1
|
Greco E, Segre E, Melchio M, Labarile G, Lison D, Morello F, Lupia E. Incidence and management of agitation during non-invasive mechanical ventilation outside intensive care units: an observational cohort study in a high dependency unit. Panminerva Med 2024; 66:75-77. [PMID: 37733013 DOI: 10.23736/s0031-0808.23.04958-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/22/2023]
Affiliation(s)
- Elisabetta Greco
- Unit of Emergency Elisabetta Greco, Medicine, Molinette Hospital, AOU Città della Salute e della Scienza, Turin, Italy -
| | - Elisabetta Segre
- Unit of Emergency Elisabetta Greco, Medicine, Molinette Hospital, AOU Città della Salute e della Scienza, Turin, Italy
| | - Monica Melchio
- Unit of Emergency Elisabetta Greco, Medicine, Molinette Hospital, AOU Città della Salute e della Scienza, Turin, Italy
| | - Giulia Labarile
- Unit of Emergency Elisabetta Greco, Medicine, Molinette Hospital, AOU Città della Salute e della Scienza, Turin, Italy
| | - Davide Lison
- Unit of Emergency Elisabetta Greco, Medicine, Molinette Hospital, AOU Città della Salute e della Scienza, Turin, Italy
| | - Fulvio Morello
- Unit of Emergency Elisabetta Greco, Medicine, Molinette Hospital, AOU Città della Salute e della Scienza, Turin, Italy
- Department of Medical Sciences, University of Turin, Turin, Italy
| | - Enrico Lupia
- Unit of Emergency Elisabetta Greco, Medicine, Molinette Hospital, AOU Città della Salute e della Scienza, Turin, Italy
- Department of Medical Sciences, University of Turin, Turin, Italy
| |
Collapse
|
2
|
Morello F, Nazerian P, Lupia E, Castelli M, Mills NL, Mueller C. Biomarkers for diagnosis and prognostication of acute aortic syndromes. Eur Heart J Acute Cardiovasc Care 2024; 13:254-256. [PMID: 38242695 DOI: 10.1093/ehjacc/zuae011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/02/2023] [Accepted: 01/15/2024] [Indexed: 01/21/2024]
Affiliation(s)
- Fulvio Morello
- Dipartimento di Scienze Mediche, Università degli Studi di Torino, C.so Dogliotti 14, 10126 Torino, Italy
- S.C. Medicina d'Urgenza U (MECAU), Ospedale Molinette, Città della Salute e della Scienza di Torino, C.so Bramante 88, 10126 Torino, Italy
| | - Peiman Nazerian
- Department of Emergency Medicine, Azienda Ospedaliero Universitaria Careggi, Firenze, Italy
| | - Enrico Lupia
- S.C. Medicina d'Urgenza U (MECAU), Ospedale Molinette, Città della Salute e della Scienza di Torino, C.so Bramante 88, 10126 Torino, Italy
- Department of Emergency Medicine, Azienda Ospedaliero Universitaria Careggi, Firenze, Italy
| | - Matteo Castelli
- Dipartimento di Scienze Mediche, Università degli Studi di Torino, C.so Dogliotti 14, 10126 Torino, Italy
| | - Nicholas L Mills
- BHF Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, UK
- Usher Institute, University of Edinburgh, Edinburgh, UK
| | - Christian Mueller
- Cardiovascular Research Institute Basel (CRIB) and Department of Cardiology, University Hospital Basel, University of Basel, Basel, Switzerland
| |
Collapse
|
3
|
Battista S, Bima P, Forno D, Luzzi D, Pizzolato E, Ianniello A, Ponzetto F, Rumbolo F, Settanni F, Mengozzi G, Morello F, Lupia E. Plasma soluble suppression of tumorigenesis 2 measured in the emergency department for diagnosis and outcome prediction of sepsis: A single-center prospective study. Clin Chim Acta 2024; 553:117710. [PMID: 38141937 DOI: 10.1016/j.cca.2023.117710] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2023] [Revised: 12/05/2023] [Accepted: 12/11/2023] [Indexed: 12/25/2023]
Abstract
BACKGROUND AND AIMS The diagnostic and prognostic performance of soluble Suppression of Tumorigenicity 2 (sST2) in suspected septic patients presenting to the Emergency Department (ED) is largely unknown. MATERIALS AND METHODS Patients were included in this prospective study if there was high suspicion of sepsis. The plasma level of sST2 was measured during initial ED evaluation. Outcomes were the evaluation of (1) sST2 diagnostic performance (alone and in combination with procalcitonin [PCT]), and (2) sST2 ability to predict 30-day and 90-day all-cause mortality. RESULTS Among 569 patients included, 481 (84.5 %) had sepsis or septic shock. Plasma sST2 levels were more elevated in septic patients (159 [71-331] vs 50 [31-103] ng/mL, P < 0.001). The AUC of sST2 for sepsis diagnosis was lower than the AUC of PCT (0.76 vs 0.85, P = 0.03). The best cut-off for sST2 was 61.7 ng/mL, with a sensitivity of 79.9 % and a specificity of 70.6 %. sST2 was able to correctly reclassify septic patients with PCT <0.5 (NRI 28.9 % [P = 0.02]). sST2 level was an independent predictor of 30-day mortality in a model including clinical variables (aHR 2.03 [1.24-3.33], C-index 0.69). CONCLUSION sST2 could be a useful adjunct in diagnosing sepsis and in all-cause mortality prediction.
Collapse
Affiliation(s)
- Stefania Battista
- Emergency Medicine Unit, "Città della Salute e della Scienza" University Hospital, Turin, Italy
| | - Paolo Bima
- Emergency Medicine Unit, "Città della Salute e della Scienza" University Hospital, Turin, Italy; Department of Medical Sciences, University of Turin, Turin, Italy; Cardiovascular Research Institute Basel, Basel, Switzerland
| | - Daniela Forno
- Emergency Medicine Unit, "Città della Salute e della Scienza" University Hospital, Turin, Italy
| | - Demetrio Luzzi
- Emergency Medicine Unit, "Città della Salute e della Scienza" University Hospital, Turin, Italy
| | - Elisa Pizzolato
- Emergency Medicine Unit, "Città della Salute e della Scienza" University Hospital, Turin, Italy
| | - Alice Ianniello
- Department of Medical Sciences, University of Turin, Turin, Italy; Clinical Biochemistry Unit, "Città della Salute e della Scienza" University Hospital, Turin, Italy
| | - Federico Ponzetto
- Department of Medical Sciences, University of Turin, Turin, Italy; Clinical Biochemistry Unit, "Città della Salute e della Scienza" University Hospital, Turin, Italy
| | - Francesca Rumbolo
- Department of Medical Sciences, University of Turin, Turin, Italy; Clinical Biochemistry Unit, "Città della Salute e della Scienza" University Hospital, Turin, Italy
| | - Fabio Settanni
- Department of Medical Sciences, University of Turin, Turin, Italy; Clinical Biochemistry Unit, "Città della Salute e della Scienza" University Hospital, Turin, Italy
| | - Giulio Mengozzi
- Department of Medical Sciences, University of Turin, Turin, Italy; Clinical Biochemistry Unit, "Città della Salute e della Scienza" University Hospital, Turin, Italy
| | - Fulvio Morello
- Emergency Medicine Unit, "Città della Salute e della Scienza" University Hospital, Turin, Italy; Department of Medical Sciences, University of Turin, Turin, Italy.
| | - Enrico Lupia
- Emergency Medicine Unit, "Città della Salute e della Scienza" University Hospital, Turin, Italy; Department of Medical Sciences, University of Turin, Turin, Italy
| |
Collapse
|
4
|
Baion DE, La Ferrara A, Maserin D, Caprioli S, Albano R, Malara F, Locascio F, Galluzzo E, Luison D, Lombardo M, Navarra R, Calzolari G, Tizzani M, Prisciandaro I, Morello F, Tuttolomondo P, Goffi A, Lupia E, Pivetta E. Mono- and bi-plane sonographic approach for difficult accesses in the emergency department - A randomized trial. Am J Emerg Med 2023; 74:49-56. [PMID: 37774550 DOI: 10.1016/j.ajem.2023.09.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2023] [Revised: 09/14/2023] [Accepted: 09/14/2023] [Indexed: 10/01/2023] Open
Abstract
BACKGROUND The insertion of peripheral intravenous (PIV) catheters is one of the most performed invasive procedures in acute healthcare settings. However, peripheral difficult vascular access (PDVA) is not uncommon and can lead to delays in administering essential medications. Ultrasound (US) has emerged as a valuable tool for facilitating PIV cannulation. Advancements in technology have introduced a technique known as bi-plane imaging, allowing the simultaneous display of both longitudinal and transverse views of vessels. We aimed to investigate whether the utilization of bi-plane imaging, as opposed to the single-plane approach, would yield superior results for PDVA in the emergency department (ED). METHODS This study was a single-center randomized controlled trial. We included adult patients admitted to the ED who required PIV cannulation. Patients were randomly assigned to undergo cannulation using either the mono-plane or bi-plane approach, both performed by skilled providers. The primary outcome of the study was to compare the first attempt success rates between the two techniques. RESULTS A total of 442 patients were enrolled, with 221 undergoing cannulation attempts using the mono-plane approach. Successful placement of a functioning PIV catheter was achieved in a single attempt for 313 out of 442 patients (70.8%). There was no significant difference in the success rates between the two study groups: 68.3% in the mono-plane group and 73.3% in the bi-plane group (p = 0.395). The median time required for a successful attempt differed between the groups, with 45 s (range 18-600) in the mono-plane group and 35 s (range 20-600) in the bi-plane group (p = 0.03). CONCLUSIONS Our study confirms that US is a highly effective tool for facilitating PIV cannulation in patients with PDVA presenting to the ED. However, our investigation into the use of bi-plane imaging did not reveal a significant improvement when compared to mono-plane imaging.
Collapse
Affiliation(s)
- Davide Enrici Baion
- Emergency Department, Città della Salute e della Scienza di Torino, Molinette Hospital, 10126 Turin, Italy
| | - Alberto La Ferrara
- Emergency Department, Città della Salute e della Scienza di Torino, Molinette Hospital, 10126 Turin, Italy
| | - Davide Maserin
- Emergency Department, Città della Salute e della Scienza di Torino, Molinette Hospital, 10126 Turin, Italy
| | - Stefania Caprioli
- Emergency Department, Città della Salute e della Scienza di Torino, Molinette Hospital, 10126 Turin, Italy
| | - Rosina Albano
- High Dependency Unit, Città della Salute e della Scienza di Torino, Molinette Hospital, 10126 Turin, Italy
| | - Francesco Malara
- Emergency Department, Città della Salute e della Scienza di Torino, Molinette Hospital, 10126 Turin, Italy
| | - Francesca Locascio
- Emergency Department, Città della Salute e della Scienza di Torino, Molinette Hospital, 10126 Turin, Italy
| | - Emanuela Galluzzo
- Emergency Department, Città della Salute e della Scienza di Torino, Molinette Hospital, 10126 Turin, Italy
| | - Deborah Luison
- Emergency Department, Città della Salute e della Scienza di Torino, Molinette Hospital, 10126 Turin, Italy
| | - Matteo Lombardo
- Emergency Department, Città della Salute e della Scienza di Torino, Molinette Hospital, 10126 Turin, Italy
| | - Roberta Navarra
- Emergency Department, Città della Salute e della Scienza di Torino, Molinette Hospital, 10126 Turin, Italy
| | - Gilberto Calzolari
- Division of Emergency Medicine and High Dependency Unit, Città della Salute e della Scienza di Torino, Molinette Hospital, 10126 Turin, Italy
| | - Maria Tizzani
- Division of Emergency Medicine and High Dependency Unit, Città della Salute e della Scienza di Torino, Molinette Hospital, 10126 Turin, Italy
| | - Isabella Prisciandaro
- Emergency Department, Città della Salute e della Scienza di Torino, Molinette Hospital, 10126 Turin, Italy
| | - Fulvio Morello
- Division of Emergency Medicine and High Dependency Unit, Città della Salute e della Scienza di Torino, Molinette Hospital, 10126 Turin, Italy; Department of Medical Sciences, University of Turin, 10126, Turin, Italy
| | - Pietro Tuttolomondo
- Emergency Department, Città della Salute e della Scienza di Torino, Molinette Hospital, 10126 Turin, Italy; Department of Healthcare Providers, Città della Salute e della Scienza di Torino, Molinette Hospital, 10126 Turin, Italy
| | - Alberto Goffi
- Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, ON, Canada; Department of Critical Care Medicine, St. Michael's Hospital, Unity Health Toronto, Toronto, ON, Canada
| | - Enrico Lupia
- Division of Emergency Medicine and High Dependency Unit, Città della Salute e della Scienza di Torino, Molinette Hospital, 10126 Turin, Italy; Department of Medical Sciences, University of Turin, 10126, Turin, Italy
| | - Emanuele Pivetta
- Division of Emergency Medicine and High Dependency Unit, Città della Salute e della Scienza di Torino, Molinette Hospital, 10126 Turin, Italy; Department of Medical Sciences, University of Turin, 10126, Turin, Italy.
