicago, Illinois
| | - Nadeem Bandealy
- Department of Internal Medicine, University of Chicago, Chicago, Illinois
| | - Krittika Teerapuncharoen
- Department of Internal Medicine, Section of Pulmonary/Critical Care Medicine, University of Chicago, Chicago, Illinois
| | - Hadleigh Luchetti
- Department of Internal Medicine, Section of Cardiology, University of Chicago, Chicago, Illinois
| | - Anthony Serritella
- Department of Hematology and Oncology, Northwestern University, Chicago, Illinois
| | - Atman P. Shah
- Department of Internal Medicine, Section of Cardiology, University of Chicago, Chicago, Illinois
| | - Sandeep Nathan
- Department of Internal Medicine, Section of Cardiology, University of Chicago, Chicago, Illinois
| | - Rohan Kalathiya
- Department of Internal Medicine, Section of Cardiology, University of Chicago, Chicago, Illinois
| | - John Blair
- Department of Internal Medicine, Section of Cardiology, University of Chicago, Chicago, Illinois
| | - Osman Ahmed
- Department of Radiology, University of Chicago, Chicago, Illinois
| | - Remzi Bag
- Department of Internal Medicine, Section of Pulmonary/Critical Care Medicine, University of Chicago, Chicago, Illinois
| | - Jonathan Paul
- Department of Internal Medicine, Section of Cardiology, University of Chicago, Chicago, Illinois
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16
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Koch V, Martin SS, Gruber-Rouh T, Eichler K, Mahmoudi S, Leistner DM, Scholtz JE, Bernatz S, Puntmann VO, Nagel E, Booz C, D'Angelo T, Alizadeh LS, Yel I, Ziegengeist NS, Torgashov K, Geyer T, Hardt SE, Vogl TJ, Gruenewald LD, Giannitsis E. Cancer patients with venous thromboembolism: Diagnostic and prognostic value of elevated D-dimers. Eur J Clin Invest 2023; 53:e13914. [PMID: 36444723 DOI: 10.1111/eci.13914] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/05/2022] [Revised: 11/22/2022] [Accepted: 11/23/2022] [Indexed: 11/30/2022]
Abstract
BACKGROUND D-dimer testing is known to have a high sensitivity at simultaneously low specificity, resulting in nonspecific elevations in a variety of conditions. METHODS This retrospective study sought to assess diagnostic and prognostic features of D-dimers in cancer patients referred to the emergency department for suspected pulmonary embolism (PE) and deep vein thrombosis (DVT). In total, 526 patients with a final adjudicated diagnosis of PE (n = 83) and DVT (n = 69) were enrolled, whereas 374 patients served as the comparative group, in which venous thromboembolism (VTE) has been excluded. RESULTS For the identification of VTE, D-dimers yielded the highest positive predictive value of 96% (95% confidence interval (CI), 85-99) at concentrations of 9.9 mg/L and a negative predictive value of 100% at .6 mg/L (95% CI, 97-100). At the established rule-out cut-off level of .5 mg/L, D-dimers were found to be very sensitive (100%) at a moderate specificity of nearly 65%. Using an optimised cut-off value of 4.9 mg/L increased the specificity to 95% for the detection of life-threatening VTE at the cost of moderate sensitivities (64%). During a median follow-up of 30 months, D-dimers positively correlated with the reoccurrence of VTE (p = .0299) and mortality in both cancer patients with VTE (p < .0001) and without VTE (p = .0008). CONCLUSIONS Although D-dimer testing in cancer patients is discouraged by current guidelines, very high concentrations above the 10-fold upper reference limit contain diagnostic and prognostic information and might be helpful in risk assessment, while low concentrations remain useful for ruling out VTE.
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Affiliation(s)
- Vitali Koch
- Goethe University Hospital Frankfurt, Frankfurt am Main, Germany.,Department of Cardiology, Angiology, and Pulmonology, University Hospital Heidelberg, Heidelberg, Germany
| | - Simon S Martin
- Goethe University Hospital Frankfurt, Frankfurt am Main, Germany
| | | | - Katrin Eichler
- Goethe University Hospital Frankfurt, Frankfurt am Main, Germany
| | | | - David M Leistner
- Goethe University Hospital Frankfurt, Frankfurt am Main, Germany
| | - Jan-Erik Scholtz
- Goethe University Hospital Frankfurt, Frankfurt am Main, Germany
| | - Simon Bernatz
- Goethe University Hospital Frankfurt, Frankfurt am Main, Germany
| | | | - Eike Nagel
- Goethe University Hospital Frankfurt, Frankfurt am Main, Germany
| | - Christian Booz
- Goethe University Hospital Frankfurt, Frankfurt am Main, Germany
| | - Tommaso D'Angelo
- Department of Biomedical Sciences and Morphological and Functional Imaging, University Hospital Messina, Messina, Italy
| | - Leona S Alizadeh
- Goethe University Hospital Frankfurt, Frankfurt am Main, Germany
| | - Ibrahim Yel
- Goethe University Hospital Frankfurt, Frankfurt am Main, Germany
| | | | | | - Tobias Geyer
- Goethe University Hospital Frankfurt, Frankfurt am Main, Germany
| | - Stefan E Hardt
- Department of Cardiology, Angiology, and Pulmonology, University Hospital Heidelberg, Heidelberg, Germany
| | - Thomas J Vogl
- Goethe University Hospital Frankfurt, Frankfurt am Main, Germany
| | | | - Evangelos Giannitsis
- Department of Cardiology, Angiology, and Pulmonology, University Hospital Heidelberg, Heidelberg, Germany
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17
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Assessment of sST2 Behaviors to Evaluate Severity/Clinical Impact of Acute Pulmonary Embolism. Int J Mol Sci 2023; 24:ijms24054591. [PMID: 36902022 PMCID: PMC10002919 DOI: 10.3390/ijms24054591] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2022] [Revised: 02/04/2023] [Accepted: 02/07/2023] [Indexed: 03/03/2023] Open
Abstract
Pulmonary embolism (PE) is a potentially life-threatening disorder. Beyond its usefulness in the prognostic stratification of heart failure, sST2 can represent a biomarker with high utility in several acute conditions. Our study was aimed to investigate whether sST2 can be used as a clinical marker of severity and prognostic outcome in acute PE. We enrolled 72 patients with documented PE and 38 healthy subjects; we measured the plasma concentrations of sST2 to evaluate the prognostic and severity performance of different levels of sST2 according to its association with the pulmonary embolism severity index (PESI) score and several parameters of respiratory function. PE patients had significantly higher levels of sST2 compared with healthy subjects (87.74 ± 17.1 vs. 17.1 ± 0.4 ng/mL, p < 0.001); we found higher PESI scores and serum lactate values in the group of patients with sST2 > 35 ng/mL compared with patients with sST2 < 35 ng/mL (138.7 ± 14.9 vs. 103.7 ± 15.1 and 2.43 ± 0.69 vs. 1.025 ± 0.05 mmol/L, respectively; p < 0.05). Patients with sST2 > 35 ng/mL showed higher radiological severity of PE compared with patients with sST2 < 35 ng/mL. Moreover, sST2 was the strongest parameter with a discriminative capacity for the development of acute respiratory failure and a PESI score >106 with respect to C reactive protein (CRP), creatinine, d-dimer, and serum lactate. We clearly demonstrated that sST2 significantly increased in PE and that its elevation was associated with disease severity. Therefore, sST2 may be used as a clinical marker in the evaluation of PE severity. However, further studies with larger patient populations are required to confirm these findings.
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18
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Luo Z, Ma G, Lu Y, Yao J, Xu N, Cao C, Ying K. Characteristics and 6-Month Mortality of Medical Oncology Patients With Incidental and Symptomatic Pulmonary Embolism: A Single-Institutional Retrospective Longitudinal Analysis. Clin Appl Thromb Hemost 2023; 29:10760296231155177. [PMID: 36748784 PMCID: PMC9909045 DOI: 10.1177/10760296231155177] [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: 02/08/2023] Open
Abstract
This study aimed to identify clinical characteristics of cancer patients with incidental pulmonary embolism (IPE) and assess the variables associated with 30-day mortality in cancer patients with PE including symptomatic pulmonary embolism (SPE) and IPE. 6-Month mortality rate in cancer patients with SPE and IPE were also compared. We retrospectively analyzed electronic medical records of cancer patients with newly diagnosed PE between January 2016 and June 2021. We compared clinical and radiological characteristics in cancer patients with IPE and SPE and identified variables associated with the overall 30-day mortality on multivariate analysis. All patients were followed up for 6 months and survival analysis was performed by use of Kaplan-Meier. Five hundred and nine eligible cancer patients with pulmonary embolism were identified during the study period. IPE is associated with lower BMI, colorectal and pancreas cancers, stage III/IV of cancer, recent antiangiogenic therapy, central venous catheter (CVC) and chronic cardiac or respiratory disease compared to SPE. The factors associated with 30-day mortality included poor performance status, lung/pleura or upper gastrointestinal cancers, stage III/IV of cancer, previous VTE, oxygen saturation < 95%, lactic acid > 2 mmol/l and bilateral PE. The overall survival in patients with IPE at 6-month follow-up was similar to those diagnosed with SPE. The present study has allowed the identification of factors associated with 30-day mortality in cancer patients with IPE and SPE. We also found similar mortality rate in cancer patients with IPE compared with patients with SPE at 6-month follow-up.
