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Siddiqui F, Tafur A, Hussain M, García-Ortega A, Darki A, Fareed J, Jiménez D, Bikdeli B, Galeano-Valle F, Fernández-Reyes JL, Pérez-Pinar M, Monreal M. The prognostic value of blood cellular indices in pulmonary embolism. Am J Hematol 2024; 99:1704-1711. [PMID: 38816957 DOI: 10.1002/ajh.27379] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2024] [Revised: 04/08/2024] [Accepted: 05/16/2024] [Indexed: 06/01/2024]
Abstract
Prognostication in acute pulmonary embolism (PE) requires reliable markers. While cellular indices such as neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), and systemic immune-inflammation index (SII) appear promising, their utility in PE prognostication needs further exploration. We utilized data from the RIETE registry and the Loyola University Medical Center (LUMC) to assess the prognostic value of NLR, PLR, and SII in acute PE, using logistic regression models. The primary outcome was 30-day all-cause mortality. We compared their prognostic value versus the simplified Pulmonary Embolism Severity Index (sPESI) alone. We included 10 085 patients from RIETE and 700 from the LUMC. Thirty-day mortality rates were 4.6% and 8.3%, respectively. On multivariable analysis, an elevated NLR (>7.0) was associated with increased mortality (adjusted odds ratio [aOR]: 3.46; 95% CI: 2.60-4.60), outperforming the PLR > 220 (aOR: 2.36; 95% CI: 1.77-3.13), and SII > 1600 (aOR: 2.52; 95% CI: 1.90-3.33). The c-statistic for NLR in patients with low-risk PE was 0.78 (95% CI: 0.69-0.86). Respective numbers were 0.66 (95% CI: 0.63-0.69) and 0.68 (95% CI: 0.59-0.76) for intermediate-risk and high-risk patients. These findings were mirrored in the LUMC cohort. Among 9810 normotensive patients in RIETE, those scoring 0 points in sPESI and with an NLR ≤ 7.0 (35% of the population) displayed superior sensitivity (97.1%; 95% CI: 95.5-98.7) and negative predictive value (99.7%; 95% CI: 99.5-99.8) than sPESI alone (87.1%; 95% CI: 83.9-90.3, and 98.7%; 95% CI: 98.4-99.1, respectively) for 30-day mortality. The NLR is a significant prognostic marker for 30-day mortality in PE patients, especially useful to identify patients with very low-risk PE.
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Affiliation(s)
- Fakiha Siddiqui
- Department of Pathology and Laboratory Medicine, Health Sciences Division, Cardiovascular Research Institute, Loyola University Chicago, Maywood, Illinois, USA
- Program in Health Sciences, UCAM - Universidad Católica San Antonio de Murcia, Murcia, Spain
| | - Alfonso Tafur
- Department of Medicine and Vascular Medicine, Evanston NorthShore University HealthSystem, Evanston, Illinois, USA
- Pritzker School of Medicine, University of Chicago, Chicago, Illinois, USA
| | - Mushtaq Hussain
- Dow College of Biotechnology, Dow University of Health Sciences, Karachi, Pakistan
| | | | - Amir Darki
- Department of Cardiology, Loyola University Medical Center, Maywood, Illinois, USA
| | - Jawed Fareed
- Department of Pathology and Laboratory Medicine, Health Sciences Division, Cardiovascular Research Institute, Loyola University Chicago, Maywood, Illinois, USA
| | - David Jiménez
- Respiratory Department, Hospital Ramón y Cajal and Universidad de Alcalá (IRYCIS), CIBER de Enfermedades Respiratorias (CIBERES), Madrid, Spain
| | - Behnood Bikdeli
- Cardiovascular Medicine Division, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
- Thrombosis Research Group, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
- YNHH/Yale Center for Outcomes Research and Evaluation (CORE), New Haven, Connecticut, USA
- Cardiovascular Research Foundation (CRF), New York, New York, USA
| | - Francisco Galeano-Valle
- Internal Medicine Department, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | | | | | - Manuel Monreal
- Faculty of Health Sciences, UCAM - Universidad Católica San Antonio de Murcia, Murcia, Spain
- CIBER Enfermedades Respiratorias (CIBERES), Madrid, Spain
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Li R, Shen S, Jiang J, Liu Y. Prognostic Value of Neutrophil/Lymphocyte Ratio for Pulmonary Embolism: A Meta-Analysis and External Validation. Ann Vasc Surg 2024; 105:48-59. [PMID: 38582200 DOI: 10.1016/j.avsg.2024.01.019] [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: 11/06/2023] [Revised: 12/26/2023] [Accepted: 01/21/2024] [Indexed: 04/08/2024]