| |
Collapse
|
5
|
Bima P, Giamello JD, Rubiolo P, Risi F, Balzaretti P, Lauria G, Vallino D, Lupia E, Morello F. Clinical Presentation and Emergency Department Management Checkpoints of Acute Aortic Syndromes during the First Two Waves of the COVID-19 Pandemic. J Clin Med 2023; 12:6601. [PMID: 37892739 PMCID: PMC10607079 DOI: 10.3390/jcm12206601] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2023] [Revised: 10/13/2023] [Accepted: 10/14/2023] [Indexed: 10/29/2023] Open
Abstract
The COVID-19 pandemic has deeply affected the activity and patient flows of Emergency Departments (EDs), and concern for the worsening outcome of cardiovascular emergencies has been raised. However, the impact of COVID-19 on all subtypes of acute aortic syndromes (AASs) has not been evaluated so far. Cases of AASs managed in the ED of three hub hospitals in a large area of Northern Italy were retrospectively analyzed, comparing those registered during the pandemic (March 2020 to May 2021) with corresponding pre-COVID-19 periods. A total of 124 patients with AAS were managed during the COVID-19 period vs. 118 pre-COVID-19 (p = 0.70), despite a -34.6% change in ED visits. Posterior chest pain at presentation was the only clinical variable with a different prevalence (46.0% vs. 32.2%, p = 0.03). Surgery and endovascular treatment rates were unchanged. Time intervals influenced by patient transfer to the hub center were longer during the COVID-19 period and longest during high viral circulation periods. Ninety-day mortality was unchanged, with a higher mortality trend during the pandemic surges. In conclusion, ED presentation and care of AASs were marginally affected by COVID-19, but efforts are needed to preserve efficient patient transfer to specialized centers and prevent mortality, especially during pandemic peaks.
Collapse
Affiliation(s)
- Paolo Bima
- S.C. Medicina d’Urgenza U (MECAU), Ospedale Molinette, A.O.U. Città della Salute e della Scienza, 10126 Torino, Italy; (P.B.); (E.L.)
- Dipartimento di Scienze Mediche, Università degli Studi di Torino, 10126 Torino, Italy; (J.D.G.)
- Cardiovascular Research Institute Basel (CRIB), 4056 Basel, Switzerland
| | - Jacopo Davide Giamello
- Dipartimento di Scienze Mediche, Università degli Studi di Torino, 10126 Torino, Italy; (J.D.G.)
- Medicina d’Urgenza, Ospedale S. Croce e Carle, 12100 Cuneo, Italy
| | - Paolo Rubiolo
- Dipartimento di Scienze Mediche, Università degli Studi di Torino, 10126 Torino, Italy; (J.D.G.)
| | - Francesca Risi
- Dipartimento di Emergenza e Accettazione, Ospedale Mauriziano, 10128 Torino, Italy
| | - Paolo Balzaretti
- Dipartimento di Emergenza e Accettazione, Ospedale Mauriziano, 10128 Torino, Italy
| | - Giuseppe Lauria
- Medicina d’Urgenza, Ospedale S. Croce e Carle, 12100 Cuneo, Italy
| | - Domenico Vallino
- Dipartimento di Emergenza e Accettazione, Ospedale Mauriziano, 10128 Torino, Italy
| | - Enrico Lupia
- S.C. Medicina d’Urgenza U (MECAU), Ospedale Molinette, A.O.U. Città della Salute e della Scienza, 10126 Torino, Italy; (P.B.); (E.L.)
- Dipartimento di Scienze Mediche, Università degli Studi di Torino, 10126 Torino, Italy; (J.D.G.)
| | - Fulvio Morello
- S.C. Medicina d’Urgenza U (MECAU), Ospedale Molinette, A.O.U. Città della Salute e della Scienza, 10126 Torino, Italy; (P.B.); (E.L.)
- Dipartimento di Scienze Mediche, Università degli Studi di Torino, 10126 Torino, Italy; (J.D.G.)
| |
Collapse
|
6
|
Morello F, Pivetta E, Lupia E. Acute heart failure in the emergency department: short stay needs rewiring. Intern Emerg Med 2023; 18:1133-1135. [PMID: 36928498 DOI: 10.1007/s11739-023-03256-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2023] [Accepted: 03/06/2023] [Indexed: 03/18/2023]
Affiliation(s)
- Fulvio Morello
- S.C. Medicina d'Urgenza U, Ospedale Molinette, A.O.U. Città della Salute e della Scienza di Torino, Torino, Italy.
- Dipartimento di Scienze Mediche, Università degli Studi di Torino, Torino, Italy.
| | - Emanuele Pivetta
- S.C. Medicina d'Urgenza U, Ospedale Molinette, A.O.U. Città della Salute e della Scienza di Torino, Torino, Italy
- Dipartimento di Scienze Mediche, Università degli Studi di Torino, Torino, Italy
| | - Enrico Lupia
- S.C. Medicina d'Urgenza U, Ospedale Molinette, A.O.U. Città della Salute e della Scienza di Torino, Torino, Italy
- Dipartimento di Scienze Mediche, Università degli Studi di Torino, Torino, Italy
| |
Collapse
|
7
|
Morello F, Santoro M, Giachino F, Caciolli F, Capretti E, Castelli M, Pivetta E, Nazerian P, Lupia E. Pre-Test Probability Assessment and d-Dimer Based Evaluation in Patients with Previous Acute Aortic Syndrome. Medicina (B Aires) 2023; 59:medicina59030548. [PMID: 36984549 PMCID: PMC10057941 DOI: 10.3390/medicina59030548] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2023] [Revised: 03/03/2023] [Accepted: 03/07/2023] [Indexed: 03/14/2023] Open
Abstract
Background and Objectives. Acute aortic syndromes (AASs) are emergencies burdened by high morbidity and mortality. Guideline-recommended diagnostic workup is based on pre-test probability assessment (PPA) and d-dimer testing. However, the performance of PPA and d-dimer has never been studied in individuals with previous AAS (pAAS), which represent a challenging population. Materials and Methods. We analyzed a registry of patients with pAAS evaluated in two Emergency Departments (EDs) for suspected novel AAS (nAAS). Enrolment criteria were history of pAAS and the presence of truncal pain, syncope or perfusion deficit. All patients underwent advanced imaging. Clinical data were registered prospectively and PPA was performed by applying the aortic dissection detection (ADD) and an aorta simplified (AORTAs) score. Results. A total of 128 patients were enrolled, including 77 patients with previous Stanford type A aortic dissection and 45 patients with previous Stanford type B aortic dissection. The final diagnosis was nAAS in 40 (31%) patients. Clinical variables associated with nAAS were: aortic valve disease, thoracic aortic aneurysm, severe pain, sudden pain, ripping/tearing pain and hypotension/shock. ADD score ≥ 2 had a sensitivity of 65% and a specificity of 83% for nAAS; AORTAs score ≥ 2 had a sensitivity of 48% and a specificity of 88%. d-dimer (cutoff ≥ 500 ng/mL or age-adjusted cutoff) had a sensitivity of 97% and a specificity of 13%/14.7%, for diagnosis of nAAS. Patients that were candidates for guideline-compliant PPA/d-dimer integrated rule-out were: 5 (4.9%) with ADD ≤ 1/d-dimer and 8 (7.8%) with AORTAs ≤ 1/d-dimer < age-adjusted cutoff. None of them had a nAAS. Conclusions. Patients with pAAS evaluated in the ED for red-flag symptoms showed intermediate-to-high pre-test probability of nAAS. The ADD score had lower sensitivity and specificity than in unselected patients. d-dimer, alone and integrated with PPA, was highly sensitive for nAAS, but very unspecific. PPA/d-dimer integrated strategies are unlikely to significantly reduce the number of patients with pAAS undergoing advanced imaging.
Collapse
Affiliation(s)
- Fulvio Morello
- S.C. Medicina d’Urgenza U (MECAU), Ospedale Molinette, A.O.U. Città della Salute e della Scienza, 10126 Torino, Italy
- Dipartimento di Scienze Mediche, Università degli Studi di Torino, 10126 Torino, Italy
- Correspondence: ; Tel.: +39-011-6337009
| | - Marco Santoro
- S.C. Medicina d’Urgenza U (MECAU), Ospedale Molinette, A.O.U. Città della Salute e della Scienza, 10126 Torino, Italy
| | - Francesca Giachino
- S.C. Medicina d’Urgenza U (MECAU), Ospedale Molinette, A.O.U. Città della Salute e della Scienza, 10126 Torino, Italy
| | - Francesca Caciolli
- S.C. Medicina d’Urgenza U (MECAU), Ospedale Molinette, A.O.U. Città della Salute e della Scienza, 10126 Torino, Italy
| | - Elisa Capretti
- Dipartimento di Emergenza e Accettazione, A.O.U. Careggi, 50134 Firenze, Italy
| | - Matteo Castelli
- Dipartimento di Emergenza e Accettazione, A.O.U. Careggi, 50134 Firenze, Italy
| | - Emanuele Pivetta
- S.C. Medicina d’Urgenza U (MECAU), Ospedale Molinette, A.O.U. Città della Salute e della Scienza, 10126 Torino, Italy
- Dipartimento di Scienze Mediche, Università degli Studi di Torino, 10126 Torino, Italy
| | - Peiman Nazerian
- Dipartimento di Emergenza e Accettazione, A.O.U. Careggi, 50134 Firenze, Italy
| | - Enrico Lupia
- S.C. Medicina d’Urgenza U (MECAU), Ospedale Molinette, A.O.U. Città della Salute e della Scienza, 10126 Torino, Italy
- Dipartimento di Scienze Mediche, Università degli Studi di Torino, 10126 Torino, Italy
| |
Collapse
|
8
|
Morello F, Bima P, Giamello JD, Baricocchi D, Risi F, Vesan M, Pivetta EE, de Stefano G, Chiarlo M, Veglia S, Schivazappa G, Mengozzi G, Lauria G, Podio S, Nazerian P, Aprà F, Ferreri E, Lupia E. A 4C mortality score based dichotomic rule supports Emergency Department discharge of COVID-19 patients. Minerva Med 2022; 113:916-926. [PMID: 35191293 DOI: 10.23736/s0026-4806.21.07779-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
BACKGROUND For COVID-19 patients evaluated in the Emergency Department (ED), decision on hospital admission vs. home discharge is challenging. The 4C mortality score (4CMS) is a prognostication tool integrating key demographic/clinical/biochemical data validated for COVID-19 inpatients. We sought to derive and validate a dichotomic rule based on 4CMS identifying patients with mild outcomes, suitable for safe ED discharge. METHODS Derivation was performed in a prospective cohort of ED patients with suspected COVID-19 from two centers (April 2020). Validation was pursued in a prospective multicenter cohort of ED patients with confirmed COVID-19 from 6 centers (October 2020 to January 2021). Chest X-ray (CXR) images were independently scored. The primary composite outcome was all-cause 30-day mortality or hospital admission. Secondary outcomes were ED re-visit, oxygen therapy and ventilation. RESULTS In a derivation cohort of 838 ED patients with suspected COVID-19, 4CMS≤8 was associated with low outpatient mortality (0.4%) and was thus selected as a feasible discharge rule. In a validation cohort of 521 COVID-19 outpatients, the mean age was 51±17 years; 97 (18.6%) patients had ≥1 CXR infiltrate. The 4CMS had an AUC of 0.82 for the primary outcome and 0.93 for mortality, outperforming other scores (CURB-65, qCSI, qSOFA, NEWS) and CXR. In 474 (91%) patients with 4CMS≤8, the mortality rate was 0.2% and the hospital admission rate was 6.8%, versus 12.8% and 36.2% for 4CMS≥9 (P<0.001). CXR did not provide additional discrimination. CONCLUSIONS COVID-19 outpatients with 4CMS≤8 have mild outcomes and can be safely discharged from the ED. [NCT0462918].