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Affiliation(s)
- Zhuanbo Luo
- Department of Respiratory Disease, Ningbo Hospital, Zhejiang University School of Medicine, Zhejiang University, Ningbo, Zhejiang, China,Department of Respiratory Disease, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Zhejiang University, Hangzhou, Zhejiang, China
| | - Guofeng Ma
- Department of Respiratory Disease, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Zhejiang University, Hangzhou, Zhejiang, China
| | - Yangfei Lu
- Department of Respiratory Disease, Hangzhou Fuyang District First People's Hospital, Hangzhou, Zhejiang, China,Department of Respiratory Disease, Deqing People’s Hospital, Deqing, Zhejiang, China
| | - Jianchang Yao
- Department of Respiratory Disease, Deqing People’s Hospital, Deqing, Zhejiang, China,Department of Respiratory Disease, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Zhejiang University, Hangzhou, Zhejiang, China
| | - Ning Xu
- Department of Respiratory Disease, Ningbo Hospital, Zhejiang University School of Medicine, Zhejiang University, Ningbo, Zhejiang, China
| | - Chao Cao
- Department of Respiratory Disease, Ningbo Hospital, Zhejiang University School of Medicine, Zhejiang University, Ningbo, Zhejiang, China
| | - Kejing Ying
- Department of Respiratory Disease, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Zhejiang University, Hangzhou, Zhejiang, China,Kejing Ying, Department of Respiratory Disease, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Zhejiang University, 3 East Qingchun Road, Hangzhou, Zhejiang 310020, China.
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19
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Keller K, Schmitt VH, Sagoschen I, Münzel T, Espinola-Klein C, Hobohm L. CRB-65 for Risk Stratification and Prediction of Prognosis in Pulmonary Embolism. J Clin Med 2023; 12:jcm12041264. [PMID: 36835800 PMCID: PMC9961795 DOI: 10.3390/jcm12041264] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2022] [Revised: 01/29/2023] [Accepted: 02/01/2023] [Indexed: 02/09/2023] Open
Abstract
BACKGROUND Pulmonary embolism (PE) is accompanied by high morbidity and mortality. The search for simple and easily assessable risk stratification scores with favourable effectiveness is still ongoing, and prognostic performance of the CRB-65 score in PE might promising. METHODS The German nationwide inpatient sample was used for this study. All patient cases of patients with PE in Germany 2005-2020 were included and stratified for CRB-65 risk class: low-risk group (CRB-65-score 0 points) vs. high-risk group (CRB-65-score ≥1 points). RESULTS Overall, 1,373,145 patient cases of patients with PE (76.6% aged ≥65 years, 47.0% females) were included. Among these, 1,051,244 patient cases (76.6%) were classified as high-risk according to CRB-65 score (≥1 points). The majority of high-risk patients according to CRB-65 score were females (55.8%). Additionally, high-risk patients according to CRB-65 score showed an aggravated comorbidity profile with increased Charlson comorbidity index (5.0 [IQR 4.0-7.0] vs. 2.0 [0.0-3.0], p < 0.001). In-hospital case fatality (19.0% vs. 3.4%, p < 0.001) and MACCE (22.4% vs. 5.1%, p < 0.001) occurred distinctly more often in PE patients of the high-risk group according to CRB-65 score (≥1 points) compared to the low-risk group (= 0 points). The CRB-65 high-risk class was independently associated with in-hospital death (OR 5.53 [95%CI 5.40-5.65], p < 0.001) as well as MACCE (OR 4.31 [95%CI 4.23-4.40], p < 0.001). CONCLUSIONS Risk stratification with CRB-65 score was helpful for identifying PE patients being at higher risk of adverse in-hospital events. The high-risk class according to CRB-65 score (≥1 points) was independently associated with a 5.5-fold increased occurrence of in-hospital death.
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Affiliation(s)
- Karsten Keller
- Department of Cardiology, University Medical Center Mainz, Johannes Gutenberg-University Mainz, 55131 Mainz, Germany
- Center for Thrombosis and Hemostasis (CTH), University Medical Center Mainz, Johannes Gutenberg-University Mainz, 55131 Mainz, Germany
- Medical Clinic VII, Department of Sports Medicine, University Hospital Heidelberg, 69120 Heidelberg, Germany
- Correspondence:
| | - Volker H. Schmitt
- Department of Cardiology, University Medical Center Mainz, Johannes Gutenberg-University Mainz, 55131 Mainz, Germany
- German Center for Cardiovascular Research (DZHK), Partner Site Rhine Main, 55131 Mainz, Germany
| | - Ingo Sagoschen
- Department of Cardiology, University Medical Center Mainz, Johannes Gutenberg-University Mainz, 55131 Mainz, Germany
| | - Thomas Münzel
- Department of Cardiology, University Medical Center Mainz, Johannes Gutenberg-University Mainz, 55131 Mainz, Germany
- German Center for Cardiovascular Research (DZHK), Partner Site Rhine Main, 55131 Mainz, Germany
| | - Christine Espinola-Klein
- Department of Cardiology, University Medical Center Mainz, Johannes Gutenberg-University Mainz, 55131 Mainz, Germany
- Center for Thrombosis and Hemostasis (CTH), University Medical Center Mainz, Johannes Gutenberg-University Mainz, 55131 Mainz, Germany
| | - Lukas Hobohm
- Department of Cardiology, University Medical Center Mainz, Johannes Gutenberg-University Mainz, 55131 Mainz, Germany
- Center for Thrombosis and Hemostasis (CTH), University Medical Center Mainz, Johannes Gutenberg-University Mainz, 55131 Mainz, Germany
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20
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Predictive Ability of the National Early Warning Score in Mortality Prediction of Acute Pulmonary Embolism in the Southeast Asian Population. J Cardiovasc Dev Dis 2023; 10:jcdd10020060. [PMID: 36826556 PMCID: PMC9960332 DOI: 10.3390/jcdd10020060] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2022] [Revised: 01/26/2023] [Accepted: 01/31/2023] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND The National Early Warning Scores (NEWS) easily and objectively measures acute clinical deterioration. However, the performance of NEWS to predict mortality in patients with acute pulmonary embolism (APE) is still required. Therefore, the objective of this study was to evaluate the performance of the NEWS in predicting the mortality of patients with APE. METHODS NEWS and Pulmonary Embolism Severity Index (PESI) at diagnosis time were calculated. Risk regression analysis was performed to identify the NEWS and PESI risk classification as a predictor for 30 days all-cause mortality and PE-related mortality. RESULTS NEWS was significantly higher in non-survivors compared to survivors (median (IQR) was 10 (7, 11) vs. 7 (2, 9), respectively, p < 0.001). The best cut-off point of NEWS in discriminating APE patients who non-survived from those who survived at 30 days was ≥9, with a sensitivity and specificity of 66.9% and 66.3%, respectively. The adjusted risk ratio of 30-day all-cause mortality in patients with initial NEWS ≥ 9 was 2.96 (95% CI; 2.13, 4.12, p < 0.001). CONCLUSIONS The NEWS can be used for mortality prediction in patients with APE. APE patients with NEWS ≥ 9 are associated with a high risk of mortality and should be closely monitored.
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21
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Utility of Combining High-Sensitive Cardiac Troponin I and PESI Score for Risk Management in Patients with Pulmonary Embolism in the Emergency Department. MEDICINA (KAUNAS, LITHUANIA) 2023; 59:medicina59020185. [PMID: 36837387 PMCID: PMC9968180 DOI: 10.3390/medicina59020185] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/30/2022] [Revised: 12/29/2022] [Accepted: 01/09/2023] [Indexed: 01/19/2023]
Abstract
BACKGROUND AND OBJECTIVES Pulmonary embolism (PE) has a major burden of morbidity and mortality, consequently the need for a prompt risk stratification for these subjects is crucial. In order to evaluate the risk management and final disposition of patients with PE in the Emergency Department (ED), we conducted a study that was divided in two phases: Phase I retrospective study (RS), Phase II prospective study (PS). MATERIALS AND METHODS In Phase I, 291 patients were enrolled while in Phase II, 83 subjects were evaluated. In both study phases, the enrolled subjects were analyzed for final disposition in ED using PESI score, right ventricle (RV) imaging, and high-sensitive cardiac troponin I (hs-cTnI) data. The RS patients were divided into low risk and high risk according to the sPESI score, while PS patients were grouped in low, intermediate, and high risk classes according to PESI score. In both study phases, all the studied patients were further divided into negative (hs-cTnI-) or positive (hs-cTnI+) groups according to hs-cTnI levels within normal or above cutoff values, respectively. For all enrolled subjects, CT pulmonary angiography was analyzed to assess the RV/LV diameter and volume ratio as an indicator of RV involvement. RESULTS In both RS and PS phases, hs-cTnI+ group showed a higher PESI score. Nevertheless, a significant percentage of hs-cTnI+ patients resulted to be in the low-risk PESI class. Patients with a positive RV/LV ratio were more likely to have a hs-cTnI+ (p < 0.01), while among those with a negative ratio, 24 to 32% showed as hs-cTnI+. In the hs-cTnI+ group from both study phases, patients were more likely to be admitted in an ICU (RR 3.7, IC: 2.1-6.5). CONCLUSIONS In conclusion, in patients with PE in the ED compared PESI score alone, the combination of hs-cTnI and PESI seems to be of greater utility in improving risk stratification and final disposition decision-making.