Abstract
BACKGROUND Prognostic value of neutrophil/lymphocyte ratio (NLR) for pulmonary embolism (PE) has been reported in several retrospective studies. The purpose of this investigation was to perform a pooled analysis and external validation of predictive value of NLR. METHODS PubMed, Embase, and Cochrane databases were searched from inception to November 5, 2022. A random effects model was used. Grade was used to evaluate the certainty of evidence. External validation was conducted in clinical cohorts before and after a propensity scoring matching (PSM). Covariates include basic clinical characteristics, such as age, gender, etc. The value of NLR in prediction model was also evaluated. RESULTS A total of 15 studies comprising 5,874 patients were included. Pooled risk ratio of NLR was 2.33 (95% confidence interval [CI]: 1.97-2.75), with an area under the curve of 0.78 (95% CI: 0.74-0.81), a sensitivity of 0.75 (95% CI: 0.71-0.79), a specificity of 0.67 (95% CI: 0.61-0.73), and a median cut-off value of 5.7. Grade of Recommendations Assessment Development and Evaluation (GRADE) certainty analysis showed the quality of the evidence was moderate. Before (n = 336) and after (n = 152) propensity scoring matching, risk ratio of NLR was 2.69 (95% CI: 1.04-6.97) and 6.58 (95% CI: 1.99-17.75). A prediction model consisting of NLR, age, D-dimer, and simplified PE severity index had an area under the curve of 0.809 (95% CI: 0.738-0.88), a sensitivity of 0.638 (95% CI: 0.511-0.745), and a specificity of 0.851 (95% CI: 0.709-0.917). Net reclassification index (12%, P = 0.035) and integrated discrimination improvement (17%, P = 0.022) indicated an improvement caused by NLR. CONCLUSIONS Prognostic value of NLR for PE was confirmed by meta-analysis and validated in an independent cohort, deserving further clinical application.
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Affiliation(s)
- Ruihua Li
- Department of General Surgery, Vascular Surgery, Qilu Hospital of Shandong University, Jinan, Shandong, China
| | - Shuohao Shen
- Department of General Surgery, Vascular Surgery, Qilu Hospital of Shandong University, Jinan, Shandong, China
| | - Jianjun Jiang
- Department of General Surgery, Vascular Surgery, Qilu Hospital of Shandong University, Jinan, Shandong, China.
| | - Yang Liu
- Department of General Surgery, Vascular Surgery, Qilu Hospital of Shandong University, Jinan, Shandong, China.
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Tang S, Hu Y. Neutrophil-to-lymphocyte ratio and platelet-to-lymphocyte ratio as predictors of mortality in acute pulmonary embolism: A systematic review and meta-analysis. Pak J Med Sci 2024; 40:1274-1279. [PMID: 38952504 PMCID: PMC11190416 DOI: 10.12669/pjms.40.6.8802] [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: 09/12/2023] [Revised: 09/20/2023] [Accepted: 02/17/2024] [Indexed: 07/03/2024] Open
Abstract
Objective The purpose of this review was to examine the association between neutrophil-to-lymphocyte ratio (NLR) and platelet-to-lymphocyte ratio (PLR) and mortality rates in patients with acute pulmonary embolism (PE). Methods PubMed Central, Scopus, Web of Science, and Embase were searched for studies reporting the association between NLR and PLR with mortality up to March 17th 2023. Adjusted ratios were sourced from studies and combined to generate pooled outcomes as odds ratio (OR) in a random-effects model. Risk of bias was assessed using the Newcastle Ottawa Scale. Results Fifteen studies were included. Meta-analysis showed that NLR was a significant predictor of mortality in patients with PE (OR: 1.42 95% CI: 1.26, 1.61 I2=92%). Results were unchanged on sensitivity analysis and subgroup analysis based on study location, method of diagnosis, sample size, overall mortality rates, cut-offs, and follow-up. Pooled analysis failed to demonstrate PLR as a predictor of mortality in patients with PE (OR: 1.00 95% CI: 1.00, 1.01 I2=57%). Results were unchanged on sensitivity analysis and subgroup analysis based on study location, diagnosis of PE, overall mortality rates, and cut-off. Conclusion Current evidence from retrospective studies shows that NLR can independently predict mortality in acute PE. Data on PLR was limited and failed to indicate an independent role in the prognosis of PE patients. Registration No. PROSPERO (CRD42023407573).