Collapse
Affiliation(s)
- Fulvio Morello
- Emergency Medicine U Unit, Molinette Hospital, Città della Salute e della Scienza, Turin, Italy - .,Department of Medical Sciences, University of Turin, Turin, Italy -
| | - Paolo Bima
- School of Emergency Medicine, University of Turin, Turin, Italy.,MeCAU Unit, Maria Vittoria Hospital, Turin, Italy
| | - Jacopo D Giamello
- School of Emergency Medicine, University of Turin, Turin, Italy.,Emergency Medicine Unit, A.O. S. Croce e Carle, Cuneo, Italy
| | - Denise Baricocchi
- School of Emergency Medicine, University of Turin, Turin, Italy.,Emergency Medicine Unit, A.O. Parini, Aosta, Italy
| | - Francesca Risi
- Emergency Medicine U Unit, Molinette Hospital, Città della Salute e della Scienza, Turin, Italy.,School of Emergency Medicine, University of Turin, Turin, Italy
| | - Matteo Vesan
- Emergency Medicine U Unit, Molinette Hospital, Città della Salute e della Scienza, Turin, Italy.,School of Emergency Medicine, University of Turin, Turin, Italy
| | - Emanuele E Pivetta
- Emergency Medicine U Unit, Molinette Hospital, Città della Salute e della Scienza, Turin, Italy
| | | | - Michela Chiarlo
- Emergency Medicine Unit, San Giovanni Bosco Hospital, Turin, Italy
| | - Simona Veglia
- Unit of Radiology2, Molinette Hospital, Città della Salute e della Scienza, Turin, Italy
| | - Giulia Schivazappa
- Unit of Radiology2, Molinette Hospital, Città della Salute e della Scienza, Turin, Italy
| | - Giulio Mengozzi
- Baldi e Riberi Laboratory, Molinette Hospital, Città della Salute e della Scienza, Turin, Italy
| | - Giuseppe Lauria
- Emergency Medicine Unit, A.O. S. Croce e Carle, Cuneo, Italy
| | | | | | - Franco Aprà
- Emergency Medicine Unit, San Giovanni Bosco Hospital, Turin, Italy
| | | | - Enrico Lupia
- Emergency Medicine U Unit, Molinette Hospital, Città della Salute e della Scienza, Turin, Italy.,Department of Medical Sciences, University of Turin, Turin, Italy
| | | |
Collapse
|
9
|
Morello F, Bima P, Castelli M, Nazerian P. Acute aortic syndromes: An internist's guide to the galaxy. Eur J Intern Med 2022; 106:45-53. [PMID: 36229285 DOI: 10.1016/j.ejim.2022.10.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/23/2022] [Revised: 09/05/2022] [Accepted: 10/05/2022] [Indexed: 11/03/2022]
Abstract
Acute aortic syndromes (AASs) are severe conditions defined by dissection, hemorrhage, ulceration or rupture of the thoracic aorta. AASs share etiological and pathophysiological features, including long-term aortic tissue degeneration and mechanisms of acute aortic damage. The clinical signs and symptoms of AASs are unspecific and heterogeneous, requiring large differential diagnosis. When evaluating a patient with AAS-compatible symptoms, physicians need to integrate clinical probability assessment, bedside imaging techniques such as point-of-care ultrasound, and blood test results such as d-dimer. The natural history of AASs is dominated by engagement of ischemic, coagulative and inflammatory pathways at large, causing multiorgan damage. Medical treatment, multiorgan monitoring and outcome prognostication are therefore paramount, with internal medicine playing a key role in non-surgical management of AASs.
Collapse
Affiliation(s)
- Fulvio Morello
- S.C. Medicina d'Urgenza U (MECAU), A.O.U. Città della Salute e della Scienza di Torino, Torino, Italy; Dipartimento di Scienze Mediche, Università degli Studi di Torino, Italy
| | - Paolo Bima
- S.C. Medicina d'Urgenza U (MECAU), A.O.U. Città della Salute e della Scienza di Torino, Torino, Italy; Cardiovascular Research Institute Basel (CRIB), University Hospital Basel, University of Basel, Basel, Switzerland
| | - Matteo Castelli
- Department of Emergency Medicine, Careggi University Hospital, Firenze, Italy
| | - Peiman Nazerian
- Department of Emergency Medicine, Careggi University Hospital, Firenze, Italy.
| |
Collapse
|
10
|
Pivetta E, Ravetti A, Paglietta G, Cara I, Buggè F, Scozzari G, Maule MM, Morello F, Locatelli S, Lupia E. Feasibility of Self-Performed Lung Ultrasound with Remote Teleguidance for Monitoring at Home COVID-19 Patients. Biomedicines 2022; 10:biomedicines10102569. [PMID: 36289831 PMCID: PMC9599353 DOI: 10.3390/biomedicines10102569] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2022] [Revised: 10/06/2022] [Accepted: 10/09/2022] [Indexed: 12/02/2022] Open
Abstract
During the COVID-19 pandemic, use of telemedicine with the aim of reducing the rate of viral transmission increased. This proof-of-concept observational study was planned to test the feasibility of a home-based lung ultrasound (LUS) follow-up performed by patients with mild COVID-19 infection on themselves. We enrolled patients presenting to the emergency department with SARS-CoV-2 infection without signs of pneumonia and indication to discharge. Each patient received a brief training on how to perform LUS and a handheld ultrasound probe. Then, patients were contacted on a daily basis, and LUS images were acquired by the patients themselves under “teleguidance” by the investigator. Twenty-one patients were enrolled with a median age of 44 years. All evaluations were of sufficient quality for a follow up. Probability of a better LUS quality was related to higher degree (odds ratio, OR, 1.42, 95% CI 0.5–3.99) and a lower quality to evaluation time (from 0.71, 95% CI 0.55–0.92 for less than 7 min, to 0.52, 95% CI 0.38–0.7, between 7 and 10 min, and to 0.29, 95% CI 0.2–0.43, for evaluations longer than 10 min). No effect related to gender or age was detected. LUS performed by patients and remotely overseen by expert providers seems to be a feasible and reliable telemedicine tool.
Collapse
Affiliation(s)
- Emanuele Pivetta
- Division of Emergency Medicine and High Dependency Unit, Città della Salute e della Scienza di Torino, Molinette Hospital, 10126 Turin, Italy
- Department of Medical Sciences, University of Turin, 10126 Turin, Italy
- Correspondence:
| | - Anna Ravetti
- Division of Emergency Medicine and High Dependency Unit, Città della Salute e della Scienza di Torino, Molinette Hospital, 10126 Turin, Italy
- Residency Program in Emergency Medicine, University of Turin, 10126 Turin, Italy
| | - Giulia Paglietta
- Division of Emergency Medicine and High Dependency Unit, Città della Salute e della Scienza di Torino, Molinette Hospital, 10126 Turin, Italy
- Residency Program in Emergency Medicine, University of Turin, 10126 Turin, Italy
| | - Irene Cara
- Division of Emergency Medicine and High Dependency Unit, Città della Salute e della Scienza di Torino, Molinette Hospital, 10126 Turin, Italy
- Residency Program in Emergency Medicine, University of Turin, 10126 Turin, Italy
| | - Federico Buggè
- Città di Torino Local Health Unit and Out-of-Hospital Care Special Unit, 10126 Turin, Italy
| | - Gitana Scozzari
- Hospital Medical Direction, Città della Salute e della Scienza di Torino, Molinette Hospital, 10126 Turin, Italy
| | - Milena M. Maule
- Department of Medical Sciences, University of Turin, 10126 Turin, Italy
- Cancer Epidemiology Unit and CPO-Piemonte, Città della Salute e della Scienza di Torino, Molinette Hospital, 10126 Turin, Italy
| | - Fulvio Morello
- Division of Emergency Medicine and High Dependency Unit, Città della Salute e della Scienza di Torino, Molinette Hospital, 10126 Turin, Italy
- Department of Medical Sciences, University of Turin, 10126 Turin, Italy
| | - Stefania Locatelli
- Division of Emergency Medicine and High Dependency Unit, Città della Salute e della Scienza di Torino, Molinette Hospital, 10126 Turin, Italy
| | - Enrico Lupia
- Division of Emergency Medicine and High Dependency Unit, Città della Salute e della Scienza di Torino, Molinette Hospital, 10126 Turin, Italy
- Department of Medical Sciences, University of Turin, 10126 Turin, Italy
| |
Collapse
|
11
|
Lupia E, Capuano M, Vizio B, Schiavello M, Bosco O, Gelardi M, Favale E, Pivetta E, Morello F, Husain S, Keshavjee S, Del Sorbo L, Montrucchio G. Thrombopoietin participates in platelet activation in COVID-19 patients. EBioMedicine 2022; 85:104305. [PMID: 36242922 PMCID: PMC9556163 DOI: 10.1016/j.ebiom.2022.104305] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2021] [Revised: 08/24/2022] [Accepted: 09/28/2022] [Indexed: 10/25/2022] Open
Abstract
BACKGROUND The pathogenesis of coronavirus disease 2019 (COVID-19) is characterized by enhanced platelet activation and diffuse hemostatic alterations, which may contribute to immunothrombosis/thromboinflammation and subsequent development of target-organ damage. Thrombopoietin (THPO), a growth factor essential to megakariocyte proliferation, is known to prime platelet activation and leukocyte-platelet interaction. In addition, THPO concentrations increase in several critical diseases, such as acute cardiac ischemia and sepsis, thus representing a potential diagnostic and prognostic biomarker. Furthermore, several data suggest that interleukin (IL)-6 is one of the most important inflammatory mediators involved in these phenomena, which led to explore the potential therapeutic role of IL-6 inhibitors. In this prospective cohort study, we aimed to study THPO and IL-6 concentrations in COVID-19 patients at the time of first clinical evaluation in the Emergency Department (ED), and to investigate their potential use as diagnostic and prognostic biomarkers. In addition, we sought to explore the role of THPO contained in plasma samples obtained from COVID-19 patients in priming in vitro platelet activation and leukocyte-platelet interaction. METHODS We enrolled 66 patients presenting to the ED with symptoms suggestive of COVID-19, including 47 with confirmed COVID-19 and 19 in whom COVID-19 was excluded (Non-COVID-19 patients). As controls, we also recruited 18 healthy subjects. In vitro, we reproduced the effects of increased circulating THPO on platelet function by adding plasma from COVID-19 patients or controls to platelet-rich plasma or whole blood obtained by healthy donors, and we indirectly studied the effect of THPO on platelet activation by blocking its biological activity. FINDINGS THPO levels were higher in COVID-19 patients than in both Non-COVID-19 patients and healthy subjects. Studying THPO as diagnostic marker for the diagnosis of COVID-19 by receiver-operating-characteristic (ROC) statistics, we found an area under the curve (AUC) of 0.73, with an optimal cut-off value of 42.60 pg/mL. IL-6 was higher in COVID-19 patients than in healthy subjects, but did not differ between COVID-19 and Non-COVID-19 patients. THPO concentrations measured at the time of diagnosis in the ED were also higher in COVID-19 patients subsequently developing a severe disease than in those with mild disease. Evaluating THPO as biomarker for severe COVID-19 using ROC analysis, we found an AUC of 0.71, with an optimal cut-off value of 57.11 pg/mL. IL-6 was also higher in severe than in mild COVID-19 patients, with an AUC for severe COVID-19 of 0.83 and an optimal cut-off value of 23 pg/ml. THPO concentrations correlated with those of IL-6 (r=0.2963; p=0.043), and decreased 24 h after the administration of tocilizumab, an IL-6 receptor blocking antibody, showing that the increase of THPO levels depends on IL-6-stimulated hepatic synthesis. In vitro, plasma obtained from COVID-19 patients, but not from healthy subjects, primed platelet aggregation and leukocyte-platelet binding, and these effects were reduced by inhibiting THPO activity. INTERPRETATION Increased THPO may be proposed as an early biomarker for the diagnosis of COVID-19 and for the identification of patients at risk of developing critical illness. Elevated THPO may contribute to enhance platelet activation and leukocyte-platelet interaction in COVID-19 patients, thus potentially participating in immunothrombosis/thromboinflammation. FUNDING This work was supported by Ministero dell'Università e della Ricerca Scientifica e Tecnologica (MURST) ex 60% to GM and EL.
