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Liao R, Yang Z, Yin Y, Sun X, Ding F. Plasma follistatin-like protein 1 is correlated with disease severity in patients with acute pulmonary embolism and predicts short-term mortality. INTERNATIONAL JOURNAL OF CLINICAL AND EXPERIMENTAL PATHOLOGY 2017; 10:8786-8794. [PMID: 31966744 PMCID: PMC6965398] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 05/22/2016] [Accepted: 07/25/2017] [Indexed: 06/10/2023]
Abstract
We investigated the plasma levels of follistatin-like protein 1 (FSTL1) in patients with acute pulmonary embolism (PE) and whether it could predict short-term mortality. A prospective observational cohort study was conducted in patients with acute PE (n = 220). FSTL1 was measured in plasma samples using enzyme-linked immunosorbent assay. Plasma FSTL1 levels were significantly increased in patients with acute PE, and positively correlated with disease severity (rs = 0.7171). Sensitivity and specificity rates for high-risk PE at a specific FSTL1 cutoff point (23 ng/ml) were 79.3% and 92.9%. Multivariant Cox regression analysis showed that FSTL1 was independently associated with 30-day mortality rate. Addition of FSTL1 to the PE severity index (PESI) scoring system significantly improved the predictive value for 30-day mortality. These results indicate that the plasma level of FSTL1 is correlated with disease severity in patients with acute PE and predicts short-term mortality.
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Affiliation(s)
- Ruomin Liao
- Department of Respiratory Medicine, Shanghai General Hospital, School of Medicine, Shanghai Jiao Tong UniversityShanghai, China
| | - Zeyong Yang
- Department of Anesthesiology, The International Peace Maternity and Child Health Hospital, School of Medicine, Shanghai Jiao Tong UniversityShanghai, China
| | - Yanan Yin
- Department of Clinical Laboratory, Shanghai General Hospital, School of Medicine, Shanghai Jiao Tong UniversityShanghai, China
| | - Xiaoyuan Sun
- Department of Respiratory Medicine, Shanghai General Hospital, School of Medicine, Shanghai Jiao Tong UniversityShanghai, China
| | - Fengming Ding
- Department of Respiratory Medicine, Shanghai General Hospital, School of Medicine, Shanghai Jiao Tong UniversityShanghai, China
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Computed Tomographic Pulmonary Angiographic Findings Can Predict Short-Term Mortality of Saddle Pulmonary Embolism: A Retrospective Multicenter Study. J Comput Assist Tomogr 2017; 40:327-34. [PMID: 26953764 DOI: 10.1097/rct.0000000000000373] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE In patients with saddle pulmonary embolism (PE), the correlation between computed tomographic pulmonary angiographic (CTPA) findings and short-term outcome remains unclear. The purpose is to determine if CTPA findings predict 1-month mortality of patients with saddle PE. METHODS This is a multicenter, retrospective study of saddle PE. Computed tomographic pulmonary angiographic findings of 115 consecutive patients (male-to-female ratio, 65:50; mean age, 64.3 ± 16.3 years) with saddle PE were evaluated. One-month mortality after diagnosis was the primary end point. RESULTS Twenty-four patients died within 1 month. Among CTPA findings, quantitative parameters including right/left ventricular area ratios (RVa/LVa), right/left atrial diameter ratios, Cobb angle, and Mastora score were significantly enlarged in survivors. Also, qualitative findings including contrast agent reflux into the azygos vein and pericardial effusion were significantly different between survivors and nonsurvivors. Areas under the curve on receiver operating characteristic curves revealed the cutoff values for predicting early mortality of saddle PE using right/left atrial diameter ratios, RVa/LVa, Mastora score, and Cobb angle, respectively, were 2.15, 2.00, 69%, and 58°. Logistic regression analysis suggested that both RVa/LVa (odds ratio, 5.100; P = 0.0004) and Cobb angle (odds ratio, 1.596; P = 0.0321) were independent predictors of early mortality. The combination of RVa/LVa and Cobb angle increased the area under the curve to 0.882, but the difference did not reach significance compared with RVa/LVa or Cobb angle, alone (P > 0.05). CONCLUSION In patients with saddle PE, RVa/LVa and Cobb angle seem valuable in predicting short-term mortality.