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Affiliation(s)
- Shanshan Tang
- Shanshan Tang, Department of Respiratory Medicine, First People’s Hospital of Linping District, 369 Yingbin Road, Hangzhou City, Zhejiang Province 311100, P.R. China
| | - Yanhua Hu
- Yanhua Hu, Department of Respiratory Medicine, First People’s Hospital of Linping District, 369 Yingbin Road, Hangzhou City, Zhejiang Province 311100, P.R. China
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Zhu N, Lin S, Cao C. A novel prognostic prediction indicator in patients with acute pulmonary embolism: Naples prognostic score. Thromb J 2023; 21:114. [PMID: 37932805 PMCID: PMC10629175 DOI: 10.1186/s12959-023-00554-8] [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: 07/07/2023] [Accepted: 10/14/2023] [Indexed: 11/08/2023] Open
Abstract
Acute pulmonary embolism (APE) is a potentially fatal disease. Early risk stratification is essential to determining appropriate treatment. We aimed to investigate the predictive value of the Naples Prognostic Score (NPS) for 30-day all-cause mortality in patients with APE. In this retrospective analysis, 325 hospitalized patients with APE were divided into Groups 0 (n = 131), 1 (n = 153), and 2 (n = 41) according to the NPS. The primary outcome event was all-cause mortality during 30 days of follow-up from the day of admission. The correlation between NPS, clinical features, and outcomes in each group was evaluated. The patients were divided into two groups, survivor (n = 294) and nonsurvivor (n = 31), according to their prognosis. The results of the comparison between the three NPS groups revealed that patients with older age, faster heart rate, lower systolic blood pressure, low albumin and total cholesterol levels, high neutrophil to lymphocyte ratio (NLR), low lymphocyte-to-monocyte ratio (LMR), right heart dilatation, heart failure, malignancy, and lower extremity venous thrombosis had significantly higher 30-day all-cause mortality (P < 0.05). Area under the receiver operating characteristic curve (AUC) for NPS to predict all-cause death within 30 days in patients with APE was 0.780 (95% confidence interval [CI] = 0.678-0.855), with sensitivity being 80.6% (95% CI = 0.667-0.946) and specificity being 72.1% (95% CI = 0.670-0.772). Kaplan-Meier (KM) curves showed that Group 2 APE patients had the highest risk of all-cause mortality compared with the other two groups (log-rank test, P = 0.0004). Forest plot visualization using the Cox proportional hazard model showed a significant increase in the risk of 30-day all-cause mortality by 239% (hazard ratio [HR] = 3.385 [1.115-10.273], P = 0.031) and 338% (HR = 4.377 [1.228-15.598], P = 0.023), and the trend test showed a statistical difference (P = 0.042). The study concluded that NPS is a novel, reliable, and multidimensional prognostic scoring system with good prediction of 30-day all-cause mortality in patients with APE.
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Affiliation(s)
- Ning Zhu
- Department of Respiratory and Critical Care Medicine, Key Laboratory of Respiratory Disease of Ningbo, The First Affiliated Hospital of Ningbo University, 59 Liuting Road, Ningbo, 315010, Zhejiang, China
| | - Shanhong Lin
- Department of Ultrasound, The First Affiliated Hospital of Ningbo University, Ningbo, China
| | - Chao Cao
- Department of Respiratory and Critical Care Medicine, Key Laboratory of Respiratory Disease of Ningbo, The First Affiliated Hospital of Ningbo University, 59 Liuting Road, Ningbo, 315010, Zhejiang, China.