Collapse
Affiliation(s)
- Enrico Lupia
- Department of Medical Sciences, University of Turin, Turin, Italy,Emergency Medicine Unit, “Città della Salute e della Scienza di Torino - Molinette” University Hospital, Turin, Italy,Corresponding author at: Department of Medical Sciences, University of Turin, via Genova 3, 10126 Turin, Italy.
| | - Marialessia Capuano
- Department of Medical Sciences, University of Turin, Turin, Italy,Emergency Medicine Unit, “Città della Salute e della Scienza di Torino - Molinette” University Hospital, Turin, Italy,School of Specialization in Emergency Medicine, University of Turin, Turin, Italy
| | - Barbara Vizio
- Department of Medical Sciences, University of Turin, Turin, Italy
| | | | - Ornella Bosco
- Department of Medical Sciences, University of Turin, Turin, Italy
| | - Maria Gelardi
- Department of Medical Sciences, University of Turin, Turin, Italy,Emergency Medicine Unit, “Città della Salute e della Scienza di Torino - Molinette” University Hospital, Turin, Italy,School of Specialization in Emergency Medicine, University of Turin, Turin, Italy
| | - Edoardo Favale
- School of Specialization in Internal Medicine, University of Turin, Turin, Italy
| | - Emanuele Pivetta
- Department of Medical Sciences, University of Turin, Turin, Italy,School of Specialization in Internal Medicine, University of Turin, Turin, Italy
| | - Fulvio Morello
- Department of Medical Sciences, University of Turin, Turin, Italy,Emergency Medicine Unit, “Città della Salute e della Scienza di Torino - Molinette” University Hospital, Turin, Italy
| | - Shahid Husain
- University Health Network, Toronto General Hospital, University of Toronto, Toronto, ON, Canada
| | - Shaf Keshavjee
- University Health Network, Toronto General Hospital, University of Toronto, Toronto, ON, Canada
| | - Lorenzo Del Sorbo
- University Health Network, Toronto General Hospital, University of Toronto, Toronto, ON, Canada
| | | |
Collapse
|
12
|
Bima P, Orlotti C, Smart OG, Morello F, Trunfio M, Brazzi L, Montrucchio G. Norepinephrine may improve survival of septic shock patients in a low-resource setting: a proof-of-concept study on feasibility and efficacy outside the Intensive Care Unit. Pathog Glob Health 2022; 116:389-394. [PMID: 35138990 PMCID: PMC9387336 DOI: 10.1080/20477724.2022.2038051] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Septic shock treatment in sub-Saharan African hospitals is challenging due to limited availability of ICUs, central venous catheters, vasopressors, and trained staff. We designed this proof-of-concept study to determine efficacy, safety, and feasibility of norepinephrine (NE) use in a non-intensive setting in a low-resource country, consisting in a peripheral infusion via a mechanical drop counter. Septic shock patients accessing a rural hospital in Uganda were included: the 2020 group (N = 12) was prospectively enrolled (Jan-Mar 2020) when NE was available; the 2019 group (N = 11) was retrospectively enrolled (Oct-Dec 2019). Enrollment was continuous to reduce selection bias. Basic clinical endpoints (noninvasive blood pressure, tissue perfusion, diuresis) defined shock control and the prognostic endpoint was survival at hospital discharge. Shock control at 6 and 12 hours was higher in the 2020 group (p = 0.012 for both). Survival at hospital discharge was 75% and 27.3%, respectively (p = 0.039). NE infusion was associated with a Hazard Ratio of 0.23 (p = 0.041) in a multivariate Cox model. No NE-induced adverse effects were detected. These preliminary results suggest that implementing NE infusion in a low-resource setting without ICU could be a safe and effective strategy in managing septic shock and that this approach could lead to a lower mortality rate.
Collapse
Affiliation(s)
- Paolo Bima
- S.C. Medicina d’Urgenza U, Molinette Hospital, A.O.U. Città Della Salute e della Scienza, Torino, Italy,Scuola di Specializzazione in Medicina d’Emergenza-Urgenza, University of Torino, Torino, Italy,CONTACT Paolo Bima S.C. Medicina d’Urgenza U, Molinette Hospital, A.O.U. Città Della Salute e della Scienza, C.so Bramante 88, Torino10126, Italy
| | | | | | - Fulvio Morello
- S.C. Medicina d’Urgenza U, Molinette Hospital, A.O.U. Città Della Salute e della Scienza, Torino, Italy,Department of Medical Sciences, Università degli Studi di Torino, Torino, Italy
| | - Mattia Trunfio
- Infectious Diseases Unit, Department of Medical Sciences, University of Torino, Amedeo di Savoia Hospital, Torino, Italy
| | - Luca Brazzi
- Anestesia e Rianimazione 1U, Department of Anesthesia, Intensive Care and Emergency, A.O.U. Città della Salute e della Scienza, Torino, Italy,Department of Surgical Sciences, University of Torino, Italy
| | - Giorgia Montrucchio
- Anestesia e Rianimazione 1U, Department of Anesthesia, Intensive Care and Emergency, A.O.U. Città della Salute e della Scienza, Torino, Italy,Department of Surgical Sciences, University of Torino, Italy
| |
Collapse
|
13
|
Pivetta E, Moretto F, Masellis S, Manasievska M, Tizzani M, Dipaola F, Bovaro F, Masoero M, Ferrera P, Morello F, Maule MM, Lupia E. Comparison between standard and ultrasound-integrated approach for risk stratification of syncope in the emergency department. Intern Emerg Med 2022; 17:1191-1198. [PMID: 35064436 DOI: 10.1007/s11739-021-02909-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2021] [Accepted: 12/08/2021] [Indexed: 11/05/2022]
Abstract
This prospective cohort enrolled all patients above 16 years of age presenting to the in the emergency department (ED) for a reported syncope was designed to test the accuracy of a point-of-care ultrasound (POCUS) integrated approach in risk stratification. The emergency physician responsible for the patient care was asked to classify the syncope risk after the initial clinical assessment and after performing POCUS evaluation. All risk group definitions were based on the 2018 European Society of Cardiology guidelines. Thirty days after the index event, all participants were followed up to assess the frequency of short-term serious outcomes as defined in the San Francisco Syncope Rule (SFSR) cohorts. We estimated the accuracy of clinical and POCUS-integrated evaluation in predicting SFSR outcomes. Between February 2016 and January 2018, 196 patients were enrolled [109 women (55.6%)]. Median age was 64 years (interquartile range 31 years). After a follow-up of 30 days, 19 patients experienced 20 SFSR outcomes. Positive and negative likelihood ratios were 1.73 (95% CI 0.87-3.44) and 0.84 (95% CI 0.62-1.12) for the clinical evaluation, and 5.93 (95% CI 2.83-12.5) and 0.63 (95% CI 0.45-0.9) for the POCUS-integrated evaluation. The POCUS-integrated approach would reduce the diagnostic error of the clinical evaluation by 4.5 cases/100 patients. This cohort study suggested that the integration of the clinical assessment with POCUS results in patients presenting to the ED for non-high-risk syncope may increase the accuracy of predicting the risk of SFSR outcomes and the usefulness of the clinical assessment alone.
Collapse
Affiliation(s)
- Emanuele Pivetta
- Division of Emergency Medicine and High Dependency Unit, Città della Salute e della Scienza di Torino, Turin, Italy.
| | - Francesca Moretto
- Residency Program in Internal Medicine, University of Turin, Turin, Italy
| | | | - Milena Manasievska
- PhD Program in Experimental Medicine and Therapy, University of Turin, Turin, Italy
| | - Maria Tizzani
- Division of Emergency Medicine and High Dependency Unit, Città della Salute e della Scienza di Torino, Turin, Italy
| | - Franca Dipaola
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy
- Internal Medicine, Humanitas Clinical and Research Center, IRCCS, Rozzano, Milan, Italy
| | - Federica Bovaro
- Residency Program in Emergency Medicine, University of Turin, Turin, Italy
| | - Monica Masoero
- Division of Emergency Medicine and High Dependency Unit, Città della Salute e della Scienza di Torino, Turin, Italy
| | - Patrizia Ferrera
- Division of Emergency Medicine and High Dependency Unit, Città della Salute e della Scienza di Torino, Turin, Italy
| | - Fulvio Morello
- Division of Emergency Medicine and High Dependency Unit, Città della Salute e della Scienza di Torino, Turin, Italy
- Deparment of Medical Sciences, University of Turin, Turin, Italy
| | - Milena M Maule
- Deparment of Medical Sciences, University of Turin, Turin, Italy
- Cancer Epidemiology Unit and CPO Piemonte, Città della Salute e della Scienza di Torino, Turin, Italy
| | - Enrico Lupia
- Division of Emergency Medicine and High Dependency Unit, Città della Salute e della Scienza di Torino, Turin, Italy
- Deparment of Medical Sciences, University of Turin, Turin, Italy
| |
Collapse
|
14
|
Bima P, Montrucchio G, Caramello V, Rumbolo F, Dutto S, Boasso S, Ferraro A, Brazzi L, Lupia E, Boccuzzi A, Mengozzi G, Morello F, Battista S. Prognostic Value of Mid-Regional Proadrenomedullin Sampled at Presentation and after 72 Hours in Septic Patients Presenting to the Emergency Department: An Observational Two-Center Study. Biomedicines 2022; 10:biomedicines10030719. [PMID: 35327521 PMCID: PMC8945269 DOI: 10.3390/biomedicines10030719] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2022] [Revised: 03/15/2022] [Accepted: 03/16/2022] [Indexed: 02/04/2023] Open
Abstract
The prognostic value of mid-regional proADM (MR-proADM) in septic patients presenting to the emergency department (ED) is not well established. In this prospective observational study enrolling septic patients evaluated in two EDs, MR-proADM was measured at arrival (t0) and after 72 h (t72). MR-proADM%change was calculated as follows: (MR-proADMt72h − MR-proADMt0)/MR-proADMt0. In total, 147 patients were included in the study, including 109 with a final diagnosis of sepsis and 38 with septic shock, according to the Sepsis-3 criteria. The overall 28-day mortality (outcome) rate was 12.9%. The AUC for outcome prognostication was 0.66 (95% CI 0.51–0.80) for MR-proADMt0, 0.77 (95% CI 0.63–0.92) for MR-proADMt72 and 0.74 (95% CI 0.64–0.84) for MR-proADM%change. MR-proADMt0 ≥ 2.78 nmol/L, MR-proADMt72 ≥ 2.7 nmol/L and MR-proADM%change ≥ −15.2% showed statistically significant log-rank test results and sensitivity/specificity of 81/65%, 69/80% and 75/70% respectively. In regression analysis, MR-proADM%change was a significant outcome predictor both in univariate and multivariate analysis, after adjustment for age, SOFA and APACHEII scores, providing up to 80% of added prognostic value. In conclusion, time trends of MR-proADM may provide additional insights for patient risk stratification over single sampling. MR-proADM levels sampled both at presentation and after 72 h predicted 28-day survival in septic patients presenting to the ED.
Collapse
Affiliation(s)
- Paolo Bima
- S.C. Medicina d’Urgenza U (MECAU), Ospedale Molinette, A.O.U Città della Salute e della Scienza di Torino, 10126 Torino, Italy; (P.B.); (S.D.); (S.B.); (E.L.); (S.B.)
- Scuola di Specializzazione in Medicina di Emergenza e Urgenza, 10126 Torino, Italy
| | - Giorgia Montrucchio
- S.C. Anestesia e Rianimazione 1U, Dipartimento di Anestesia, Terapia Intensiva ed Emergenza, Ospedale Molinette, A.O.U Città della Salute e della Scienza di Torino, 10126 Torino, Italy; (G.M.); (L.B.)