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Xu Q, Huang K, Zhai Z, Yang Y, Wang J, Wang C. Initial thrombolysis treatment compared with anticoagulation for acute intermediate-risk pulmonary embolism: a meta-analysis. J Thorac Dis 2015; 7:810-21. [PMID: 26101636 DOI: 10.3978/j.issn.2072-1439.2015.04.51] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2015] [Accepted: 04/16/2015] [Indexed: 01/25/2023]
Abstract
BACKGROUND The use of thrombolysis in patients with acute, intermediate-risk pulmonary embolism (PE) remains controversial. This meta-analysis compared the efficacy and safety of thrombolysis and anticoagulation treatments for intermediate-risk PE patients. METHODS Two investigators independently reviewed the literature and collected data from randomized controlled trials (RCTs) of thrombolysis for intermediate-risk PE in the PubMed, MEDLINE, EMBASE, the Cochrane Library, and Chinese Biomedical Literature Databases (CBM). RESULTS A total of 1,631 intermediate-risk PE patients from seven studies were included. Significant differences were not found regarding the 30-day, all-cause mortality rates between the thrombolytic and anticoagulant groups [odds ratio (OR), 0.60; 95% confident interval (CI), 0.34-1.06; P=0.08]. The rate of clinical deterioration in the thrombolytic group was lower than that in the anticoagulant group (OR, 0.27; 95% CI, 0.18-0.41; P<0.01). Recurrent PE in the thrombolytic group was also significantly lower than that in the anticoagulant group (OR, 0.34; 95% CI, 0.15-0.77; P=0.01). Comparing the thrombolytic and anticoagulation groups, the incidence of minor bleeding was significantly higher in the thrombolytic group (OR, 5.33; 95% CI, 2.85-9.97; P<0.00001), but there were no difference in the incidences of major bleeding events (OR, 2.07; 95% CI, 0.60-7.16; P=0.25). CONCLUSIONS Thrombolytic treatment for intermediate-risk PE patients, if not contraindicated, could reduce clinical deterioration and recurrence of PE, and trends towards a decrease in all-cause, 30-day mortality. Despite thrombolytic treatment having an increased total bleeding risk, there was no difference in the incidence of major bleeding events, compared with patients receiving anticoagulation treatment.
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Affiliation(s)
- Qixia Xu
- 1 Department of Respiratory and Critical Care Medicine, Beijing Institute of Respiratory Medicine, Beijing Chao-Yang Hospital, Capital Medical University, Beijing 100020, China ; 2 Beijing Key Laboratory of Respiratory and Pulmonary Circulation Disorders, Beijing 100069, China ; 3 Department of Respiratory and Critical Care Medicine, The First Affiliated Hospital of Bengbu Medical College, Bengbu 233004, China ; 4 Department of Respiratory and Critical Care Medicine, China-Japan Friendship Hospital, Peking University Health Science Center, Beijing 100029, China ; 5 Department of Physiology, School of Basic Medical Science, Capital Medical University, Beijing 100069, China ; 6 Department of Respiratory Medicine, Capital Medical University, Beijing 100069, China ; 7 China-Japan Friendship Hospital, Beijing 100029, China
| | - Ke Huang
- 1 Department of Respiratory and Critical Care Medicine, Beijing Institute of Respiratory Medicine, Beijing Chao-Yang Hospital, Capital Medical University, Beijing 100020, China ; 2 Beijing Key Laboratory of Respiratory and Pulmonary Circulation Disorders, Beijing 100069, China ; 3 Department of Respiratory and Critical Care Medicine, The First Affiliated Hospital of Bengbu Medical College, Bengbu 233004, China ; 4 Department of Respiratory and Critical Care Medicine, China-Japan Friendship Hospital, Peking University Health Science Center, Beijing 100029, China ; 5 Department of Physiology, School of Basic Medical Science, Capital Medical University, Beijing 100069, China ; 6 Department of Respiratory Medicine, Capital Medical University, Beijing 100069, China ; 7 China-Japan Friendship Hospital, Beijing 100029, China
| | - Zhenguo Zhai
- 1 Department of Respiratory and Critical Care Medicine, Beijing Institute of Respiratory Medicine, Beijing Chao-Yang Hospital, Capital Medical University, Beijing 100020, China ; 2 Beijing Key Laboratory of Respiratory and Pulmonary Circulation Disorders, Beijing 100069, China ; 3 Department of Respiratory and Critical Care Medicine, The First Affiliated Hospital of Bengbu Medical College, Bengbu 233004, China ; 4 Department of Respiratory and Critical Care Medicine, China-Japan Friendship Hospital, Peking University Health Science Center, Beijing 100029, China ; 5 Department of Physiology, School of Basic Medical Science, Capital Medical University, Beijing 100069, China ; 6 Department of Respiratory Medicine, Capital Medical University, Beijing 100069, China ; 7 China-Japan Friendship Hospital, Beijing 100029, China
| | - Yuanhua Yang