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Liu Y, Sun H, Jiang J. Platelet/Lymphocyte Ratio Predicted Long-Term Prognosis for Acute Upper Extremity Deep Vein Thrombosis from a Retrospective Study. J Inflamm Res 2023; 16:225-234. [PMID: 36686277 PMCID: PMC9849917 DOI: 10.2147/jir.s399000] [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: 11/24/2022] [Accepted: 01/10/2023] [Indexed: 01/15/2023] Open
Abstract
Background In this study, we aimed to determine the mortality risk factors and whether placement of a vena cava filter improves the prognosis of acute upper extremity deep vein thrombosis (UEDVT). Methods Clinical data and follow-up results were retrospectively analyzed. Cox regression analysis was conducted to identify the risk factors associated with all-cause mortality in all patients and subgroups of patients. Results are expressed as hazard ratio (HR) with 95% confidence intervals (95% CI). Receiver operating characteristic curves (ROC) were used to determine the optimal cut-off value. Kaplan-Meier survival curves were constructed and compared by the Log rank test. Results The study cohort comprised 109 patients of median age 56 years (47.5, 64.5). The median follow-up time was 25 months (8, 47): 39 patients (35.8%) had died by 12 months, 55 (50.5%) by 36 months, and 60 (55%) by the end of follow-up. Presence of malignancy (HR: 5.882, 95% CI: 2.128-16.667), D-dimer (HR: 1.56, 95% CI: 1.09-1.94), platelet/lymphocyte ratio (PLR; HR: 2.02, 95% CI: 1.15-3.54), and the systemic immune/inflammatory index (SII; HR: 1.471, 95% CI: 1.062-1.991) were identified as independent risk factors for mortality. Subgroup analysis of patients with malignancy determined gender (HR: 2.936, 95% CI: 1.599-5.393) and PLR (HR: 1.427,95% CI: 1.023-1.989) as independent risk factors. Kaplan-Meier analysis showed that the mortality rate was much higher in patients with malignancy, high D-dimer (≥ 0.92ug/mL), high PLR (≥ 291) and high SII (≥ 1487). However, there was no significant difference between patients with and without vena cava filters. Conclusion In this study, we identified PLR as an new independent predictor of mortality in patients with acute UEDVT. Emergency placement of a vena cava filter did not improve long-term prognosis.
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Affiliation(s)
- Yang Liu
- Department of General Surgery, Vascular Surgery, Qilu Hospital of Shandong University, Jinan, People’s Republic of China
| | - Hongze Sun
- Department of General Surgery, Vascular Surgery, Qilu Hospital of Shandong University, Jinan, People’s Republic of China
| | - Jianjun Jiang
- Department of General Surgery, Vascular Surgery, Qilu Hospital of Shandong University, Jinan, People’s Republic of China,Correspondence: Jianjun Jiang, Department of General Surgery, Vascular Surgery, Qilu Hospital of Shandong University, Jinan, Shandong, 250012, People’s Republic of China, Tel +86 18560085133, Email
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Su H, Shou Y, Fu Y, Zhao D, Heidari AA, Han Z, Wu P, Chen H, Chen Y. A new machine learning model for predicting severity prognosis in patients with pulmonary embolism: Study protocol from Wenzhou, China. Front Neuroinform 2022; 16:1052868. [PMID: 36590908 PMCID: PMC9802582 DOI: 10.3389/fninf.2022.1052868] [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: 09/24/2022] [Accepted: 11/28/2022] [Indexed: 12/23/2022] Open
Abstract
Introduction Pulmonary embolism (PE) is a common thrombotic disease and potentially deadly cardiovascular disorder. The ratio of clinical misdiagnosis and missed diagnosis of PE is very large because patients with PE are asymptomatic or non-specific. Methods Using the clinical data from the First Affiliated Hospital of Wenzhou Medical University (Wenzhou, China), we proposed a swarm intelligence algorithm-based kernel extreme learning machine model (SSACS-KELM) to recognize and discriminate the severity of the PE by patient's basic information and serum biomarkers. First, an enhanced method (SSACS) is presented by combining the salp swarm algorithm (SSA) with the cuckoo search (CS). Then, the SSACS algorithm is introduced into the KELM classifier to propose the SSACS-KELM model to improve the accuracy and stability of the traditional classifier. Results In the experiments, the benchmark optimization performance of SSACS is confirmed by comparing SSACS with five original classical methods and five high-performance improved algorithms through benchmark function experiments. Then, the overall adaptability and accuracy of the SSACS-KELM model are tested using eight public data sets. Further, to highlight the superiority of SSACS-KELM on PE datasets, this paper conducts comparison experiments with other classical classifiers, swarm intelligence algorithms, and feature selection approaches. Discussion The experimental results show that high D-dimer concentration, hypoalbuminemia, and other indicators are important for the diagnosis of PE. The classification results showed that the accuracy of the prediction model was 99.33%. It is expected to be a new and accurate method to distinguish the severity of PE.