- Dipartimento di Scienze Chirurgiche, Università degli Studi di Torino, 10126 Torino, Italy; (A.F.); (A.B.)
| | - Valeria Caramello
- S.C. Medicina d’Urgenza, A.O.U. San Luigi Gonzaga, 10043 Orbassano, Italy;
| | - Francesca Rumbolo
- S.C. Biochimica Clinica, A.O.U Città Della Salute e Della Scienza, 10126 Torino, Italy; (F.R.); (G.M.)
| | - Stefania Dutto
- S.C. Medicina d’Urgenza U (MECAU), Ospedale Molinette, A.O.U Città della Salute e della Scienza di Torino, 10126 Torino, Italy; (P.B.); (S.D.); (S.B.); (E.L.); (S.B.)
- Scuola di Specializzazione in Medicina di Emergenza e Urgenza, 10126 Torino, Italy
| | - Sarah Boasso
- S.C. Medicina d’Urgenza U (MECAU), Ospedale Molinette, A.O.U Città della Salute e della Scienza di Torino, 10126 Torino, Italy; (P.B.); (S.D.); (S.B.); (E.L.); (S.B.)
| | - Anita Ferraro
- Dipartimento di Scienze Chirurgiche, Università degli Studi di Torino, 10126 Torino, Italy; (A.F.); (A.B.)
| | - Luca Brazzi
- S.C. Anestesia e Rianimazione 1U, Dipartimento di Anestesia, Terapia Intensiva ed Emergenza, Ospedale Molinette, A.O.U Città della Salute e della Scienza di Torino, 10126 Torino, Italy; (G.M.); (L.B.)
| | - Enrico Lupia
- S.C. Medicina d’Urgenza U (MECAU), Ospedale Molinette, A.O.U Città della Salute e della Scienza di Torino, 10126 Torino, Italy; (P.B.); (S.D.); (S.B.); (E.L.); (S.B.)
- Dipartimento di Scienze Mediche, Università degli Studi di Torino, C.so Bramante 88, 10126 Torino, Italy
| | - Adriana Boccuzzi
- Dipartimento di Scienze Chirurgiche, Università degli Studi di Torino, 10126 Torino, Italy; (A.F.); (A.B.)
| | - Giulio Mengozzi
- S.C. Biochimica Clinica, A.O.U Città Della Salute e Della Scienza, 10126 Torino, Italy; (F.R.); (G.M.)
- Dipartimento di Scienze Mediche, Università degli Studi di Torino, C.so Bramante 88, 10126 Torino, Italy
| | - Fulvio Morello
- S.C. Medicina d’Urgenza U (MECAU), Ospedale Molinette, A.O.U Città della Salute e della Scienza di Torino, 10126 Torino, Italy; (P.B.); (S.D.); (S.B.); (E.L.); (S.B.)
- Dipartimento di Scienze Mediche, Università degli Studi di Torino, C.so Bramante 88, 10126 Torino, Italy
- Correspondence: ; Tel.: +39-011-6337122
| | - Stefania Battista
- S.C. Medicina d’Urgenza U (MECAU), Ospedale Molinette, A.O.U Città della Salute e della Scienza di Torino, 10126 Torino, Italy; (P.B.); (S.D.); (S.B.); (E.L.); (S.B.)
| |
Collapse
|
15
|
Ascione G, Morello F, Bonaccorsi L, Ranaldi F, Santosuosso U, Nazerian P. History taking for suspected acute aortic syndrome: other predictors outside the aortic dissection detection risk score bundle? Intern Emerg Med 2021; 16:2307-2308. [PMID: 34115288 DOI: 10.1007/s11739-021-02785-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/26/2021] [Accepted: 05/31/2021] [Indexed: 10/21/2022]
Affiliation(s)
- Giovanni Ascione
- Department of Emergency Medicine, Careggi University Hospital, largo Brambilla 3, 50134, Firenze, Italy
| | - Fulvio Morello
- S.C. Medicina d'Urgenza, Ospedale Molinette, A.O.U. Città della Salute e della Scienza di Torino, Torino, Italy
- Department of Medical Sciences, University of Turin, Turin, Italy
| | - Lorella Bonaccorsi
- Department of Clinical and Experimental Medicine, University of Firenze, Firenze, Italy
| | - Francesco Ranaldi
- Department of Clinical and Experimental Medicine, University of Firenze, Firenze, Italy
| | - Ugo Santosuosso
- Department of Clinical and Experimental Medicine, University of Firenze, Firenze, Italy
| | - Peiman Nazerian
- Department of Emergency Medicine, Careggi University Hospital, largo Brambilla 3, 50134, Firenze, Italy.
| |
Collapse
|
16
|
Nazerian P, Ascione G, Castelli M, Capretti E, Ranaldi F, Bonaccorsi L, Santosuosso U, Grifoni S, Morello F. Additional risk factors for evaluation of suspected acute aortic syndromes in the emergency department. Acad Emerg Med 2021; 28:1177-1178. [PMID: 33615600 DOI: 10.1111/acem.14238] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2020] [Revised: 02/08/2021] [Accepted: 02/19/2021] [Indexed: 01/16/2023]
Affiliation(s)
- Peiman Nazerian
- Department of Emergency Medicine Careggi University Hospital Firenze Italy
| | - Giovanni Ascione
- Department of Emergency Medicine Careggi University Hospital Firenze Italy
| | - Matteo Castelli
- Department of Emergency Medicine Careggi University Hospital Firenze Italy
| | - Elisa Capretti
- Department of Emergency Medicine Careggi University Hospital Firenze Italy
| | - Francesco Ranaldi
- Department of Clinical and Experimental Medicine Università degli Studi di Firenze Firenze Italy
| | - Lorella Bonaccorsi
- Department of Clinical and Experimental Medicine Università degli Studi di Firenze Firenze Italy
| | - Ugo Santosuosso
- Department of Clinical and Experimental Medicine Università degli Studi di Firenze Firenze Italy
| | - Stefano Grifoni
- Department of Emergency Medicine Careggi University Hospital Firenze Italy
| | - Fulvio Morello
- S.C. Medicina d’Urgenza Department of Emergency Medicine A.O.U. Città della Salute e della Scienza di TorinoMolinette Hospital Torino Italy
- Department of Medical Sciences University of Turin Turin Italy
| |
Collapse
|
17
|
Morello F, Bima P, Ferreri E, Chiarlo M, Balzaretti P, Tirabassi G, Petitti P, Aprà F, Vallino D, Carbone G, Pivetta EE, Lupia E. After the first wave and beyond lockdown: long-lasting changes in emergency department visit number, characteristics, diagnoses, and hospital admissions. Intern Emerg Med 2021; 16:1683-1690. [PMID: 33683538 PMCID: PMC7938273 DOI: 10.1007/s11739-021-02667-2] [Citation(s) in RCA: 25] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/03/2020] [Accepted: 02/08/2021] [Indexed: 11/21/2022]
Abstract
The first wave (FW) of COVID-19 led to a rapid reduction in total emergency department (ED) visits and hospital admissions for other diseases. Whether this represented a transient "lockdown and fear" phenomenon, or a more persisting trend, is unknown. We divided acute from post-wave changes in ED flows, diagnoses, and hospital admissions, in an Italian city experiencing a FW peak followed by nadir. This multicenter, retrospective, cross-sectional study involved five general EDs of a large Italian city (January-August 2020). Percent changes were calculated versus 2019, using four 14-day periods (FW peak, early/mid/late post-wave). ED visits were 147,446 in 2020, versus 214,868 in 2019. During the FW peak, visits were reduced by 66.4% (P < 0.001). The drop was maximum during daytime (69.8%) and for pediatric patients (89.4%). Critical triage codes were unchanged. Reductions were found for all non-COVID-19 diagnoses. Non-COVID-19 hospital admissions were reduced by 39.5% (P < 0.001), involving all conditions except hematologic, metabolic/endocrine, respiratory diseases, and traumas. In the early, mid, and late post-wave periods, visits were reduced by 25.4%, 25.3% and 23.5% (all P < 0.001) respectively. In the late period, reduction was greater for female (27.9%) and pediatric patients (44.6%). Most critical triage codes were unchanged. Oncological, metabolic/endocrine, and hematological diagnoses were unchanged, while other diagnoses had persistent reductions. Non-COVID-19 hospital admissions were reduced by 12.8% (P = 0.001), 6.3% (P = 0.1) and 12.2% (P = 0.001), respectively. Reductions in ED flows, led by non-critical codes, persisted throughout the summer nadir of COVID-19. Hospital admissions for non-COVID-19 diseases had transient changes.
Collapse
Affiliation(s)
- Fulvio Morello
- S.C. Medicina d'Urgenza U, Ospedale Molinette, A.O.U. Città della Salute e della Scienza and Università degli Studi di Torino, C.so Bramante 88, 10126, Torino, Italy.
- Dipartimento di Scienze Mediche, Università degli Studi di Torino, Torino, Italy.
| | - Paolo Bima
- S.C. Medicina d'Urgenza U, Ospedale Molinette, A.O.U. Città della Salute e della Scienza and Università degli Studi di Torino, C.so Bramante 88, 10126, Torino, Italy
- Scuola di Specializzazione in Medicina d'Emergenza-Urgenza, Università degli Studi di Torino, Torino, Italy
| | - Enrico Ferreri
- Medicina e Chirurgia d'Accettazione e d'Urgenza, Ospedale Maria Vittoria, Torino, Italy
| | - Michela Chiarlo
- Medicina e Chirurgia d'Accettazione e d'Urgenza, Ospedale San Giovanni Bosco, Torino, Italy
| | - Paolo Balzaretti
- S.C. Medicina e Chirurgia d'Accettazione e d'Urgenza, A.O. Ordine Mauriziano, Torino, Italy
| | - Gloria Tirabassi
- S.C. Medicina e Chirurgia d'Accettazione e d'Urgenza, Humanitas, Torino, Italy
- Scuola di Specializzazione in Medicina d'Emergenza-Urgenza, Humanitas University, Pieve Emanuele, Milano, Italy
| | - Paolo Petitti
- Medicina e Chirurgia d'Accettazione e d'Urgenza, Ospedale Maria Vittoria, Torino, Italy
| | - Franco Aprà
- Medicina e Chirurgia d'Accettazione e d'Urgenza, Ospedale San Giovanni Bosco, Torino, Italy
| | - Domenico Vallino
- S.C. Medicina e Chirurgia d'Accettazione e d'Urgenza, A.O. Ordine Mauriziano, Torino, Italy
| | - Giorgio Carbone
- S.C. Medicina e Chirurgia d'Accettazione e d'Urgenza, Humanitas, Torino, Italy
| | - Emanuele Emilio Pivetta
- S.C. Medicina d'Urgenza U, Ospedale Molinette, A.O.U. Città della Salute e della Scienza and Università degli Studi di Torino, C.so Bramante 88, 10126, Torino, Italy
| | - Enrico Lupia
- S.C. Medicina d'Urgenza U, Ospedale Molinette, A.O.U. Città della Salute e della Scienza and Università degli Studi di Torino, C.so Bramante 88, 10126, Torino, Italy
- Dipartimento di Scienze Mediche, Università degli Studi di Torino, Torino, Italy
| |
Collapse
|
18
|
Pivetta E, Goffi A, Tizzani M, Locatelli SM, Porrino G, Losano I, Leone D, Calzolari G, Vesan M, Steri F, Ardito A, Capuano M, Gelardi M, Silvestri G, Dutto S, Avolio M, Cavallo R, Bartalucci A, Paglieri C, Morello F, Richiardi L, Maule MM, Lupia E. Lung Ultrasonography for the Diagnosis of SARS-CoV-2 Pneumonia in the Emergency Department. Ann Emerg Med 2021; 77:385-394. [PMID: 33461884 PMCID: PMC7552969 DOI: 10.1016/j.annemergmed.2020.10.008] [Citation(s) in RCA: 42] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2020] [Revised: 09/28/2020] [Accepted: 10/06/2020] [Indexed: 12/17/2022]
Abstract
STUDY OBJECTIVE Accurate diagnostic testing to identify severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection is critical. Although highly specific, SARS-CoV-2 reverse transcriptase-polymerase chain reaction (RT-PCR) has been shown in clinical practice to be affected by a noninsignificant proportion of false-negative results. This study seeks to explore whether the integration of lung ultrasonography with clinical evaluation is associated with increased sensitivity for the diagnosis of coronavirus disease 2019 pneumonia, and therefore may facilitate the identification of false-negative SARS-CoV-2 RT-PCR results. METHODS This prospective cohort study enrolled consecutive adult patients with symptoms potentially related to SARS-CoV-2 infection who were admitted to the emergency department (ED) of an Italian academic hospital. Immediately after the initial assessment, a lung ultrasonographic evaluation was performed and the likelihood of SARS-CoV-2 infection, based on both clinical and lung ultrasonographic findings ("integrated" assessment), was recorded. RT-PCR SARS-CoV-2 detection was subsequently performed. RESULTS We enrolled 228 patients; 107 (46.9%) had SARS-CoV-2 infection. Sensitivity and negative predictive value of the clinical-lung ultrasonographic integrated assessment were higher than first RT-PCR result (94.4% [95% confidence interval {CI} 88.2% to 97.9%] versus 80.4% [95% CI 71.6% to 87.4%] and 95% [95% CI 89.5% to 98.2%] versus 85.2% [95% CI 78.3% to 90.6%], respectively). Among the 142 patients who initially had negative RT-PCR results, 21 tested positive at a subsequent molecular test performed within 72 hours. All these false-negative cases were correctly identified by the integrated assessment. CONCLUSION This study suggests that, in patients presenting to the ED with symptoms commonly associated with SARS-CoV-2 infection, the integration of lung ultrasonography with clinical evaluation has high sensitivity and specificity for coronavirus disease 2019 pneumonia and it may help to identify false-negative results occurring with RT-PCR.