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22
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Bavalia R, Stals MAM, Mulder FI, Bistervels IM, Coppens M, Faber LM, Hendriks SV, Hofstee HMA, Huisman MV, van der Hulle T, Mairuhu ATA, Kruip MJHA, Middeldorp S, Klok FA, Hutten BA, Holleman F. Use of the National Early Warning Score for predicting deterioration of patients with acute pulmonary embolism: a post-hoc analysis of the YEARS Study. J Accid Emerg Med 2023; 40:61-66. [PMID: 36344240 DOI: 10.1136/emermed-2021-211506] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2021] [Accepted: 10/13/2022] [Indexed: 11/09/2022]
Abstract
BACKGROUND The Pulmonary Embolism Severity Index (PESI) and the simplified PESI (sPESI) are validated scores for mortality prediction in patients with pulmonary embolism (PE). National Early Warning Score (NEWS) is a general prognostic risk score for multiple clinical settings. We investigated whether the NEWS had a comparable performance with the PESI and sPESI, for predicting intensive care unit (ICU) admission and death in patients with acute PE. METHODS In haemodynamically stable patients with confirmed PE from the YEARS Study (2013-2015), we evaluated the performance of the NEWS, PESI and sPESI for predicting 7-day ICU admission and 30-day mortality. Receiver operating characteristic curves were plotted and the area under the curve (AUC) was calculated. RESULTS Of 352 patients, 12 (3.4%) were admitted to the ICU and 5 (1.4%) died. The AUC of the NEWS for ICU admission was 0.80 (95% CI 0.66 to 0.94) and 0.92 (95% CI 0.82 to 1.00) for 30-day mortality. At a threshold of 3 points, NEWS yielded a sensitivity and specificity of 92% and 53% for ICU admission and 100% and 52% for 30-day mortality. The AUC of the PESI was 0.64 (95% CI 0.48 to 0.79) for ICU admission and 0.94 (95% CI 0.87 to 1.00) for mortality. At a threshold of 66 points, PESI yielded a sensitivity of 75% and a specificity of 38% for ICU admission. For mortality, these were 100% and 37%, respectively. The performance of the sPESI was similar to that of PESI. CONCLUSION In comparison with PESI and sPESI, NEWS adequately predicted 7-day ICU admission as well as 30-day mortality, supporting its potential relevance for clinical practice.
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Affiliation(s)
- Roisin Bavalia
- Vascular Medicine, Amsterdam UMC Locatie AMC, Amsterdam, The Netherlands
| | | | - Frits I Mulder
- Vascular Medicine, Amsterdam UMC Locatie AMC, Amsterdam, The Netherlands
| | - Ingrid M Bistervels
- Vascular Medicine, Amsterdam UMC Locatie AMC, Amsterdam, The Netherlands.,Internal Medicine, Flevo Hospital, Almere, The Netherlands
| | - Michiel Coppens
- Vascular Medicine, Amsterdam UMC Locatie AMC, Amsterdam, The Netherlands
| | - Laura M Faber
- Internal Medicine, Red Cross Hospital, Beverwijk, The Netherlands
| | - Stephan V Hendriks
- Thrombosis and Hemostasis, LUMC, Leiden, The Netherlands.,Internal Medicine, Haga Hospital, Den Haag, The Netherlands
| | | | | | | | | | | | - Saskia Middeldorp
- Vascular Medicine, Amsterdam UMC Locatie AMC, Amsterdam, The Netherlands.,Internal Medicine & Radboud Institute of Health Sciences, Radboud University Nijmegen Faculty of Medical Sciences, Nijmegen, The Netherlands
| | | | - Barbara A Hutten
- Epidemiology and Data Science, Amsterdam UMC Locatie AMC, Amsterdam, The Netherlands
| | - Frits Holleman
- Internal Medicine, Amsterdam UMC Locatie AMC, Amsterdam, The Netherlands
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23
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Lüthi-Corridori G, Giezendanner S, Kueng C, Boesing M, Leuppi-Taegtmeyer AB, Mbata MK, Schuetz P, Leuppi JD. Risk factors for hospital outcomes in pulmonary embolism: A retrospective cohort study. Front Med (Lausanne) 2023; 10:1120977. [PMID: 37113610 PMCID: PMC10126285 DOI: 10.3389/fmed.2023.1120977] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2022] [Accepted: 03/15/2023] [Indexed: 04/29/2023] Open
Abstract
Background Pulmonary embolism (PE) is not only a life-threatening disease but also a public health issue with significant economic burden. The aim of the study was to identify factors-including the role of primary care-that predict length of hospital stay (LOHS), mortality and re-hospitalization within 6 months of patients admitted for PE. Method A retrospective cohort study was conducted with patients presenting to a Swiss public hospital with PE diagnosed at the hospital between November 2018 and October 2020. Multivariable logistic and zero-truncated negative binomial regression analyses were performed to assess risk factors for mortality, re-hospitalization and LOHS. Primary care variables encompassed whether patients were sent by their general practitioner (GP) to the emergency department and whether a GP follow-up assessment after discharge was recommended. Further analyzed variables were pulmonary embolism severity index (PESI) score, laboratory values, comorbidities, and medical history. Results A total of 248 patients were analyzed (median 73 years and 51.6% females). On average patients were hospitalized for 5 days (IQR 3-8). Altogether, 5.6% of these patients died in hospital, and 1.6% died within 30 days (all-cause mortality), 21.8% were re-hospitalized within 6 months. In addition to high PESI scores, we detected that, patients with an elevated serum troponin, as well as with diabetes had a significantly longer hospital stay. Significant risk factors for mortality were elevated NT-proBNP and PESI scores. Further, high PESI score and LOHS were associated with re-hospitalization within 6 months. PE patients who were sent to the emergency department by their GPs did not show improved outcomes. Follow-up with GPs did not have a significant effect on re-hospitalization. Conclusion Defining the factors that are associated with LOHS in patients with PE has clinical implications and may help clinicians to allocate adequate resources in the management of these patients. Serum troponin and diabetes in addition to PESI score might be of prognostic use for LOHS. In this single-center cohort study, PESI score was not only a valid predictive tool for mortality but also for long-term outcomes such as re-hospitalization within 6 months.
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Affiliation(s)
- Giorgia Lüthi-Corridori
- Cantonal Hospital Baselland, University Center of Internal Medicine, Liestal, Switzerland
- Faculty of Medicine, University of Basel, Basel, Switzerland
- *Correspondence: Giorgia Lüthi-Corridori,
| | - Stéphanie Giezendanner
- Cantonal Hospital Baselland, University Center of Internal Medicine, Liestal, Switzerland
- Faculty of Medicine, University of Basel, Basel, Switzerland
- Centre for Primary Health Care, University of Basel, Basel, Switzerland
| | - Cedrine Kueng
- Cantonal Hospital Baselland, University Center of Internal Medicine, Liestal, Switzerland
- Faculty of Medicine, University of Basel, Basel, Switzerland
| | - Maria Boesing
- Cantonal Hospital Baselland, University Center of Internal Medicine, Liestal, Switzerland
- Faculty of Medicine, University of Basel, Basel, Switzerland
| | - Anne B. Leuppi-Taegtmeyer
- Cantonal Hospital Baselland, University Center of Internal Medicine, Liestal, Switzerland
- Faculty of Medicine, University of Basel, Basel, Switzerland
- Department of Patient Safety, Medical Directorate, University Hospital Basel, Basel, Switzerland
| | | | - Philipp Schuetz
- Faculty of Medicine, University of Basel, Basel, Switzerland
- Cantonal Hospital Aarau, University Department of Medicine, Aarau, Switzerland
| | - Joerg D. Leuppi
- Cantonal Hospital Baselland, University Center of Internal Medicine, Liestal, Switzerland
- Faculty of Medicine, University of Basel, Basel, Switzerland
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Tseluyko VY, Yakovleva LM, Radchenko OV, Zhadan AV, Sukhova SM, Gurov OM, Askierov RN. PECULIARITIES OF THE COURSE OF PULMONARY EMBOLISM DURING THE COVID-19 PANDEMIC. WIADOMOSCI LEKARSKIE (WARSAW, POLAND : 1960) 2023; 76:1029-1038. [PMID: 37326086 DOI: 10.36740/wlek202305122] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/17/2023]
Abstract
OBJECTIVE The aim: A comparative analysis of the course of pulmonary embolism during the COVID-19 pandemic and the era before pandemia. PATIENTS AND METHODS Materials and methods: 294 patients with pulmonary embolism (PE) , 1 group - 188 with PE before the pandemic, 2 group -106 during the pandemic. Two subgroups were distinguished in 2 group : 1- with laboratory-excluded coronavirus (acute and in anamnesis) and 2 - with a history of COVID-19. The diagnosis of PE was confirmed by CT. Echocardiography and ultrasound Doppler imaging of the veins of the lower extremities were performed. RESULTS Results: In 1 group there was a more significant increase in pulmonary artery pressure (44.29 ± 17.04 vs 36.91 ± 16.6, p 0.0023) and a decrease in the E/A ratio of the right ventricle (0.80 ± 0,21 vs 1.28 ± 1.42, p 0.0202). In 2 subgroup of patients with COVID-19 had a significantly higher incidence of Diabetes mellitus (73.7% vs 13.3%, p 0.00001) and significantly lower signs of superficial venous thrombosis of the lower extremities (5.3% vs 33,3%, p 0,0175) and signs of proximal deep vein thrombosis (0% vs 56.7%, p 0.00001) and 3 times less often there was a high risk of adverse disease, right ventricular dysfunction were more pronounced (ratio E/A 0.87 ± 0.25 vs 1.13 ± 0.28, p 0.022). CONCLUSION Conclusions: In patients with coronavirus infection, PE was significantly more common in the presence of diabetes mellitus , right ventricular diastole disorders were more common, and superficial and proximal deep vein thrombosis of the lower extremities were less common.