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Affiliation(s)
- Hang Su
- College of Computer Science and Technology, Changchun Normal University, Changchun, Jilin, China
| | - Yeqi Shou
- Department of Pulmonary and Critical Care Medicine, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Yujie Fu
- Department of Pulmonary and Critical Care Medicine, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Dong Zhao
- College of Computer Science and Technology, Changchun Normal University, Changchun, Jilin, China,*Correspondence: Dong Zhao,
| | - Ali Asghar Heidari
- School of Surveying and Geospatial Engineering, College of Engineering, University of Tehran, Tehran, Iran
| | - Zhengyuan Han
- Department of Pulmonary and Critical Care Medicine, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Peiliang Wu
- Department of Pulmonary and Critical Care Medicine, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China,Peiliang Wu,
| | - Huiling Chen
- College of Computer Science and Artificial Intelligence, Wenzhou University, Wenzhou, Zhejiang, China,Huiling Chen,
| | - Yanfan Chen
- Department of Pulmonary and Critical Care Medicine, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China,Yanfan Chen,
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Hu J, Cai Z, Zhou Y. The Association of Neutrophil-Lymphocyte Ratio with Venous Thromboembolism: A Systematic Review and Meta-Analysis. Clin Appl Thromb Hemost 2022; 28:10760296221130061. [PMID: 36189877 PMCID: PMC9530558 DOI: 10.1177/10760296221130061] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
The neutrophil–lymphocyte ratio(NLR) has been used for diagnosing venous
thromboembolism (VTE). We aimed to assess the accuracy of NLR to diagnose VTE by
meta-analysis. Systematic electronic searches were conducted June 2, 2021 in
PubMed, Embase(Ovid), and Cochrane Library. The search did not have any language
or time restriction applied. Our search strategy was based on keywords in
combination with both medical subject headings (MeSH) terms and text words. The
diagnostic odds ratio, summary receiver operating characteristics, sensitivity,
specificity, positive likelihood ratio, and negative likelihood ratio were
estimated. 10 articles with 1513 VTE participants and 2593 control participants
were included for quantitative synthesis. The pooled values were as follows:
sensitivity = 0.68(95% CI 0.45-0.84), specificity = 0.73(95% CI 0.6-0.83),
positive likelihood ratio = 2.5(95% CI 1.8-3.4), negative likelihood
ratio = 0.44(95% CI 0.26-0.75), diagnostic odds ratio = 6(95% CI 3-11), and
SROC = 0.76(95% CI: 0.73-0.8). NLR could be diagnostic factor for the detection
of potential VTE, the accuracy thereof in the current meta-analysis exhibited
moderate accuracy for diagnosing VTE. Furthermore, further large cohort studies
are needed to determine optimal cut-off values of NLR.
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Affiliation(s)
- Jingjing Hu
- Department of Emergency Medicine, Hangzhou Third People's
Hospital, Hangzhou, Zhejiang, China
| | - Zhaobin Cai
- Department of Emergency Medicine, Hangzhou Third People's
Hospital, Hangzhou, Zhejiang, China,Zhaobin Cai, Department of Emergency
Medicine, Hangzhou Third People's Hospital, Hangzhou, Zhejiang, China.
| | - Yidan Zhou
- Department of Emergency Medicine, Hangzhou Third People's
Hospital, Hangzhou, Zhejiang, China,Yidan Zhou, Department of Emergency
Medicine, Hangzhou Third People's Hospital, Hangzhou, Zhejiang, China.
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Orun S, Celikkol A, Basol BI, Yeniay E. Diagnostic accuracy of adropin as a preliminary test to exclude acute pulmonary embolism: a prospective study. BMC Pulm Med 2022; 22:351. [PMID: 36115957 PMCID: PMC9482749 DOI: 10.1186/s12890-022-02156-y] [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: 04/05/2022] [Accepted: 09/15/2022] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
This study aims to investigate the diagnostic accuracy of adropin as a biomarker to exclude the diagnosis of acute pulmonary embolism (PE).
Methods
Patients admitted to the emergency department of a tertiary health centre between August 2019 and August 2020 and diagnosed with PE were included in this prospective cohort study. The amount of serum adropin was determined in patients with (PE) and compared with that of healthy volunteers. Receiver operating characteristic analysis was performed with the obtained data, and the area under the curve (AUC) with a 95% confidence interval was determined. The parameters of diagnostic accuracy for PE were determined.