Collapse
Affiliation(s)
- Emanuele Pivetta
- Division of Emergency Medicine and High Dependency Unit, AOU Città della Salute e della Scienza di Torino, Molinette Hospital, Turin, Italy.
| | - Alberto Goffi
- Li Ka Shing Knowledge Institute, Department of Critical Care Medicine, St. Michael's Hospital, Unity Health Toronto, Toronto, Ontario, Canada; Department of Medicine and Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Maria Tizzani
- Division of Emergency Medicine and High Dependency Unit, AOU Città della Salute e della Scienza di Torino, Molinette Hospital, Turin, Italy
| | - Stefania M Locatelli
- Division of Emergency Medicine and High Dependency Unit, AOU Città della Salute e della Scienza di Torino, Molinette Hospital, Turin, Italy
| | - Giulio Porrino
- Division of Emergency Medicine and High Dependency Unit, AOU Città della Salute e della Scienza di Torino, Molinette Hospital, Turin, Italy
| | - Isabel Losano
- Division of Emergency Medicine and High Dependency Unit, AOU Città della Salute e della Scienza di Torino, Molinette Hospital, Turin, Italy
| | - Dario Leone
- Division of Emergency Medicine and High Dependency Unit, AOU Città della Salute e della Scienza di Torino, Molinette Hospital, Turin, Italy
| | - Gilberto Calzolari
- Division of Emergency Medicine and High Dependency Unit, AOU Città della Salute e della Scienza di Torino, Molinette Hospital, Turin, Italy
| | - Matteo Vesan
- Division of Emergency Medicine and High Dependency Unit, AOU Città della Salute e della Scienza di Torino, Molinette Hospital, Turin, Italy
| | - Fabio Steri
- Division of Emergency Medicine and High Dependency Unit, AOU Città della Salute e della Scienza di Torino, Molinette Hospital, Turin, Italy
| | - Arianna Ardito
- Division of Emergency Medicine and High Dependency Unit, AOU Città della Salute e della Scienza di Torino, Molinette Hospital, Turin, Italy
| | | | - Maria Gelardi
- Residency Program in Emergency Medicine, University of Turin, Turin, Italy
| | - Giulia Silvestri
- Residency Program in Emergency Medicine, University of Turin, Turin, Italy
| | - Stefania Dutto
- Residency Program in Emergency Medicine, University of Turin, Turin, Italy
| | - Maria Avolio
- Clinical Microbiology, AOU Città della Salute e della Scienza di Torino, Molinette Hospital, Turin, Italy
| | - Rossana Cavallo
- Clinical Microbiology, AOU Città della Salute e della Scienza di Torino, Molinette Hospital, Turin, Italy; Department of Medical Sciences, University of Turin, Turin, Italy
| | - Alice Bartalucci
- Division of Emergency Medicine and High Dependency Unit, AOU Città della Salute e della Scienza di Torino, Molinette Hospital, Turin, Italy
| | - Cristina Paglieri
- Division of Emergency Medicine and High Dependency Unit, AOU Città della Salute e della Scienza di Torino, Molinette Hospital, Turin, Italy
| | - Fulvio Morello
- Division of Emergency Medicine and High Dependency Unit, AOU Città della Salute e della Scienza di Torino, Molinette Hospital, Turin, Italy; Department of Medical Sciences, University of Turin, Turin, Italy
| | - Lorenzo Richiardi
- Cancer Epidemiology Unit and CPO-Piemonte, AOU Città della Salute e della Scienza di Torino, Molinette Hospital, Turin, Italy; Department of Medical Sciences, University of Turin, Turin, Italy
| | - Milena M Maule
- Cancer Epidemiology Unit and CPO-Piemonte, AOU Città della Salute e della Scienza di Torino, Molinette Hospital, Turin, Italy; Department of Medical Sciences, University of Turin, Turin, Italy
| | - Enrico Lupia
- Division of Emergency Medicine and High Dependency Unit, AOU Città della Salute e della Scienza di Torino, Molinette Hospital, Turin, Italy; Department of Medical Sciences, University of Turin, Turin, Italy
| |
Collapse
|
19
|
Nazerian P, Morello F, Prota A, Betti L, Lupia E, Apruzzese L, Oddi M, Grosso F, Grifoni S, Pivetta E, Catini E, Gualtieri S, Casanova B, De Villa E, Cerini G, Lumini E, Gagliano M, Annovi A, Mucaj S, Albanesi M, Cavigli E, Moroni C, Miele V, Lagi F, Fanelli A, Rossolini GM, Turco L, Tomaiuolo M, Paolini D, Tonietti B, Tizzani M, Locatelli SM, Porrino G, Losano I, Leone D, Calzolari G, Versan M, Steri F, Ardito A, Capuano M, Gelardi M, Silvestri G, Tutto S, Avolio M, Cavallo R, Bartalucci A, Paglieri C, Baldassa F, Baron P, Bianchi G, Busso V, Conterno A, Del Rizzo P, Fascio Pecetto P, Giachino F, Iannacone A, Ferrera P, Riccardini F, Sacchi C, Sozzi M, Totaro S, Visconti P, Risi F, Basile F, Baricocchi D, Beaux A, Valentina B, Bima P, Cara I, Chichizola L, Dellavalle F, Labarile G, Ottimo M, Pia I, Scategni V, Surra A. Diagnostic accuracy of physician's gestalt in suspected COVID-19: Prospective bicentric study. Acad Emerg Med 2021; 28:404-411. [PMID: 33576155 PMCID: PMC8014604 DOI: 10.1111/acem.14232] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2020] [Revised: 02/09/2021] [Accepted: 02/09/2021] [Indexed: 12/16/2022]
Abstract
Objectives Physicians’ gestalt is central in the diagnostic pipeline of suspected COVID‐19, due to the absence of a single tool allowing conclusive rule in or rule out. The aim of this study was to estimate the diagnostic test characteristics of physician's gestalt for COVID‐19 in the emergency department (ED), based on clinical findings or on a combination of clinical findings and bedside imaging results. Methods From April 1 to April 30, 2020, patients with suspected COVID‐19 were prospectively enrolled in two EDs. Physicians prospectively dichotomized patients in COVID‐19 likely or unlikely twice: after medical evaluation of clinical features (clinical gestalt [CG]) and after evaluation of clinical features and results of lung ultrasound or chest x‐ray (clinical and bedside imaging–integrated gestalt [CBIIG]). The final diagnosis was adjudicated after independent review of 30‐day follow‐up data. Results Among 838 ED enrolled patients, 193 (23%) were finally diagnosed with COVID‐19. The area under the curve (AUC), sensitivity, and specificity of CG and CBIIG for COVID‐19 were 80.8% and 91.6% (p < 0.01), 82.9% and 91.4% (p = 0.01), and 78.6% and 91.8% (p < 0.01), respectively. CBIIG had similar AUC and sensitivity to reverse transcription–polymerase chain reaction (RT‐PCR) for SARS‐CoV‐2 on the first nasopharyngeal swab per se (93.5%, p = 0.24; and 87%, p = 0.17, respectively). CBIIG plus RT‐PCR had a sensitivity of 98.4% for COVID‐19 (p < 0.01 vs. RT‐PCR alone) compared to 95.9% for CG plus RT‐PCR (p = 0.05). Conclusions In suspected COVID‐19, CG and CBIIG have fair diagnostic accuracy, in line with physicians’ gestalt for other acute conditions. Negative RT‐PCR plus low probability based on CBIIG can rule out COVID‐19 with a relatively low number of false‐negative cases.
Collapse
Affiliation(s)
- Peiman Nazerian
- Department of Emergency Medicine Careggi University Hospital Firenze Italy
| | - Fulvio Morello
- Department of Emergency Medicine S.C. Medicina d’UrgenzaA.O.U. Città della Salute e della Scienza di TorinoMolinette Hospital Torino Italy
- Department of Medical Sciences University of Turin Turin Italy
| | - Alessio Prota
- Department of Emergency Medicine Careggi University Hospital Firenze Italy
| | - Laura Betti
- Department of Emergency Medicine Careggi University Hospital Firenze Italy
| | - Enrico Lupia
- Department of Emergency Medicine S.C. Medicina d’UrgenzaA.O.U. Città della Salute e della Scienza di TorinoMolinette Hospital Torino Italy
- Department of Medical Sciences University of Turin Turin Italy
| | - Luc Apruzzese
- Department of Emergency Medicine Careggi University Hospital Firenze Italy
| | - Matteo Oddi
- Residency Program in Emergency Medicine University of Torino Torino Italy
| | - Federico Grosso
- Residency Program in Emergency Medicine University of Torino Torino Italy
| | - Stefano Grifoni
- Department of Emergency Medicine Careggi University Hospital Firenze Italy
| | - Emanuele Pivetta
- Department of Emergency Medicine S.C. Medicina d’UrgenzaA.O.U. Città della Salute e della Scienza di TorinoMolinette Hospital Torino Italy
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
20
|
Morello F, Bima P, Pivetta E, Santoro M, Catini E, Casanova B, Leidel BA, de Matos Soeiro A, Nestelberger T, Mueller C, Grifoni S, Lupia E, Nazerian P. Development and Validation of a Simplified Probability Assessment Score Integrated With Age-Adjusted d-Dimer for Diagnosis of Acute Aortic Syndromes. J Am Heart Assoc 2021; 10:e018425. [PMID: 33474974 PMCID: PMC7955418 DOI: 10.1161/jaha.120.018425] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Background When acute aortic syndromes (AASs) are suspected, pretest clinical probability assessment and d‐dimer (DD) testing are diagnostic options allowing standardized care. Guidelines suggest use of a 12‐item/3‐category score (aortic dissection detection) and a DD cutoff of 500 ng/mL. However, a simplified assessment tool and a more specific DD cutoff could be advantageous. Methods and Results In a prospective derivation cohort (n=1848), 6 items identified by logistic regression (thoracic aortic aneurysm, severe pain, sudden pain, pulse deficit, neurologic deficit, hypotension), composed a simplified score (AORTAs) assigning 2 points to hypotension and 1 to the other items. AORTAs≤1 and ≥2 defined low and high clinical probability, respectively. Age‐adjusted DD was calculated as years/age × 10 ng/mL (minimum 500). The AORTAs score and AORTAs≤1/age‐adjusted DD rule were validated in 2 patient cohorts: a high‐prevalence retrospective cohort (n=1035; 22% AASs) and a low‐prevalence prospective cohort (n=447; 11% AASs) subjected to 30‐day follow‐up. The AUC of the AORTAs score was 0.729 versus 0.697 of the aortic dissection detection score (P=0.005). AORTAs score assessment reclassified 16.6% to 25.1% of patients, with significant net reclassification improvement of 10.3% to 32.7% for AASs and −8.6 to −17% for alternative diagnoses. In both cohorts, AORTAs≥2 had superior sensitivity and slightly lower specificity than aortic dissection detection ≥2. In the prospective validation cohort, AORTAs≤1/age‐adjusted DD had a sensitivity of 100%, a specificity of 48.6%, and an efficiency of 43.3%. Conclusions AORTAs is a simplified score with increased sensitivity, improved AAS classification, and minor trade‐off in specificity, amenable to integration with age‐adjusted DD for diagnostic rule‐out.