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Affiliation(s)
- Vira Y Tseluyko
- KHARKIV NATIONAL UNIVERSITY NAMED AFTER V.N. KARAZINA, KHARKIV, UKRAINE
| | | | - Olha V Radchenko
- KHARKIV NATIONAL UNIVERSITY NAMED AFTER V.N. KARAZINA, KHARKIV, UKRAINE
| | - Andriy V Zhadan
- KHARKIV NATIONAL UNIVERSITY NAMED AFTER V.N. KARAZINA, KHARKIV, UKRAINE
| | | | | | - Roman N Askierov
- MUNICIPAL NON-PROFIT ENTERPRISE "CITY CLINICAL HOSPITAL No8" OF KHARKIV CITY COUNCIL, KHARKIV, UKRAINE
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25
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Li H, Yu Y, Wang Y, Zhang Q, Gu Y. Prognostic Risk Factors of 30-Day Death in Traumatic Lower Limb Fracture Patients with Acute Pulmonary Embolism: A Single-Center Retrospective Study. Can Respir J 2023; 2023:8246730. [PMID: 37207250 PMCID: PMC10191750 DOI: 10.1155/2023/8246730] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2023] [Revised: 04/02/2023] [Accepted: 04/21/2023] [Indexed: 05/21/2023] Open
Abstract
Background To explore the prognostic risk factors of 30-day death in patients with traumatic lower limb fracture (TLLF) complicated with acute pulmonary embolism (APE). Methods 295 consecutive TLLF patients diagnosed as APE according to pulmonary artery CT angiography, hospitalized in our hospital from January 2017 to December 2021, were included in this study. Patients were divided into nonsurvival group and survival group according to 30-day follow-up results. After adjusting age, sex, and all the clinical variables with P values of <0.2 with backward stepwise method (likelihood ratio), multivariate Cox regression analysis was used to analyze risk factors of 30 days all-cause death in TLLF patients with APE. The area under curve (AUC) calculated by receiver operating characteristic curve (ROC) and the incremental model were used to determine the prognostic potential of identified risk factors. Results 29 patients died during 30-day follow-up. Simplified pulmonary embolism severity index (sPESI) score ≥1 (P < 0.05), Wells score ≥7 (P < 0.01), and pulmonary hypertension (P < 0.01) were associated with higher risk, while anticoagulant therapy (P < 0.01) was associated with lower risk of all-cause death during 30 days follow-up in APE patients. Compared with sPESI score, Wells score plus pulmonary hypertension produced better predictive efficacy. Prognostic value of sPESI score could be enhanced by adding Wells score, pulmonary hypertension, and anticoagulant therapy to the predicting models. Conclusions Wells score ≥7 and pulmonary hypertension are independent predictive risk factors of 30-day all-cause death in TLLF patients with APE.
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Affiliation(s)
- Huanhuan Li
- Department of Cardiology, Wuhan Fourth Hospital, Wuhan, Hubei, China
| | - Yijun Yu
- Department of Cardiology, Wuhan Fourth Hospital, Wuhan, Hubei, China
| | - Yuting Wang
- Department of Cardiology, Wuhan Fourth Hospital, Wuhan, Hubei, China
| | - Qian Zhang
- Department of Ultrasonic Imaging, Wuhan Fourth Hospital, Wuhan, Hubei, China
| | - Ye Gu
- Department of Cardiology, Wuhan Fourth Hospital, Wuhan, Hubei, China
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26
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Aydınyılmaz F, Özbeyaz NB, Algül E, Aksakal A, Guliyev İ, Şahan HF, Aksakal E, Saraç İ, Kalkan K. The relationship between pesi score and pulmonary venous flow parameters in patients with acute pulmonary embolism. Echocardiography 2022; 39:1532-1539. [PMID: 36348259 DOI: 10.1111/echo.15483] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2022] [Revised: 10/01/2022] [Accepted: 10/19/2022] [Indexed: 11/11/2022] Open
Abstract
BACKGROUND Acute pulmonary embolism (APE) is an important cause of cardiovascular morbidity and mortality. PESI scoring is used in risk classification. This study was designed to determine the relationship between echocardiographic pulmonary vein measurements and PESI score, which is an important tool in diagnosis and treatment. METHODS A total of 210 patients were evaluated. Pulmonary vein measurements and PESI scores of the patients at the time of diagnosis were calculated. Correlation analysis was performed to determine the relationship between the two parameters. RESULTS Total PESI scores were 112.9 ± 33.9. The pulmonary vein S wave .39 ± .14, the D wave .48 ± .18, and the S/D ratio was found to be .86 ± .35. It was determined that there was a significant correlation between pulmonary S/D ratio and PESI score. (Pearson correlation coefficient = -.693, R2 Linear:.484; p < .001) The AUC of S/D for mortality prediction was .729 (95% CI = .653-.804; p < .001), the cutoff value was .63, the sensitivity and specificity were 55.6% and 55.7%, respectively. CONCLUSION Pulmonary vein measurements were found to be correlated with the PESI score and were found to be a parameter that could predict mortality.
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Affiliation(s)
- Faruk Aydınyılmaz
- Department of Cardiology, University of Health Sciences, Erzurum Bolge Training and Research Hospital, Erzurum, Turkey
| | | | - Engin Algül
- Department of Cardiology, University of Health Sciences, Dışkapı Yıldırım Beyazıt Training and Research Hospital, Ankara, Turkey
| | - Alperen Aksakal
- Department of Chest Disease, University of Health Sciences, Erzurum Bolge Training and Research Hospital, Erzurum, Turkey
| | - İlkin Guliyev
- Department of Cardiology, MedicalPark Hospital, Tokat, Turkey
| | - Haluk Furkan Şahan
- Department of Cardiology, University of Health Sciences, Dışkapı Yıldırım Beyazıt Training and Research Hospital, Ankara, Turkey
| | - Emrah Aksakal
- Department of Cardiology, University of Health Sciences, Erzurum Bolge Training and Research Hospital, Erzurum, Turkey
| | - İbrahim Saraç
- Department of Cardiology, University of Health Sciences, Erzurum Bolge Training and Research Hospital, Erzurum, Turkey
| | - Kamuran Kalkan
- Department of Cardiology, University of Health Sciences, Dışkapı Yıldırım Beyazıt Training and Research Hospital, Ankara, Turkey
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Shen J, Casie Chetty S, Shokouhi S, Maharjan J, Chuba Y, Calvert J, Mao Q. Massive external validation of a machine learning algorithm to predict pulmonary embolism in hospitalized patients. Thromb Res 2022; 216:14-21. [DOI: 10.1016/j.thromres.2022.05.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2022] [Revised: 05/26/2022] [Accepted: 05/30/2022] [Indexed: 10/18/2022]
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28
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Kara K, Sökücü SN, Tural Önür S, Özdemir C, Tokgöz Akyil F, Kahya Ö. The Role of Hemogram Parameters in Predicting the Severity of Pulmonary Embolism. ISTANBUL MEDICAL JOURNAL 2022. [DOI: 10.4274/imj.galenos.2022.03367] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
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29
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Bobadilla L, Scatularo CE, Antoniolli M, Lerech E, Cigalini IM, Zaidel EJ. IMPACT OF REPERFUSION ON CLINICAL OUTCOMES IN PATIENTS WITH INTERMEDIATE-HIGH RISK PULMONARY EMBOLISM. Curr Probl Cardiol 2022; 47:101308. [DOI: 10.1016/j.cpcardiol.2022.101308] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2022] [Accepted: 06/28/2022] [Indexed: 11/28/2022]
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30
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Aramberri M, Benegas M, Sanchez M, Muñoz-Guglielmetti D, Zamora C, García-Villa A, Diaz-Pedroche C, Font C. Saddle Pulmonary Embolism in Patients with Cancer in the Era of Incidental Events: Clinical Findings and Outcomes in a Single Centre Cohort. TH OPEN 2022; 6:e267-e275. [PMID: 36299808 PMCID: PMC9800169 DOI: 10.1055/s-0042-1755605] [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] [Received: 05/23/2022] [Accepted: 07/04/2022] [Indexed: 11/15/2022] Open
Abstract
Background There is scarce information regarding the prevalence and clinical impact of saddle pulmonary embolism (PE) in patients with cancer. Objectives This study aimed to assess the prevalence, clinical findings, and short-term outcomes of patients with cancer-related saddle PE including acute symptomatic and unsuspected events. Patients/Methods Consecutive patients with cancer-related PE (March 1, 2006-October 31, 2014) were retrospectively reviewed by a chest radiologist to assess PE burden and signs of right ventricular (RV) overload. The clinical outcomes within 30 days were evaluated according to saddle versus nonsaddle PE. Results Thirty-six (12%) out of 289 patients with newly diagnosed cancer-related PE presented with saddle PE. Saddle PE was found in 21 cases (58%) with acute symptomatic PE and the remaining 15 cases (42%) were found as unsuspected findings. Patients with saddle PE had more frequently experienced a previous thrombotic event (31 vs. 13%; p =0.008), and it occurred more frequently as an acute symptomatic event (58 vs. 39%; p =0.025) compared with those with nonsaddle PE. Signs of RV overload including RV/left ventricle ratio ≥1 (22 vs. 4%; p <0.001) and interventricular septum displacement (53 vs. 20%; p <0.001) were also more common in patients with saddle PE compared with nonsaddle PE. Overall, PE-related mortality, venous thromboembolism recurrence, and major bleeding within 30 days were found to be similar according to saddle versus nonsaddle PE. Conclusion Saddle PE is not uncommon in patients with cancer-related PE including in those with unsuspected PE. Similar 30-day outcomes were found according to saddle versus nonsaddle PE in our cohort.