Results
A total of 57 participants were included in the study (28 controls and 29 PE patients). The mean adropin level in the PE group was 187.33 ± 62.40 pg/ml, which was significantly lower than that in the control group (524.06 ± 421.68 pg/ml) (p < 0.001). When the optimal adropin cut-off value was 213.78 pg/ml, the likelihood ratio of the adropin test was 3.4, and the sensitivity of the adropin test at this value was 82% with specificity of 75% (95% CI; AUC: 0.821).
Conclusion
Our results suggest that adropin may be considered for further study as a candidate marker for the exclusion of the diagnosis of PE. However, more research is required to verify and support the generalizability of our study results.
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Jiang J, Xue J, Liu Y. A Prediction Model Based on Blood Biomarker for Mortality Risk in Patients with Acute Venous Thromboembolism. J Inflamm Res 2022; 15:4725-4735. [PMID: 36003675 PMCID: PMC9394732 DOI: 10.2147/jir.s379360] [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: 06/29/2022] [Accepted: 08/10/2022] [Indexed: 12/02/2022] Open
Abstract
Background Most studies to date have focused on predicting the risk of venous thromboembolism (VTE), but prediction models about mortality risk in VTE are rarely reported. We sought to develop and validate a multivariable model to predict the all-cause mortality risk in patients with acute VTE in emergency settings. Methods A total of 700 patients were included from Qilu Hospital of Shandong University and were randomly assigned into training set (n=490) and validation set (n=210) in an 7:3 ratio. Multivariate logistics regression analysis was performed to identify independent variables and develop a prediction model, which was validated internally using bootstrap method. The discrimination, calibration and clinical utility were evaluated by receiver operating characteristic curve (ROC) analysis, Hosmer-Lemeshow (HL) test, Kaplan-meier (KM) analysis and decision curve analysis (DCA). Results There were 52 patients (10.6%) dying and 437 (89.4%) surviving in training set. Age (odds ratio [OR]: 4.158, 95% confidence interval [CI]: 2.426–7.127), pulmonary embolism (OR: 1.779, 95% CI: 1.124–2.814), platelet count (OR: 0.507, 95% CI: 0.310–0.830), D-dimer (OR: 1.826, 95% CI: 1.133–2.942) and platelet/lymphocyte ratio (OR: 2.166, 95% CI: 1.259–3.727) were independent risk variables associated with all-cause mortality. The model had good predictive capability with an AUC of 0.746 (95% CI: 0.668,0.825), a sensitivity of 0.769 (95% CI: 0.607,0.889), a specificity of 0.672 (95% CI: 0.634,0.707). The validation model had an AUC of 0.739 (95% CI: 0.685,0.793), a sensitivity of 0.690 (95% CI: 0.580,0.787), a specificity of 0.693 (95% CI: 0.655,0.729). The model is well calibrated and the HL test showed a good fit (χ2=5.291, p=0.726, Nagelkerke R2=0.137). KM analysis and DCA showed a good clinical utility of the nomogram. Conclusion This study identified independent variables affecting all-cause mortality in patients with acute VTE, and developed a prediction model and provided a nomogram with good prediction capability and clinical utility.