- 1 Department of Respiratory and Critical Care Medicine, Beijing Institute of Respiratory Medicine, Beijing Chao-Yang Hospital, Capital Medical University, Beijing 100020, China ; 2 Beijing Key Laboratory of Respiratory and Pulmonary Circulation Disorders, Beijing 100069, China ; 3 Department of Respiratory and Critical Care Medicine, The First Affiliated Hospital of Bengbu Medical College, Bengbu 233004, China ; 4 Department of Respiratory and Critical Care Medicine, China-Japan Friendship Hospital, Peking University Health Science Center, Beijing 100029, China ; 5 Department of Physiology, School of Basic Medical Science, Capital Medical University, Beijing 100069, China ; 6 Department of Respiratory Medicine, Capital Medical University, Beijing 100069, China ; 7 China-Japan Friendship Hospital, Beijing 100029, China
| | - Jun Wang
- 1 Department of Respiratory and Critical Care Medicine, Beijing Institute of Respiratory Medicine, Beijing Chao-Yang Hospital, Capital Medical University, Beijing 100020, China ; 2 Beijing Key Laboratory of Respiratory and Pulmonary Circulation Disorders, Beijing 100069, China ; 3 Department of Respiratory and Critical Care Medicine, The First Affiliated Hospital of Bengbu Medical College, Bengbu 233004, China ; 4 Department of Respiratory and Critical Care Medicine, China-Japan Friendship Hospital, Peking University Health Science Center, Beijing 100029, China ; 5 Department of Physiology, School of Basic Medical Science, Capital Medical University, Beijing 100069, China ; 6 Department of Respiratory Medicine, Capital Medical University, Beijing 100069, China ; 7 China-Japan Friendship Hospital, Beijing 100029, China
| | - Chen Wang
- 1 Department of Respiratory and Critical Care Medicine, Beijing Institute of Respiratory Medicine, Beijing Chao-Yang Hospital, Capital Medical University, Beijing 100020, China ; 2 Beijing Key Laboratory of Respiratory and Pulmonary Circulation Disorders, Beijing 100069, China ; 3 Department of Respiratory and Critical Care Medicine, The First Affiliated Hospital of Bengbu Medical College, Bengbu 233004, China ; 4 Department of Respiratory and Critical Care Medicine, China-Japan Friendship Hospital, Peking University Health Science Center, Beijing 100029, China ; 5 Department of Physiology, School of Basic Medical Science, Capital Medical University, Beijing 100069, China ; 6 Department of Respiratory Medicine, Capital Medical University, Beijing 100069, China ; 7 China-Japan Friendship Hospital, Beijing 100029, China
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Ince O, Altintas N, Findik S, Sariaydin M. Risk stratification in submassive pulmonary embolism via alveolar-arterial oxygen gradient. Hippokratia 2014; 18:333-339. [PMID: 26052200 PMCID: PMC4453807] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
AIM This study investigated the utility of the alveolar-arterial (AaDO2) gradient in predicting the short-term prognosis of submassive pulmonary embolism (PE). MATERIAL AND METHODS This study retrospectively enrolled 124 patients with acute submassive PE. During the first 24 h of admission, all patients had initial artery blood gas collected under room air. Cardiac troponin T (cTn-T) was measured and on spiral computed tomography pulmonary angiography (CTPA) and echocardiography both right ventricle diameter and left ventricle diameter was calculated (RV/LV ratio). Patients who did not have objectively confirmed submassive PE and who had curative anticoagulant treatment for more than 24 hours and had a life expectancy less than 3 months were excluded from the study. RESULTS The best cut-off value for AaDO2 was 42.38 mmHg and using this, fourteen of 15 patients who died had AaO2 ≥ 42.38 and 71 of 109 patients who survived had a AaO2 lower than 42.38 with a sensitivity, specificity and negative predictive value (NPV) for overall deaths were 93.3%, 65.1% and 98.6% respectively. In addition, AaDO2 < 42.38 showed significant survival benefit for overall mortality rates. In this study, having high cTn-T and PaO2/ PaCO2 < 1.83 and pulmonary artery pressure > 47.5 were also an indicator of poor prognosis for patients with submasssive PE. CONCLUSION The AaDO2 measurement is a highly useful and simple measurement for predicting short-term prognosis in patients with submassive PE. It may be used in risk stratification of patients with submassive PE. Aggressive thrombolytic treatment strategies may be considered for patients who have AaO2 < 42.38. Hippokratia 2014; 18 (4): 333-339.
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Affiliation(s)
- O Ince
- Department of Pulmonary Medicine, Faculty of Medicine, 19 Mayis University, Samsun, Turkey
| | - N Altintas
- Department of Pulmonary, Allergy, and Critical Care Medicine, Faculty of medicine, University of Pittsburgh, PA/USA
| | - S Findik
- Department of Pulmonary Medicine, Faculty of Medicine, 19 Mayis University, Samsun, Turkey
| | - M Sariaydin
- Department of Pulmonary Medicine, Faculty of Medicine, 19 Mayis University, Samsun, Turkey
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