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Affiliation(s)
- Mario Aramberri
- Department of Internal Medicine, Hospital de Galdakao-Usansolo, Galdakao, Spain
| | - Mariana Benegas
- Department of Radiology, Hospital Clinic de Barcelona, Barcelona, Spain
| | - Marcelo Sanchez
- Department of Radiology, Hospital Clinic de Barcelona, Barcelona, Spain
| | | | - Carles Zamora
- Department of Medical Oncology, Hospital Clinic de Barcelona, Barcelona, Spain
| | - Adrián García-Villa
- Department of Internal Medicine, Hospital Nuestra Señora del Prado, Talavera de la Reina, Spain
| | - Carmen Diaz-Pedroche
- Department of Internal Medicine, Hospital Universitario 12 de Octubre, Madrid, Spain
| | - Carme Font
- Department of Medical Oncology, Hospital Clinic de Barcelona, Barcelona, Spain
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31
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Trott T, Bowman J. Diagnosis and Management of Pulmonary Embolism. Emerg Med Clin North Am 2022; 40:565-581. [DOI: 10.1016/j.emc.2022.05.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Danilatou V, Nikolakakis S, Antonakaki D, Tzagkarakis C, Mavroidis D, Kostoulas T, Ioannidis S. Outcome Prediction in Critically-Ill Patients with Venous Thromboembolism and/or Cancer Using Machine Learning Algorithms: External Validation and Comparison with Scoring Systems. Int J Mol Sci 2022; 23:ijms23137132. [PMID: 35806137 PMCID: PMC9266386 DOI: 10.3390/ijms23137132] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2022] [Revised: 06/17/2022] [Accepted: 06/19/2022] [Indexed: 12/16/2022] Open
Abstract
Intensive care unit (ICU) patients with venous thromboembolism (VTE) and/or cancer suffer from high mortality rates. Mortality prediction in the ICU has been a major medical challenge for which several scoring systems exist but lack in specificity. This study focuses on two target groups, namely patients with thrombosis or cancer. The main goal is to develop and validate interpretable machine learning (ML) models to predict early and late mortality, while exploiting all available data stored in the medical record. To this end, retrospective data from two freely accessible databases, MIMIC-III and eICU, were used. Well-established ML algorithms were implemented utilizing automated and purposely built ML frameworks for addressing class imbalance. Prediction of early mortality showed excellent performance in both disease categories, in terms of the area under the receiver operating characteristic curve (AUC–ROC): VTE-MIMIC-III 0.93, eICU 0.87, cancer-MIMIC-III 0.94. On the other hand, late mortality prediction showed lower performance, i.e., AUC–ROC: VTE 0.82, cancer 0.74–0.88. The predictive model of early mortality developed from 1651 VTE patients (MIMIC-III) ended up with a signature of 35 features and was externally validated in 2659 patients from the eICU dataset. Our model outperformed traditional scoring systems in predicting early as well as late mortality. Novel biomarkers, such as red cell distribution width, were identified.
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Affiliation(s)
- Vasiliki Danilatou
- Sphynx Technology Solutions, 6300 Zug, Switzerland
- School of Medicine, European University of Cyprus, 2404 Nicosia, Cyprus
- Correspondence: or
| | - Stylianos Nikolakakis
- School of Electrical and Computer Engineering, Technical University of Crete, 73100 Chania, Greece; (S.N.); (S.I.)
| | - Despoina Antonakaki
- Institute of Computer Science (ICS)-Foundation for Research and Technology-Hellas (FORTH), 70013 Heraklion, Greece; (D.A.); (C.T.); (D.M.)
| | - Christos Tzagkarakis
- Institute of Computer Science (ICS)-Foundation for Research and Technology-Hellas (FORTH), 70013 Heraklion, Greece; (D.A.); (C.T.); (D.M.)
| | - Dimitrios Mavroidis
- Institute of Computer Science (ICS)-Foundation for Research and Technology-Hellas (FORTH), 70013 Heraklion, Greece; (D.A.); (C.T.); (D.M.)
| | - Theodoros Kostoulas
- Department of Information and Communication Systems Engineering, School of Engineering, University of the Aegean, 83200 Samos, Greece;
| | - Sotirios Ioannidis
- School of Electrical and Computer Engineering, Technical University of Crete, 73100 Chania, Greece; (S.N.); (S.I.)
- Institute of Computer Science (ICS)-Foundation for Research and Technology-Hellas (FORTH), 70013 Heraklion, Greece; (D.A.); (C.T.); (D.M.)
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Muñoz OM, Ruiz-Talero P, Hernández-Florez C, Lombo-Moreno CE, Casallas-Rivera MA, Mayorga-Hernández CA. Validation of the PESI Scale to Predict in-Hospital Mortality in Patients with Pulmonary Thromboembolism Secondary to SARS CoV - 2 Infection. Clin Appl Thromb Hemost 2022; 28:10760296221102940. [PMID: 35593084 PMCID: PMC9125100 DOI: 10.1177/10760296221102940] [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: 01/09/2023] Open
Abstract
OBJECTIVE To evaluate the discriminative ability and the calibration of the Pulmonary Embolism Severity Index (PESI) to predict in-hospital mortality in patients with Pulmonary Embolism (PE) secondary to COVID 19 in two hospitals in Bogotá. METHODS External validation study of a prediction model based on a retrospective cohort of patients with PE secondary to COVID-19 treated at Hospital Universitario San Ignacio and Hospital universitario La Samaritana, between March 2020 and August 2021. Calibration of the scale was evaluated using the Hosmer-Lemeshow test and a calibration belt diagram. Discrimination ability was evaluated using a ROC curve. RESULTS 272 patients were included (median age 61.5 years, male 58.8%). PE was diagnosed in 45.6% of the patients at the time of admission. Of the remaining 54.4%, 95.9% received thromboprophylaxis until the time of diagnosis.17.6% of the patients died. Regarding calibration, the scale systematically underestimates risk in all classes of PESI. For class I, the ratio of observed/expected events was 4.4 vs 0.8%, class II 4.8 vs 1.8%, class III 15.2 vs 4.2%, class IV 14.3 vs 5.9% and class V 46.7 vs 5.8%. The calibration test rejected the adequate calibration hypothesis (p < 0.001). The discriminatory ability was adequate (AUC = 0.7128, 95% CI 0.63-0.79). CONCLUSIONS The PESI scale in patients with PE secondary to COVID 19 underestimates the risk of in-hospital mortality, while maintaining adequate discrimination. It is suggested not to use the PESI scale until it is recalibrated in this context.
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Affiliation(s)
- Oscar M Muñoz
- Internal Medicine Department, Pontificia Universidad Javeriana, Bogota, Colombia,Hospital Universitario San Ignacio, Bogota, Colombia
| | - Paula Ruiz-Talero
- Internal Medicine Department, Pontificia Universidad Javeriana, Bogota, Colombia,Hospital Universitario San Ignacio, Bogota, Colombia
| | - Catalina Hernández-Florez
- Internal Medicine Department, Pontificia Universidad Javeriana, Bogota, Colombia,Hospital Universitario San Ignacio, Bogota, Colombia
| | - Carlos Ernesto Lombo-Moreno
- Internal Medicine Department, Pontificia Universidad Javeriana, Bogota, Colombia,Carlos Ernesto Lombo-Moreno, Internal Medicine, Pontificia Universidad Javeriana, Cra 7 # 40-62. Piso 7, Bogotá, Colombia.
| | - Martha Alejandra Casallas-Rivera
- RICAVTA investigation group, Bogota, Colombia,Internal Medicine Department, Hospital Universitario La Samaritana, Bogota, Colombia,Universidad de La Sabana, Chia, Colombia
| | - Carol Anne Mayorga-Hernández
- Internal Medicine Department, Hospital Universitario La Samaritana, Bogota, Colombia,Universidad de La Sabana, Chia, Colombia
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Muñoz-Guglielmetti D, Cooksley T, Ahn S, Beato C, Aramberri M, Escalante C, Font C. Risk stratification for clinical severity of pulmonary embolism in patients with cancer: a narrative review and MASCC clinical guidance for daily care. Support Care Cancer 2022; 30:8527-8538. [PMID: 35579753 DOI: 10.1007/s00520-022-07131-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2021] [Accepted: 05/09/2022] [Indexed: 11/26/2022]
Abstract
Pulmonary embolism (PE) is a leading cause of morbidity and mortality in patients with cancer. The clinical presentation and outcomes of PE range from an acute life-threatening condition requiring intensive care to a mild symptomatic condition associated with favorable outcomes and potentially candidate for early hospital discharge. The wide clinical spectrum of PE has led to the development of risk stratification models aimed at the triage of patients in emergency care departments and optimizing the utilization of health care resources. Incidental or unsuspected PE (UPE), detected during routine staging computed tomography scans, make up a significant proportion of this cohort among the oncology population. The present narrative review is aimed at examining the currently available PE risk assessment models developed for the general population and for patients with cancer including UPE. We include general recommendations for the daily care of patients with cancer-related PE and hypothesize on the factors that would potentially favor hospitalization with early discharge or ambulatory management in this setting.
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Affiliation(s)
| | - Tim Cooksley
- The Christie Hospital, University of Manchester, Wythenshawe Hospital, Manchester, UK
| | - Shin Ahn
- Department of Emergency Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Carmen Beato
- Medical Oncology Department, Hospital Universitario Macarena, Seville, Spain
| | - Mario Aramberri
- Internal Medicine Department, Hospital Galdakao-Usansolo, Vizcaya, Spain
| | - Carmen Escalante
- Internal Medicine Department, MD Anderson Cancer Center, University of Texas, Houston, USA
| | - Carme Font
- Medical Oncology Department, Hospital Clinic Barcelona, Barcelona, Spain.
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Maraziti G, Cimini LA, Becattini C. Risk stratification to optimize the management of acute pulmonary embolism. Expert Rev Cardiovasc Ther 2022; 20:377-387. [PMID: 35544707 DOI: 10.1080/14779072.2022.2077194] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
INTRODUCTION Pulmonary embolism (PE) is a life-threatening disease. Risk stratification in patients with acute PE can guide clinical decisions. Clinical assessment, including hemodynamics, respiratory parameters, patient history, and right ventricle evaluation, has a pivotal role in this scope. AREAS COVERED This review aims to describe: i) the role of individual tools for prognostic stratification, from simple clinical parameters to the models suggested by international guidelines; ii) the implications of risk stratification in terms of patient disposition and treatment. The bleeding risk assessment in acute PE was also reviewed. The literature search was performed in PubMed and Embase to address these issues. EXPERT OPINION Prognostic assessment is essential to proceed with life-saving treatments in hemodynamically unstable patients and consider home treatment or short hospital stay in patients at low risk for death. In hemodynamically stable patients, risk stratification allows the implementation of personalized treatment pathways to reduce the risk of death, early PE recurrence, and bleeding. With the aim of optimizing healthcare resources, risk stratification may suggest appropriate patient disposition.