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Affiliation(s)
- Jianjun Jiang
- Department of General Surgery, Vascular Surgery, Qilu Hospital of Shandong University, Jinan, Shandong, 250012, People's Republic of China
| | - Junshuai Xue
- Department of General Surgery, Qilu Hospital of Shandong University, Jinan, Shandong, 250012, People's Republic of China
| | - Yang Liu
- Department of General Surgery, Vascular Surgery, Qilu Hospital of Shandong University, Jinan, Shandong, 250012, People's Republic of China
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Boyuk F. The role of the multi-inflammatory index as a novel inflammation-related index in the differential diagnosis of massive and non-massive pulmonary embolism. Int J Clin Pract 2021; 75:e14966. [PMID: 34626044 DOI: 10.1111/ijcp.14966] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/28/2021] [Accepted: 10/06/2021] [Indexed: 02/06/2023] Open
Abstract
OBJECTIVE Systemic inflammatory response and pro-coagulator factors are critical in acute pulmonary embolism. Recently, there is increasing evidence that the multi-inflammatory index (MII) may be prognostic in many clinical situations. The study investigated whether MII-1 and MII-2 can distinguish massive (MPE) and non-massive pulmonary embolism (NMPE). METHODS A total of 146 patients (73 MPE and 73 NMPE) were included in the study that was designed as a retrospective cross-sectional analysis. Following haemogram analysis, MII-1 (platelet-to-lymphocyte x CRP) and MII-2 (neutrophil-to-lymphocyte x CRP) were calculated manually. RESULTS MII-1 and 2 showed a positive significant correlation with PLR and NLR, moderate positive correlation with CPR, and weak positive correlation with PAP (P < .001). CRP, MII-1, MII-2, PAP and systolic BP variables showed strong diagnostic value in distinguishing MPE and NMPE [AUC (SE): 0.816 (0.037), 0.811 (0.038), 0.810 (0.037), 0.870 (0.032) and 0.864 (0.032); respectively] (P < .001). MPR, MPV, RDW, and PLR in distinguishing MPE and NMPE groups did not show significance (P > .05). CONCLUSION Although MII-1 and MII-2 are simple, cheap, and easy indexes to calculate, they showed a strong ability to distinguish MPE and NMPE compared with the previously studied classical inflammatory indexes.
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Affiliation(s)
- Ferit Boyuk
- Department of Cardiology, Yedikule Chest Diseases and Thoracic Surgery Training and Research Hospital, Istanbul, Turkey
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Xue J, Ma D, Jiang J, Liu Y. Diagnostic and Prognostic Value of Immune/Inflammation Biomarkers for Venous Thromboembolism: Is It Reliable for Clinical Practice? J Inflamm Res 2021; 14:5059-5077. [PMID: 34629886 PMCID: PMC8494998 DOI: 10.2147/jir.s327014] [Citation(s) in RCA: 33] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2021] [Accepted: 09/19/2021] [Indexed: 12/17/2022] Open
Abstract
Venous thromboembolism (VTE), which includes deep vein thrombosis (DVT) and pulmonary embolism (PE), has been an important cause of sudden in-hospital death. Studies have shown that the immune/inflammatory response plays an important role in the pathogenesis of vascular disease, with representative markers in the blood including the neutrophil/lymphocyte ratio (NLR), platelet/lymphocyte ratio (PLR), monocyte/lymphocyte ratio (MLR), systemic immune/inflammatory index (SII), etc. However, there is a variety of immune/inflammatory indicators. Moreover, most previous studies have been single-center investigations involving one or two indicators, with varying nature of cases, number of cases and study objectives, thereby making it difficult to reach consensus conclusions with good clinical guidelines. This article reviews the clinical value of immunoinflammatory indicators for VTE based on previous studies, including the diagnostic and prognostic capabilities. In conclusion, NLR provides promising predictive capability for the onset and prognosis of VTE and deserves extensive application in clinical practice. PLR also has certain diagnostic and prognostic value, but further studies are warranted to identify its reliability and stability. Monocytes, eosinophils and platelet-related indicators show some clinical association with VTE, although the predictive capabilities are mediocre. SII is of promising potential value for VTE and deserves further investigations. This review will provide new clues and valuable clinical guidance for the diagnosis and therapy of VTE.