Collapse
Affiliation(s)
- Fulvio Morello
- S.C.U. Medicina d'UrgenzaOspedale Molinette, A.O.U. Città della Salute e della Scienza Torino Italy.,Dipartimento di Scienze Mediche Università degli Studi di Torino Torino Italy
| | - Paolo Bima
- S.C.U. Medicina d'UrgenzaOspedale Molinette, A.O.U. Città della Salute e della Scienza Torino Italy
| | - Emanuele Pivetta
- S.C.U. Medicina d'UrgenzaOspedale Molinette, A.O.U. Città della Salute e della Scienza Torino Italy
| | - Marco Santoro
- S.C.U. Medicina d'UrgenzaOspedale Molinette, A.O.U. Città della Salute e della Scienza Torino Italy
| | - Elisabetta Catini
- Department of Emergency Medicine Careggi University Hospital Firenze Italy
| | - Barbara Casanova
- Department of Emergency Medicine Careggi University Hospital Firenze Italy
| | - Bernd A Leidel
- Department of Emergency Medicine Charité-Universitätsmedizin Berlin Berlin Germany
| | | | - Thomas Nestelberger
- Cardiovascular Research Institute University Hospital Basel Basel Switzerland
| | - Christian Mueller
- Cardiovascular Research Institute University Hospital Basel Basel Switzerland
| | - Stefano Grifoni
- Department of Emergency Medicine Careggi University Hospital Firenze Italy
| | - Enrico Lupia
- S.C.U. Medicina d'UrgenzaOspedale Molinette, A.O.U. Città della Salute e della Scienza Torino Italy.,Dipartimento di Scienze Mediche Università degli Studi di Torino Torino Italy
| | - Peiman Nazerian
- Department of Emergency Medicine Careggi University Hospital Firenze Italy
| |
Collapse
|
21
|
Morello F, Santoro M, Fargion AT, Grifoni S, Nazerian P. Diagnosis and management of acute aortic syndromes in the emergency department. Intern Emerg Med 2021; 16:171-181. [PMID: 32358680 DOI: 10.1007/s11739-020-02354-8] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/25/2020] [Accepted: 04/21/2020] [Indexed: 12/12/2022]
Abstract
Acute aortic syndromes (AASs) are deadly cardiovascular emergencies involving the thoracic aorta. AASs are relatively rare conditions, have unspecific signs and symptoms (including truncal pain, syncope, neurologic deficit and limb ischemia) and require contrast-enhanced tomography angiography (CTA) of the chest and abdomen for conclusive diagnosis and subsequent therapeutic planning. In the Emergency Department (ED), most patients with potential signs/symptoms of AASs are finally found affected by other alternative diagnoses. Hence, misdiagnosis and delayed diagnosis of AASs are major concerns. In critically ill patients, decision to perform CTA is usually straightforward, as exam benefits largely outweigh risks. In patients with ST-tract elevation on ECG, suspected primary ischemic stroke and in stable patients (representing the most prevalent ED scenarios), proper selection of patients necessitating CTA is cumbersome, due to concurrent risks of misdiagnosis and over-testing. Available studies support an algorithm integrating clinical probability assessment, bedside echocardiography and D-dimer (if the clinical probability is not high). Therapeutic management includes medical therapy for all patients including an opioid and anti-impulse drugs (a beta-blocker and a vasodilator), targeting a heart rate of 60 bpm and systolic blood pressure of 100-120 mmHg. Patients with AASs involving the ascending aorta are likely candidate for urgent surgery, and complicated type B AASs (severe aortic dilatation, impending or frank rupture, organ malperfusion, refractory pain, severe hypertension) necessitate evaluation for urgent endovascular treatment. For uncomplicated type B AASs, optimal medical therapy is the current standard of care.
Collapse
Affiliation(s)
- Fulvio Morello
- S.C.U. Medicina d'Urgenza, Ospedale Molinette, A.O.U. Città della Salute e della Scienza, Torino, Italy
- Dipartimento di Scienze Mediche, Università degli Studi di Torino, Torino, Italy
| | - Marco Santoro
- S.C.U. Medicina d'Urgenza, Ospedale Molinette, A.O.U. Città della Salute e della Scienza, Torino, Italy
| | | | - Stefano Grifoni
- Department of Emergency Medicine, Careggi University Hospital, Largo Brambilla, 3, 50134, Firenze, Italy
| | - Peiman Nazerian
- Department of Emergency Medicine, Careggi University Hospital, Largo Brambilla, 3, 50134, Firenze, Italy.
| |
Collapse
|
22
|
Nazerian P, Mueller C, Vanni S, Soeiro ADM, Leidel BA, Cerini G, Lupia E, Palazzo A, Grifoni S, Morello F. Integration of transthoracic focused cardiac ultrasound in the diagnostic algorithm for suspected acute aortic syndromes. Eur Heart J 2020; 40:1952-1960. [PMID: 31226214 DOI: 10.1093/eurheartj/ehz207] [Citation(s) in RCA: 30] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2018] [Revised: 09/25/2018] [Accepted: 04/12/2019] [Indexed: 01/16/2023] Open
Abstract
AIMS The diagnosis of acute aortic syndromes (AASs) is challenging and requires integrated strategies. Transthoracic focused cardiac ultrasound (FoCUS) is endorsed by guidelines as a first-line/triage tool allowing rapid bedside assessment of the aorta. However, the performance of FoCUS in the European Society of Cardiology-recommended workup of AASs awaits validation. METHODS AND RESULTS This was a prespecified subanalysis of the ADvISED multicentre prospective study. Patients with suspected AAS underwent FoCUS for detection of direct/indirect signs of AAS. Clinical probability assessment was performed with the aortic dissection detection risk score (ADD-RS). Case adjudication was based on advanced imaging, surgery, autopsy, or 14-day follow-up. An AAS was diagnosed in 146 (17.4%) of 839 patients. Presence of direct FoCUS signs had a sensitivity and specificity of 45.2% [95% confidence interval (CI) 37-53.6%] and 97.4% (95% CI 95.9-98.4%), while presence of any FoCUS sign had a sensitivity and specificity of 89% (95% CI 82.8-93.6%) and 74.5% (95% CI 71-77.7%) for AAS. The additive value of FoCUS was most evident within low clinical probability (ADD-RS ≤1). Herein, direct FoCUS signs were identified in 40 (4.8%) patients (P < 0.001), including 29 with AAS. ADD-RS ≤1 plus negative FoCUS for AAS rule-out had a sensitivity of 93.8% (95% CI 88.6-97.1%) and a failure rate of 1.9% (95% CI 0.9-3.6%). Addition of negative D-dimer led to a failure rate of 0% (95% CI 0-1.2%). CONCLUSION FoCUS has additive value in the workup of AASs. Direct FoCUS signs can rapidly identify patients requiring advanced imaging despite low clinical probability. In integrated bundles, negative FoCUS is useful for rule-out of AASs.
Collapse
Affiliation(s)
- Peiman Nazerian
- Department of Emergency Medicine, Careggi University Hospital, Largo Brambilla 3, Firenze, Firenze, Italy
| | - Christian Mueller
- Department of Cardiology and Cardiovascular Research Institute Basel (CRIB), University Hospital of Basel, Petersgraben 4, Basel, Switzerland
| | - Simone Vanni
- Department of Emergency Medicine, Careggi University Hospital, Largo Brambilla 3, Firenze, Firenze, Italy
| | - Alexandre de Matos Soeiro
- Emergency Care Unit, Heart Institute, University of São Paulo, Av. Dr. Enéas Carvalho de Aguiar, 44 - Cerqueira César, São Paulo, Brazil
| | - Bernd A Leidel
- Department of Emergency Medicine, Campus Benjamin Franklin, Charité - Universitätsmedizin Berlin, Hindenburgdamm 30, Berlin, Germany
| | - Gabriele Cerini
- Department of Emergency Medicine, Careggi University Hospital, Largo Brambilla 3, Firenze, Firenze, Italy
| | - Enrico Lupia
- Department of Emergency Medicine, S.C.U. Medicina d'Urgenza, Molinette Hospital, A.O.U. Città della Salute e della Scienza, Corso Bramante 88, Torino, Italy
| | - Andrea Palazzo
- Department of Emergency Medicine, Careggi University Hospital, Largo Brambilla 3, Firenze, Firenze, Italy
| | - Stefano Grifoni
- Department of Emergency Medicine, Careggi University Hospital, Largo Brambilla 3, Firenze, Firenze, Italy
| | - Fulvio Morello
- Department of Emergency Medicine, S.C.U. Medicina d'Urgenza, Molinette Hospital, A.O.U. Città della Salute e della Scienza, Corso Bramante 88, Torino, Italy
| |
Collapse
|
23
|
Bima P, Pivetta E, Nazerian P, Toyofuku M, Gorla R, Bossone E, Erbel R, Lupia E, Morello F. Systematic Review of Aortic Dissection Detection Risk Score Plus D-dimer for Diagnostic Rule-out Of Suspected Acute Aortic Syndromes. Acad Emerg Med 2020; 27:1013-1027. [PMID: 32187432 DOI: 10.1111/acem.13969] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2019] [Revised: 03/12/2020] [Accepted: 03/16/2020] [Indexed: 12/11/2022]
Abstract
OBJECTIVES In patients at low clinical probability of acute aortic syndromes (AASs), decision on advanced aortic imaging is cumbersome. Integration of the aortic dissection detection risk score (ADD-RS) with D-dimer (DD) provides a potential pipeline for standardized diagnostic rule-out. We systematically reviewed and summarized supporting data. METHODS Cross-sectional studies assessing integration of ADD-RS with DD for diagnosis of AASs were identified on MEDLINE, EMBASE and Web Of Science databases. Two reviewers independently screened articles, assessed quality, and extracted data. The quality of design and reporting was evaluated with the QUADAS-2 and STARD tools. Individual patient data were obtained, to allow analysis of both conventional (500 ng/mL) and age-adjusted (DDage-adj ) DD cutoffs. Data were summarized for four diagnostic strategies combining ADD-RS = 0 or ≤ 1, with DD < 500 ng/mL or < DDage-adj . The statistical heterogeneity of the diagnostic variables was estimated with Higgins' I2 . Pooled values were calculated for variables showing nonsignificant heterogeneity. RESULTS After screening of 680 studies, four articles (including a total of 3,804 patients) met inclusion criteria. One prospective study provided a low risk of bias/applicability concerns, while methodologic limitations were found in the other three retrospective studies. Statistical heterogeneity was negligible for sensitivity and negative likelihood ratio (LR) values and significant for specificity and positive LR values of all diagnostic strategies. Pooled sensitivity was 99.9% (95% confidence interval [CI] = 99.3% to 100%, I2 = 0) for ADD-RS = 0 and DD < 500 ng/mL or < DDage-adj , 98.9% (95% CI = 97.9% to 99.9%, I2 = 0) for ADD-RS ≤ 1 and DD < 500 ng/mL, and 97.6% (95% CI = 96.3% to 98.9%, I2 = 0) for ADD-RS ≤ 1 and DD < DDage-adj . CONCLUSIONS Despite methodologic limitations, integration of ADD-RS = 0 or ≤ 1 with DD < 500 ng/mL shows negligible heterogeneity and consistently high sensitivity across studies, thus supporting reliability for diagnostic rule-out of AASs. Data supporting ADD-RS = 0 plus DDage-adj appear preliminary and require further scrutiny.