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Affiliation(s)
- Giorgio Maraziti
- Internal and Cardiovascular Medicine - Stroke Unit, Ospedale Santa Maria della Misericordia -University of Perugia, Perugia, Italy
| | - Ludovica Anna Cimini
- Internal and Cardiovascular Medicine - Stroke Unit, Ospedale Santa Maria della Misericordia -University of Perugia, Perugia, Italy
| | - Cecilia Becattini
- Internal and Cardiovascular Medicine - Stroke Unit, Ospedale Santa Maria della Misericordia -University of Perugia, Perugia, Italy
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Angelini DE, Khorana AA. Building a CAT clinic - real-world systems approaches to prevention and treatment. Thromb Res 2022; 213 Suppl 1:S84-S86. [DOI: 10.1016/j.thromres.2021.12.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2021] [Revised: 11/11/2021] [Accepted: 11/12/2021] [Indexed: 10/18/2022]
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Continuous Aspiration Mechanical Thrombectomy for the management of intermediate- and high-risk pulmonary embolism: Data from the first cohort in Portugal. Rev Port Cardiol 2022; 41:533-545. [DOI: 10.1016/j.repc.2021.04.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2020] [Revised: 03/19/2021] [Accepted: 04/07/2021] [Indexed: 12/17/2022] Open
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Rodrigues T, Silva BV, Plácido R, Mendonça C, Urbano ML, Rigueira J, Almeida AG, Pinto FJ. Comparison of 5 acute pulmonary embolism mortality risk scores in patients with COVID-19. IJC HEART & VASCULATURE 2022; 39:100984. [PMID: 35252539 PMCID: PMC8882432 DOI: 10.1016/j.ijcha.2022.100984] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2022] [Revised: 02/13/2022] [Accepted: 02/23/2022] [Indexed: 11/02/2022]
Abstract
Objective Methods Results Conclusion
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Quintero-Martinez JA, Wysokinski WE, Cordova-Madera SN, Mogollon RJ, Garcia-Arango M, Vlazny DT, Houghton DE, Casanegra AI, Villarraga HR. Pulmonary artery capacitance and pulmonary vascular resistance as prognostic indicators in acute pulmonary embolism. EUROPEAN HEART JOURNAL OPEN 2022; 2:oeac007. [PMID: 35919120 PMCID: PMC9242029 DOI: 10.1093/ehjopen/oeac007] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/15/2021] [Revised: 12/28/2021] [Accepted: 02/21/2022] [Indexed: 12/13/2022]
Abstract
Abstract
Aims
The non-invasive calculation of right ventricular (RV) haemodynamics as pulmonary artery (PA) capacitance (PAC) and pulmonary vascular resistance (PVR) have proved to be feasible, easy to perform, and of high prognostic value. We, therefore, evaluated whether baseline PAC and PVR could predict clinical outcomes for patients with acute pulmonary embolism (PE).
Methods and results
We prospectively followed 373 patients [mean (standard deviation) age, 64.1 (14.9) years; 58.4% were men, and 27.9% had cancer] who had acute PE and transthoracic echocardiography within 1 day of diagnosis from 1 March 2013 through 30 June 2020. Pulmonary artery capacitance was calculated as left ventricular stroke volume/(PA systolic pressure − PA diastolic pressure). Pulmonary vascular resistance was calculated as (tricuspid regurgitant velocity/RV outflow tract velocity time integral) × 10 + 0.16. These two variables were calculated retrospectively from the values obtained with transthoracic echocardiography. Pulmonary artery capacitance was acquired in 99 (27%) patients and PVR in 65 (17%) patients. Univariable and bivariable logistic regression analyses, and receiver operating characteristic curves were used to evaluate the ability of these haemodynamic measurements to predict mortality up to 6 months. After using bivariable models to adjust individually for age, cancer, and pulmonary hypertension. Pulmonary vascular resistance was associated with all-cause mortality at 3 months [area under the curve (AUC) 0.75, 95% confidence interval (CI) 0.61–0.86; P = 0.01], and 6 months (AUC 0.81; 95% CI 0.69–0.91; P≤ 0.03). Pulmonary artery capacitance was associated with all-cause mortality at 30 days (AUC 0.95; 95% CI 0.82–0.99; P < 0.001) and 3 months (AUC 0.84; 95% CI 0.65–0.99; P = 0.003).
Conclusion
Non-invasive measurement of RV haemodynamics could provide prognostic information of patients with acute PE. Pulmonary artery capacitance and PVR are potentially important predictors of all-cause mortality in these patients and should be explored in future studies.
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Affiliation(s)
- Juan A Quintero-Martinez
- Division of Cardiovascular Ultrasound, Department of Cardiovascular Medicine , Mayo Clinic, Rochester, MN, USA
- Department of Cardiovascular Medicine, Mayo Clinic , 200 First St SW, Rochester, MN 55905, USA
| | - Waldemar E Wysokinski
- Gonda Vascular Center, Thrombophilia Clinic, Department of Cardiovascular Medicine , Mayo Clinic, Rochester, MN, USA
- Department of Cardiovascular Medicine, Mayo Clinic , 200 First St SW, Rochester, MN 55905, USA
| | - Sandra N Cordova-Madera
- Division of Cardiovascular Ultrasound, Department of Cardiovascular Medicine , Mayo Clinic, Rochester, MN, USA
- Department of Cardiovascular Medicine, Mayo Clinic , 200 First St SW, Rochester, MN 55905, USA
| | - Renzo J Mogollon
- Division of Cardiovascular Ultrasound, Department of Cardiovascular Medicine , Mayo Clinic, Rochester, MN, USA
- Department of Cardiovascular Medicine, Mayo Clinic , 200 First St SW, Rochester, MN 55905, USA
| | - Mariana Garcia-Arango
- Division of Cardiovascular Ultrasound, Department of Cardiovascular Medicine , Mayo Clinic, Rochester, MN, USA
- Department of Cardiovascular Medicine, Mayo Clinic , 200 First St SW, Rochester, MN 55905, USA
| | - Danielle T Vlazny
- Gonda Vascular Center, Thrombophilia Clinic, Department of Cardiovascular Medicine , Mayo Clinic, Rochester, MN, USA
- Department of Cardiovascular Medicine, Mayo Clinic , 200 First St SW, Rochester, MN 55905, USA
| | - Damon E Houghton
- Gonda Vascular Center, Thrombophilia Clinic, Department of Cardiovascular Medicine , Mayo Clinic, Rochester, MN, USA
- Department of Cardiovascular Medicine, Mayo Clinic , 200 First St SW, Rochester, MN 55905, USA
| | - Ana I Casanegra
- Gonda Vascular Center, Thrombophilia Clinic, Department of Cardiovascular Medicine , Mayo Clinic, Rochester, MN, USA
- Department of Cardiovascular Medicine, Mayo Clinic , 200 First St SW, Rochester, MN 55905, USA
| | - Hector R Villarraga
- Division of Cardiovascular Ultrasound, Department of Cardiovascular Medicine , Mayo Clinic, Rochester, MN, USA
- Department of Cardiovascular Medicine, Mayo Clinic , 200 First St SW, Rochester, MN 55905, USA
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Building a CAT Clinic - real-world systems approaches to prevention and treatment. Thromb Res 2022. [DOI: 10.1016/j.thromres.2022.03.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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Alirezaei T, Mahboubi-Fooladi Z, Irilouzadian R, Saberi Shahrbabaki A, Golestani H. CHA 2 DS 2 -VASc and PESI scores are associated with right ventricular dysfunction on computed tomography pulmonary angiography in patients with acute pulmonary thromboembolism. Clin Cardiol 2022; 45:224-230. [PMID: 35132667 PMCID: PMC8860482 DOI: 10.1002/clc.23786] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2021] [Revised: 01/13/2022] [Accepted: 01/17/2022] [Indexed: 11/09/2022] Open
Abstract
BACKGROUND Accurate risk stratification is the most important step in the management of patients with acute pulmonary thromboembolism (PTE). Pulmonary embolism severity index (PESI) is a clinical tool for PTE risk stratification. CHA2 DS2 -VASc score, a risk assessment tool in patients with atrial fibrillation, is recently considered for acute PTE. The presence of right ventricular (RV) dysfunction in imaging is more efficient in acute PTE risk evaluation. HYPOTHESIS This study aims to evaluate the association between CHA2 DS2 -VASc and PESI score and each of them with RV dysfunction on computed tomography pulmonary angiography (CTPA). METHODS One hundred eighteen patients with a definite diagnosis of PTE were entered. The CHA2 DS2 -VASc and PESI scores were calculated for all of them. RV dysfunction including an increase in RV to left ventricular diameter ratio, interventricular septal bowing, and reflux of contrast medium into the inferior vena cava was examined by CTPA. RESULTS PESI and CHA2 DS2 -VASc scores were significantly associated with RV dysfunction. In addition, different classes of PESI scores were correlated with RV dysfunction. Moreover, this study showed that the CHA2 DS2 -VASc score and PESI score had a positive correlation. The area under the curve value for the CHA2 DS2 -VASc score was 0.625 with 61.54% sensitivity and 60.0% specificity for predicting RV dysfunction while for PESI score was 0.635 with 66.7% sensitivity and 60.0% specificity. CONCLUSION This study showed that not only CHA2 DS2 -VASc and PESI scores are positively correlated, but they are both associated with RV dysfunction diagnosed by CTPA. CHA2 DS2 -VASc and PESI scores are able to predict RV dysfunction.