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Affiliation(s)
- Junshuai Xue
- Department of General Surgery, Vascular Surgery, Shandong University Qilu Hospital, Jinan City, Shandong Province, People's Republic of China
| | - Delin Ma
- Department of General Surgery, Shandong University Qilu Hospital, Jinan City, Shandong Province, People's Republic of China
| | - Jianjun Jiang
- Department of General Surgery, Vascular Surgery, Shandong University Qilu Hospital, Jinan City, Shandong Province, People's Republic of China
| | - Yang Liu
- Department of General Surgery, Vascular Surgery, Shandong University Qilu Hospital, Jinan City, Shandong Province, People's Republic of China
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Wang MF, Li FX, Feng LF, Zhu CN, Fang SY, Su CM, Yang QF, Ji QY, Li WM. Development and validation of a novel risk assessment model to estimate the probability of pulmonary embolism in postoperative patients. Sci Rep 2021; 11:18087. [PMID: 34508171 PMCID: PMC8433319 DOI: 10.1038/s41598-021-97638-0] [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: 03/29/2021] [Accepted: 08/25/2021] [Indexed: 11/24/2022] Open
Abstract
Pulmonary embolism (PE) is a leading cause of mortality in postoperative patients. Numerous PE prevention clinical practice guidelines are available but not consistently implemented. This study aimed to develop and validate a novel risk assessment model to assess the risk of PE in postoperative patients. Patients who underwent Grade IV surgery between September 2012 and January 2020 (n = 26,536) at the Affiliated Dongyang Hospital of Wenzhou Medical University were enrolled in our study. PE was confirmed by an identified filling defect in the pulmonary artery system in CT pulmonary angiography. The PE incidence was evaluated before discharge. All preoperative data containing clinical and laboratory variables were extracted for each participant. A novel risk assessment model (RAM) for PE was developed with multivariate regression analysis. The discrimination ability of the RAM was evaluated by the area under the receiver operating characteristic curve, and model calibration was assessed by the Hosmer–Lemeshow statistic. We included 53 clinical and laboratory variables in this study. Among them, 296 postoperative patients developed PE before discharge, and the incidence rate was 1.04%. The distribution of variables between the training group and the validation group was balanced. After using multivariate stepwise regression, only variable age (OR 1.070 [1.054–1.087], P < 0.001), drinking (OR 0.477 [0.304–0.749], P = 0.001), malignant tumor (OR 2.552 [1.745–3.731], P < 0.001), anticoagulant (OR 3.719 [2.281–6.062], P < 0.001), lymphocyte percentage (OR 2.773 [2.342–3.285], P < 0.001), neutrophil percentage (OR 10.703 [8.337–13.739], P < 0.001), red blood cell (OR 1.872 [1.384–2.532], P < 0.001), total bilirubin (OR 1.038 [1.012–1.064], P < 0.001), direct bilirubin (OR 0.850 [0.779–0.928], P < 0.001), prothrombin time (OR 0.768 [0.636–0.926], P < 0.001) and fibrinogen (OR 0.772 [0.651–0.915], P < 0.001) were selected and significantly associated with PE. The final model included four variables: neutrophil percentage, age, malignant tumor and lymphocyte percentage. The AUC of the model was 0.949 (95% CI 0.932–0.966). The risk prediction model still showed good calibration, with reasonable agreement between the observed and predicted PE outcomes in the validation set (AUC 0.958). The information on sensitivity, specificity and predictive values according to cutoff points of the score in the training set suggested a threshold of 0.012 as the optimal cutoff value to define high-risk individuals. We developed a new approach to select hazard factors for PE in postoperative patients. This tool provided a consistent, accurate, and effective method for risk assessment. This finding may help decision-makers weigh the risk of PE and appropriately select PE prevention strategies.
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Affiliation(s)
- Mao-Feng Wang
- Department of Biomedical Sciences Laboratory, Affiliated Dongyang Hospital of Wenzhou Medical University, Dongyang, 322100, Zhejiang, China
| | - Fei-Xiang Li
- Department of Cardiology, Affiliated Dongyang Hospital of Wenzhou Medical University, Wuning West Road No. 60, Dongyang, 322100, Zhejiang, China
| | - Lan-Fang Feng
- Department of Respiratory, Affiliated Dongyang Hospital of Wenzhou Medical University, Dongyang, 322100, Zhejiang, China
| | - Chao-Nan Zhu
- Shanghai Key Laboratory of Artificial Intelligence for Medical Image and Knowledge Graph, Hangzhou, 310000, Zhejiang, China
| | - Shuang-Yan Fang
- Department of Respiratory, Affiliated Dongyang Hospital of Wenzhou Medical University, Dongyang, 322100, Zhejiang, China
| | - Cai-Min Su
- Department of Respiratory, Affiliated Dongyang Hospital of Wenzhou Medical University, Dongyang, 322100, Zhejiang, China
| | - Qiong-Fang Yang
- Department of Respiratory, Affiliated Dongyang Hospital of Wenzhou Medical University, Dongyang, 322100, Zhejiang, China
| | - Qiao-Ying Ji
- Department of Respiratory, Affiliated Dongyang Hospital of Wenzhou Medical University, Dongyang, 322100, Zhejiang, China
| | - Wei-Min Li
- Department of Cardiology, Affiliated Dongyang Hospital of Wenzhou Medical University, Wuning West Road No. 60, Dongyang, 322100, Zhejiang, China.
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