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Affiliation(s)
- Toktam Alirezaei
- Clinical Research Development Unit, Shohada-e-Tajrish Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | | | - Rana Irilouzadian
- Clinical Research Development Unit, Shohada-e-Tajrish Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | | | - Haniyeh Golestani
- Clinical Research Development Unit, Shohada-e-Tajrish Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
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Mudrakola HV, Caples SM, Hyde RJ, McBane Ii RD, Ahmad SR. Inpatient Management of Pulmonary Embolism: Clinical Characteristics and Mortality in a High-Volume Tertiary Care Center. J Thromb Thrombolysis 2022; 54:145-152. [PMID: 35022990 PMCID: PMC8754518 DOI: 10.1007/s11239-021-02619-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/28/2021] [Indexed: 10/29/2022]
Abstract
The optimal management strategy for submassive or intermediate risk pulmonary embolism (IRPE)-anticoagulation alone versus anticoagulation plus advanced therapies-remains in equipoise leading many institutions to create multidisciplinary PE response teams (PERTs) to guide therapy. Cause-specific mortality of IRPE has not been thoroughly examined, which is a meaningful outcome when examining the effect of specific interventions for PE. In this retrospective study, we reviewed all adult inpatient admissions between 8/1/2018 and 8/1/2019 with an encounter diagnosis of PE to study all cause and PE cause specific mortality as the primary outcomes and bleeding complications from therapies as a secondary outcome. There were 429 total inpatient admissions, of which 59.7% were IRPE. The IRPE 30-day all-cause mortality was 8.7% and PE cause-specific mortality was 0.79%. Treatment consisted of anticoagulation alone in 93.4% of cases. Advanced therapies-systemic thrombolysis, catheter directed thrombolysis, or mechanical thrombectomy, were performed in only six IRPE cases (2.3%). Decompensation of IRPE cases requiring higher level of care and/or rescue advanced therapy occurred in only five cases (2%). In-hospital major bleeding and clinically relevant non-major bleeding were more common in those receiving systemic thrombolysis (61.5%) compared to anticoagulation combined with other advanced therapies (11.7%). Despite the high overall acuity of PE cases at our institution, in-hospital all-cause mortality was low and cause-specific mortality for IRPE was rare. These data suggest the need to target other clinically meaningful outcomes when examining advanced therapies for IRPE.
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Affiliation(s)
- Harsha V Mudrakola
- Division of Pulmonary, Critical Care & Sleep Medicine, Department of Internal Medicine, Mayo Clinic, 200 1st St SW, Rochester, MN, 55902, USA.
| | - Sean M Caples
- Division of Pulmonary, Critical Care & Sleep Medicine, Department of Internal Medicine, Mayo Clinic, 200 1st St SW, Rochester, MN, 55902, USA
| | - Robert J Hyde
- Department of Emergency Medicine, Mayo Clinic, Rochester, MN, USA
| | - Robert D McBane Ii
- Division of Vascular Medicine, Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN, USA
| | - Sumera R Ahmad
- Division of Pulmonary, Critical Care & Sleep Medicine, Department of Internal Medicine, Mayo Clinic, 200 1st St SW, Rochester, MN, 55902, USA
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Clinical and radiological characteristics of acute pulmonary embolus in relation to 28-day and 6-month mortality. PLoS One 2021; 16:e0258843. [PMID: 34962922 PMCID: PMC8714121 DOI: 10.1371/journal.pone.0258843] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2021] [Accepted: 10/07/2021] [Indexed: 12/03/2022] Open
Abstract
Background Patients with acute pulmonary embolism (PE) exhibit a wide spectrum of clinical and laboratory features when presenting to hospital and pathophysiologic mechanisms differentiating low-risk and high-risk PE are poorly understood. Objectives To investigate the prognostic value of clinical, laboratory and radiological information that is available within routine tests undertaken for patients with acute PE. Methods Electronic patient records (EPR) of patients who underwent Computed Tomography Pulmonary Angiogram (CTPA) scan for the investigation of acute PE during 6-month period (01.01.2016–30.06.2016) were examined. Data was gathered from EPR for patients that met inclusion criteria and all CTPA scans were re-evaluated. Biochemical thresholds of low-grade and high-grade inflammation, serum CRP >10mg/L and >150mg/L and serum albumin concentrations <35g/L and <25 g/L, were combined in the Glasgow Prognostic Score (GPS) and peri-operative Glasgow Prognostic Score (poGPS) respectively. Neutrophil Lymphocyte ratio (NLR) was also calculated. Pulmonary Embolus Severity Index score was calculated. Results Of the total CTPA reports (n = 2129) examined, 245 patients were eligible for inclusion. Of these, 20 (8%) patients had died at 28-days and 43 (18%) at 6-months. Of the 197 non-cancer related presentations, 28-day and 6-month mortality were 3% and 8% respectively. Of the 48 cancer related presentations, 28-day and 6-month mortality were 29% and 58% respectively. On univariate analysis, age ≥65 years (p<0.01), PESI score ≥100(p = <0.001), NLR ≥3(p<0.001) and Coronary Artery Calcification (CAC) score ≥ 6 (p<0.001) were associated with higher 28-day and 6-month mortality. PESI score ≥100 (OR 5.2, 95% CI: 1.1, 24.2, P <0.05), poGPS ≥1 (OR 2.5, 95% CI: 1.2–5.0, P = 0.01) and NLR ≥3 (OR 3.7, 95% CI: 1.0–3.4, P <0.05) remained independently associated with 28-day mortality. On multivariate binary logistic regression analysis of factors associated with 6-month mortality, PESI score ≥100 (OR 6.2, 95% CI: 2.3–17.0, p<0.001) and coronary artery calcification score ≥6 (OR 2.3, 95% CI: 1.1–4.8, p = 0.030) remained independently associated with death at 6-months. When patients who had an underlying cancer diagnosis were excluded from the analysis only GPS≥1 remained independently associated with 6-month mortality (OR 5.0, 95% CI 1.2–22.0, p<0.05). Conclusion PESI score >100, poGPS≥1, NLR ≥3 and CAC score ≥6 were associated with 28-day and 6-month mortality. PESI score ≥100, poGPS≥1 and NLR ≥3 remained independently associated with 28-day mortality. PESI score ≥100 and CAC score ≥6 remained independently associated with 6-month mortality. When patients with underlying cancer were excluded from the analysis, GPS≥1 remained independently associated with 6-month mortality. The role of the systemic inflammatory response (SIR) in determining treatment and prognosis requires further study. Routine reporting of CAC scores in CTPA scans for acute PE may have a role in aiding clinical decision-making regarding treatment and prognosis.
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Xia W, Yu H, Chen W, Chen B, Huang Y. A Radiological Nomogram to Predict 30-day Mortality in Patients with Acute Pulmonary Embolism. Acad Radiol 2021; 29:1169-1177. [PMID: 34953727 DOI: 10.1016/j.acra.2021.11.021] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2021] [Revised: 11/20/2021] [Accepted: 11/22/2021] [Indexed: 11/27/2022]
Abstract
RATIONALE AND OBJECTIVES Acute pulmonary embolism (APE) is a common disease with a high mortality, especially in the short term. Computed tomographic pulmonary angiography (CTPA) is a recommended method in the diagnostic workup for APE; thus, this study aimed to establish a CTPA-based radiological nomogram to predict the 30-day mortality in patients with APE, and to further compare this model with the pulmonary embolism severity index (PESI) and simplified pulmonary embolism severity index (SPESI). MATERIALS AND METHODS We retrospectively recruited 158 adults with confirmed APE who underwent CTPA from August 1, 2017, to August 1, 2020. These adults were stratified into two groups according to their 30-day mortality. CTPA-based variables were analyzed using univariate and multivariate analyses, independent risk factors for 30-day mortality were established, and a radiological nomogram was constructed. Subsequently, PESI and SPESI were calculated. The performance of the radiological nomogram model was compared to that of the PESI and SPESI using decision curve analysis and receiver-operating characteristic curve analysis. RESULTS Thirty-three patients died within 30 days (30-day mortality rate, 20.9%). On logistic regression analysis, the right and left ventricular diameter ratio (odds ratio [OR] = 8.709, 95% confidence interval [CI]: 1.085-69.903, p = 0.042), ventricular septal bowing (OR = 8.085, 95% CI: 1.947-33.567, p = 0.004), chronic bronchitis (OR = 4.383, 95% CI: 1.025-18.740, p = 0.046), malignant lung lesions (OR = 17.530, 95% CI: 2.408-127.636, p = 0.005), and pneumonia (OR = 3.477, 95% CI: 1.123-10.766, p = 0.031) were identified as the independent predictors of 30-day mortality. The area under the curve of the radiological nomogram, PESI, and SPESI were 0.900 (95% CI: 0.828-0.971), 0.729 (95% CI: 0.642-0.815), and 0.718 (95% CI: 0.621-0.815), respectively. CONCLUSION The CTPA-based radiological nomogram appeared valuable for the prediction of 30-day mortality in patients with APE, and was superior to both PESI and SPESI.
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Comparison of Direct Oral Anticoagulants for Acute Hospital Mortality in Venous Thromboembolism. Am J Cardiovasc Drugs 2021; 22:407-416. [PMID: 34927214 DOI: 10.1007/s40256-021-00514-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/22/2021] [Indexed: 10/19/2022]
Abstract
BACKGROUND The choice of direct oral anticoagulants (DOACs) for venous thromboembolism (VTE) is at the physician's discretion; however, it is useful to know the differences in the clinical data of DOACs to help physicians choose. OBJECTIVE We aimed to compare the mortality associated with the use of rivaroxaban, edoxaban, and apixaban in clinical practice. METHODS We identified 38,245 patients with first hospitalization for VTE from the Diagnosis Procedure Combination database in the Japanese Registry of All Cardiac and Vascular Datasets (JROAD-DPC). We classified patients into three groups by DOAC (rivaroxaban and edoxaban group, rivaroxaban and apixaban group, and edoxaban and apixaban group) and compared the in-hospital mortality and bleeding risk by propensity score (PS) matching in each group. RESULTS After PS matching, patients with rivaroxaban use had significantly lower total in-hospital mortality (1.2% vs. 2.1%; odds ratio [OR] 0.55, p = 0.012) and in-hospital mortality within 21 days (0.4% vs. 1.0%; OR 0.41, p = 0.020) and 28 days (0.7% vs. 1.3%; OR 0.53, p = 0.042) than patients with apixaban use. In the subanalysis, significant differences were only observed in patients younger than 80 years of age, patients with pulmonary embolism, and patients without heart failure. There was no significant difference in in-hospital mortality in the other groups and in the rate of bleeding events among the three groups. CONCLUSION On PS-matched analysis, there was a difference in in-hospital mortality, especially in the rivaroxaban and apixaban group. Identifying the clinical characteristics of patients associated with each DOAC, as well as prognosis, will be useful in determining treatment strategies for VTE.
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Angelini DE, Khorana AA. Building a CAT clinic - real-world systems approaches to prevention and treatment. Thromb Res 2021; 208:173-175. [PMID: 34801921 DOI: 10.1016/j.thromres.2021.11.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2021] [Revised: 11/11/2021] [Accepted: 11/12/2021] [Indexed: 10/19/2022]
Abstract
Cancer patients have an increased risk of developing venous thrombosis. The implementation of a cancer associated thrombosis clinic can be instrumental for the prevention, early recognition, and management of venous thromboembolism in this vulnerable population. Cancer thrombosis clinics rely on a multidisciplinary approach to care and require standardization along with a dedicated team of healthcare professionals. Cancer thrombosis clinics have the potential to improve patient outcomes and lower healthcare expenditure. Herein, we describe a successful model of a cancer thrombosis clinic and highlight the potential impact on clinical outcomes.
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Affiliation(s)
- Dana E Angelini
- Department of Hematology and Medical Oncology, Taussig Cancer Institute, Cleveland Clinic Foundation, Cleveland, OH, United States of America.
| | - Alok A Khorana
- Department of Hematology and Medical Oncology, Taussig Cancer Institute, Cleveland Clinic Foundation, Cleveland, OH, United States of America
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Wu YY, Tan Y, Yan M, Cheng Z, Pan XT. Analysis of CRP, Antithrombin, Fibrinogen, and Hematological Changes in 433 Patients with PTE. Int J Gen Med 2021; 14:7181-7185. [PMID: 34737613 PMCID: PMC8558423 DOI: 10.2147/ijgm.s333747] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2021] [Accepted: 09/30/2021] [Indexed: 02/04/2023] Open
Abstract
Objective To investigate the characteristics of coagulation indicators, such as C-reactive protein (CRP), antithrombin (AT), and fibrinogen (FB) in patients with pulmonary thromboembolism (PTE) and their relationship with PTE. Methods The clinical characteristics, CRP, AT, FB, plasma D-dimer (D-D) and platelet (PLT) counts, and blood coagulation indicators of 433 patients with PTE diagnosed by computed tomographic pulmonary angiography (CTPA) were comprehensively analyzed, and the relevant clinical significance was discussed. Results The total incidence of PTE was 1.60% (433/270,983 cases), and the age group with the highest incidence was over 60 years old. D-D increased in 412 (95.2%) patients. PLT was normal in 331 (76.4%) cases, but decreased in 53 (12.3%) cases and increased in 49 (11.3%) cases. CRP increased in 76.0% (288/379 cases) and was normal in 24.0% (91/379 cases). AT decreased in 109 (25.2%) cases and FB increased in 102 (23.6%) cases. There were no significant changes in other coagulation indexes. CRP was positively correlated with PLT and FB (r = 0.1026, t = 2.0118, P < 0.05, and r = 0.5360, t = 12.2963, P < 0.01, respectively). CRP was negatively correlated with AT (r = –0.2005, t = 4.0100, P < 0.01). Conclusion The incidence of PTE was higher in hospitalized patients. Most patients with PTE have increased CRP and FB and decreased AT, and these levels may be related to the occurrence of PTE.
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Affiliation(s)
- Yu-Yan Wu
- Department of Hematology, Taicang Hospital of Soochow University, Taicang, Jiangsu, People's Republic of China
| | - Yong Tan
- Department of Hematology, Taicang Hospital of Soochow University, Taicang, Jiangsu, People's Republic of China
| | - Min Yan
- Department of Hematology, Taicang Hospital of Soochow University, Taicang, Jiangsu, People's Republic of China
| | - Zhen Cheng
- Department of Hematology, Taicang Hospital of Soochow University, Taicang, Jiangsu, People's Republic of China
| | - Xiang-Tao Pan
- Department of Hematology, Taicang Hospital of Soochow University, Taicang, Jiangsu, People's Republic of China
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Tavoly M, Gleditsch J, Ghanima JP, Bremtun F, Schintzkewitz M, Thrane KJ, Jervan O, Ghanima W. The mean bilateral proximal extension of the clot is associated with pulmonary embolism severity parameters and management-associated outcomes. Acta Radiol 2021; 62:1309-1316. [PMID: 33100028 DOI: 10.1177/0284185120966724] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND The value of the proximal extension of the clot in risk stratification of pulmonary embolism (PE) has not been established. The mean bilateral proximal extension of the clot (MBPEC) is a computed tomography (CT) radiological score, where initial evaluation showed promising results considering its ability in predicting the severity of PE. PURPOSE To explore the possible associations between MBPEC and PE-severity parameters, short- and long-term outcomes of PE, and inter-observer agreement. MATERIAL AND METHODS Patients diagnosed with PE at Østfold Hospital, Norway during 2003-2011 were identified. MBPEC was calculated by calculating the mean of a score in the range of 1-4 assigned for the most proximal extension of the clot in each lung: sub-segmental; segmental; lobar; and main pulmonary arteries. Medical records were reviewed to capture clinical, biochemical, and management-associated data (thrombolysis, admission to ICU). RESULTS The mean age of 245 included patients was 55 ± 16 years; 42% were women. Patients with higher MBPEC scores had a significantly higher pulse rate and lower oxygen saturation. MBPEC score <4 predicted a negative troponin value with a negative predictive value of 90% (95% confidence interval [CI] 81-95). Patients with MBPEC 4 were 5.3 times more likely to have elevated troponin (odds ratio [OR] 5.3, 95% CI 2.0-14.3). MBPEC score of 4 was independently associated with admission to ICU (OR 3.8, 95% CI 1.8-7.9). The inter-observer agreement was excellent; weighted kappa 0.82. CONCLUSION MBPEC is associated with PE-severity parameters and can predict short-term adverse outcomes.
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Affiliation(s)
- Mazdak Tavoly
- Medical Division, Østfold Hospital, Sarpsborg, Norway
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway
- Department of Medicine, Sahlgrenska University Hospital, Gothenburg, Sweden
| | | | | | | | | | | | - Oyvind Jervan
- Medical Division, Østfold Hospital, Sarpsborg, Norway
| | - Waleed Ghanima
- Medical Division, Østfold Hospital, Sarpsborg, Norway
- Department of Haematology, Institute of Clinical Medicine, University of Oslo, Oslo, Norway
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ÖSKEN A, ÇAM N. The predictive value of systemic immune inflammation index on long-term outcomes among acute pulmonary embolism patients. JOURNAL OF HEALTH SCIENCES AND MEDICINE 2021. [DOI: 10.32322/jhsm.931405] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
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Surov A, Akritidou M, Bach AG, Bailis N, Lerche M, Meyer HJ, Pech M, Wienke A. A New Index for the Prediction of 30-Day Mortality in Patients With Pulmonary Embolism: The Pulmonary Embolism Mortality Score (PEMS). Angiology 2021; 72:787-793. [PMID: 33557585 PMCID: PMC8326960 DOI: 10.1177/0003319721993346] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Our aim was to analyze possibility of combination of basic clinical and radiological signs to predict 30-day mortality after acute pulmonary embolism (PE). We included 486 patients. Age, gender, simplified pulmonary embolism index (sPESI), pH, troponin, N-terminal natriuretic peptide, minimal systolic and diastolic blood pressure, O2 saturation, syncope, need for vasopressors, thrombotic obstruction, vessel diameter, short axis ratio right ventricle/left ventricle, and contrast medium reflux into the inferior vena cava (IVC) were analyzed. A backward algorithm in a logistic regression model was used to identify relevant risk factors. Multiple logistic regression analysis identified that sPESI, pH, minimal diastolic blood pressure, IVC reflux, and need for vasopressors influenced 30-day mortality. A score for mortality prediction was constructed (the Pulmonary Embolism Mortality Score): sPESI >2 points (1 point), pH <7.35 (1 point), minimal diastolic blood pressure <45 mm Hg (1 point), IVC reflux (1 point), and need for vasopressors (2 points). Patients with >3 points showed higher 30-day mortality (sensitivity: 84.9%, specificity: 83.0%, positive predictive value: 51.8%, negative predictive value: 96.2%). The net reclassification improvement compared with the sPESI was 0.94 (95% CI = 0.73-1.15). In conclusion, a new score can predict 30-day mortality in patients with PE and is more sensitive than sPESI.
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Affiliation(s)
- Alexey Surov
- Department of Radiology, University of Leipzig, Germany
- Department of Radiology and Nuclear Medicine, Otto-von-Guericke University Magdeburg, Germany
| | - Mideia Akritidou
- Department of Internal Medicine, Otto-von-Guericke University Magdeburg, Germany
| | - Andreas Gunther Bach
- Department of Radiology, Martin-Luther-University Halle-Wittenberg, Halle, Germany
| | | | - Marianne Lerche
- Department of Respiratory Medicine, University of Leipzig, Germany
| | | | - Maciej Pech
- Department of Radiology and Nuclear Medicine, Otto-von-Guericke University Magdeburg, Germany
| | - Andreas Wienke
- Institute of Medical Epidemiology, Biostatistics, and Informatics, Martin-Luther-University Halle-Wittenberg, Halle, Germany
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