Collapse
Affiliation(s)
- Paolo Bima
- S.C.U. Medicina d’Urgenza Molinette Hospital, A.O.U. Città della Salute e della Scienza Torino Italy
| | - Emanuele Pivetta
- S.C.U. Medicina d’Urgenza Molinette Hospital, A.O.U. Città della Salute e della Scienza Torino Italy
| | - Peiman Nazerian
- Department of Emergency Medicine Careggi University Hospital Firenze Italy
| | | | - Riccardo Gorla
- Department of Clinical and Interventional Cardiology IRCCS Policlinico San Donato San Donato Milanese Italy
| | | | - Raimund Erbel
- Institute for Medical Informatics, Biometry and Epidemiology University Hospital Essen University Duisburg‐Essen Essen Germany
| | - Enrico Lupia
- S.C.U. Medicina d’Urgenza Molinette Hospital, A.O.U. Città della Salute e della Scienza Torino Italy
| | - Fulvio Morello
- S.C.U. Medicina d’Urgenza Molinette Hospital, A.O.U. Città della Salute e della Scienza Torino Italy
| |
Collapse
|
24
|
Ceccarelli F, Olivieri G, Dominici L, Celia AI, Cipriano E, Garufi C, Mancuso S, Natalucci F, Orefice V, Perricone C, Pirone C, Pacucci VA, Morello F, Truglia S, Miranda F, Spinelli FR, Alessandri C, Conti F. OP0204 LUPUS COMPREHENSIVE DISEASE CONTROL IN SYSTEMIC LUPUS ERYTHEMATOSUS PATIENTS: APPLICATION OF A NEW INDEX. Ann Rheum Dis 2020. [DOI: 10.1136/annrheumdis-2020-eular.4560] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Background:The main outcomes in SLE patients management are represented by the remission achievement and chronic damage prevention. Even though activity and damage are intimately connected, to date indices including both these outcomes are not available.Objectives:In the present study, we aimed at assessing the application of a new index, the Lupus comprehensive disease control (LupusCDC), including disease activity and chronic damage progression.Methods:We performed a longitudinal analysis, including SLE patients according to ACR 1997 criteria, followed-up in the period between January 2014 and December 2018, and with at least one visit per year. Disease activity was assessed by SLE Disease Activity Index 2000 (SLEDAI-2K) and three different remission levels were evaluated, as reported in Table 1 (1).Table 1.Remission levels considered in the study (1).Remission levelDefinitionComplete Remission(CR)No clinical and serological activity (SLEDAI-2K=0) in corticosteroid-free and immunosuppressant-free patients (antimalarials allowed)Clinical remission off-corticosteroids(ClR-GCoff)Serological activity with clinical quiescent disease according to SLEDAI-2K in corticosteroid-free patients (stable immunosuppressive therapy and antimalarials allowed)clinical remission on-corticosteroids(ClR-GCon)Clinical quiescent disease according to SLEDAI-2K in patients on prednisone 1–5 mg/day (stable immunosuppressants and antimalarials allowed)Chronic damage was registered according to SLICC damage index (SDI). All the patients were evaluated at baseline (T0) and every 12 months (T1, T2, T3, T4). At each time-point, we calculated the prevalence of LupusCDC, defined as remission achievement plus absence of chronic damage progression in the previous one year. We calculated this outcome including separately the different remission levels.Results:According with inclusion criteria, 172 SLE patients were evaluated in the present analysis [M/F 16/156, median age 49 years (IQR 16.7), median disease duration 180 months (IQR 156)]. At first assessment, we observed a mean±SD SDI value of 0.7±1.1. In details, 56 patients (32.5%) showed damage in at least one organ/system and the presence of damage was significantly associated with age (p<0.0001, r=0.3) and disease duration (p=0.0003, r=0.3). During the follow-up, we observed a significant increase in SDI values compared with T0 (T1: mean±DS 0.8±1.3, p<0.0001; T2: 0.8±1.4, p<0.0001; T3: 0.9±1.4 p=0.0001; T4: 1.0±1.5 p<0.0001).In figure 1A and 1B we reported the proportion of patients achieving the different levels of remission and LupusCDC, respectively. In particular, the LupusCDC definition including CR was the most frequently detected in all time-points evaluated (T1: 18.0%; T2: 31.9%; T3: 27.9%; T4: 24.4%), with a significant difference at T2 [LupusCDC(CR)versusLupusCDC(ClR-GCoff), p=0.0002; LupusCDC(CR)versusLupusCDC(ClR-GCon) p=0.0002)], T3 [LupusCDC(CR)versusLupusCDC(ClR-GCoff), p=0.03; LupusCDC(CR)versusLupusCDC(ClR-GCon) p=0.006], T4 [LupusCDC(CR)versusLupusCDC(ClR-GCon), p=0.002]. No significant differences were found when comparing the prevalence of different remission levels and the prevalence of LupusCDC including the corresponding remission.Conclusion:In the present analysis we proposed for the first time a new index including disease activity and chronic damage, in order to evaluate the proportion of SLE patients reaching a comprehensive disease control. We found that CR is most frequently associated with the absence of damage progression.References:[1]Zen M et al. Ann Rheum Dis 2017.Disclosure of Interests:Fulvia Ceccarelli: None declared, Giulio Olivieri: None declared, Lorenzo Dominici: None declared, Alessandra Ida Celia: None declared, enrica cipriano: None declared, Cristina Garufi: None declared, Silvia Mancuso: None declared, Francesco Natalucci: None declared, Valeria Orefice: None declared, Carlo Perricone: None declared, Carmelo Pirone: None declared, viviana antonella pacucci: None declared, Francesca Morello: None declared, Simona Truglia: None declared, Francesca Miranda: None declared, Francesca Romana Spinelli Grant/research support from: Pfizer, Consultant of: Novartis, Gilead, Lilly, Sanofi, Celgene, Speakers bureau: Lilly, cristiano alessandri Grant/research support from: Pfizer, fabrizio conti Speakers bureau: BMS, Lilly, Abbvie, Pfizer, Sanofi
Collapse
|
25
|
Morello F, Bartalucci A, Bironzo M, Santoro M, Pivetta E, Ianniello A, Rumbolo F, Mengozzi G, Lupia E. Prospective diagnostic accuracy study of plasma soluble ST2 for diagnosis of acute aortic syndromes. Sci Rep 2020; 10:3103. [PMID: 32080259 PMCID: PMC7033105 DOI: 10.1038/s41598-020-59884-6] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2019] [Accepted: 01/28/2020] [Indexed: 01/16/2023] Open
Abstract
Acute aortic syndromes (AASs) are difficult to diagnose emergencies. Plasma soluble ST2 (sST2), a prognostic biomarker for heart failure, has been proposed as a diagnostic biomarker of AASs outperforming D-dimer, the current diagnostic standard. We performed a prospective diagnostic accuracy study of sST2 for AASs in the Emergency Department (ED). In 2017–2018, patients were enrolled if they had ≥1 red-flag symptoms (chest/abdominal/back pain, syncope, perfusion deficit) and a clinical suspicion of AAS. sST2 was detected with the Presage® assay. Adjudication was based on computed tomography angiography (CTA) or on diagnostic outcome inclusive of 30-day follow-up. 297 patients were enrolled, including 88 with AASs. The median age was 67 years. In 162 patients with CTA, the median sST2 level was 41.7 ng/mL (IQR 29.4–103.2) in AASs and 34.6 ng/mL (IQR 21.4–51.5) in alternative diagnoses (P = 0.005). In ROC analysis, the AUC of sST2 was 0.63, as compared to 0.82 of D-dimer (P < 0.001). Sensitivity and specificity values of sST2 associated with different cutoffs were: 95.5% and 10.8% (≥12 ng/mL), 84.1% and 29.7% (≥23.7 ng/mL), 35.2% and 85.1% (≥66.5 ng/mL). Results were similar in the full cohort. In conclusion, in patients from a European ED, plasma sST2 provided modest accuracy for diagnosis of AASs.
Collapse
Affiliation(s)
- Fulvio Morello
- S.C.U. Medicina d'Urgenza, Molinette Hospital, A.O.U. Città della Salute e della Scienza, Torino, Italy. .,Dipartimento di Scienze Mediche, Università degli Studi di Torino, Torino, Italy.
| | - Alice Bartalucci
- S.C.U. Medicina d'Urgenza, Molinette Hospital, A.O.U. Città della Salute e della Scienza, Torino, Italy
| | - Marco Bironzo
- S.C.U. Medicina d'Urgenza, Molinette Hospital, A.O.U. Città della Salute e della Scienza, Torino, Italy
| | - Marco Santoro
- S.C.U. Medicina d'Urgenza, Molinette Hospital, A.O.U. Città della Salute e della Scienza, Torino, Italy
| | - Emanuele Pivetta
- S.C.U. Medicina d'Urgenza, Molinette Hospital, A.O.U. Città della Salute e della Scienza, Torino, Italy
| | - Alice Ianniello
- S.C. Biochimica Clinica, A.O.U. Città della Salute e della Scienza, Torino, Italy
| | - Francesca Rumbolo
- S.C. Biochimica Clinica, A.O.U. Città della Salute e della Scienza, Torino, Italy
| | - Giulio Mengozzi
- S.C. Biochimica Clinica, A.O.U. Città della Salute e della Scienza, Torino, Italy
| | - Enrico Lupia
- S.C.U. Medicina d'Urgenza, Molinette Hospital, A.O.U. Città della Salute e della Scienza, Torino, Italy.,Dipartimento di Scienze Mediche, Università degli Studi di Torino, Torino, Italy
| |
Collapse
|
26
|
Nazerian P, Pivetta E, Veglia S, Cavigli E, Mueller C, Soeiro A, Leidel BA, Lupia E, Rutigliano C, Wussler D, Grifoni S, Morello F. Integrated Use of Conventional Chest Radiography Cannot Rule Out Acute Aortic Syndromes in Emergency Department Patients at Low Clinical Probability. Acad Emerg Med 2019; 26:1255-1265. [PMID: 31220387 DOI: 10.1111/acem.13819] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2019] [Revised: 06/10/2019] [Accepted: 06/14/2019] [Indexed: 12/13/2022]
Abstract
OBJECTIVES Guidelines recommend chest radiography (CR) in the workup of suspected acute aortic syndromes (AASs) if the pretest clinical probability is low. However, the diagnostic impact of CR integration for the rule-in and rule-out of AASs is unknown. METHODS We performed a secondary analysis of the ADvISED multicenter study. Emergency department outpatients were eligible if an AAS was clinically suspected. Clinical probability was defined with the aortic dissection detection risk score (ADD-RS). CR was evaluated blindly by a radiologist, who judged on mediastinum enlargement (ME) and other signs. RESULTS In 2014 through 2016, a total of 1,129 patients were enrolled and 1,030 were analyzed, including 48 (4.7%) with AASs. ADD-RS/ME and ADD-RS/any CR sign (aCRs) integration were more accurate than ADD-RS alone (area under the curve = 0.8 and 0.78 vs. 0.66, p < 0.001). The sensitivity and specificity of the integrated strategies were 66.7% (95% confidence interval [CI] = 51.5% to 79.9%) and 82.5% (95% CI = 79.9% to 84.8%) for ADD-RS/ME and 68.8% (95% CI = 53.6% to 80.9%) and 76.5% (95% CI = 73.7% to 79.1%) for ADD-RS/aCRs, respectively. The sensitivity and specificity of CR per se were 54.2% (95% CI = 39.2% to 68.6%) and 92.4% (95% CI = 90.5% to 93.9%) for ME and 60.4% (95% CI = 45.3% to 74.2%) and 85.2% (95% CI = 82.9% to 87.4%) for aCRs. The agreement (κ) between attending physicians and radiologists for ME was 0.44 (95% CI = 0.35 to 0.54). ADD-RS/ME rule-in (ADD-RS ≤ 1 and ME-present, or ADD-RS > 1) applied to 204 versus 130 patients with ADD-RS > 1, including 14 with AAS and 60 false-positives (FP). ADD-RS/aCRs rule-in (ADD-RS ≤ 1 and aCRs-present, or ADD-RS > 1) applied to 264 patients, including 15 with AAS and 119 FP. ADD-RS/ME rule-out (ADD-RS ≤ 1 and ME-absent) applied to 826 (80.2%) patients, including 16 with AAS (33.3% of cases). ADD-RS/aCRs rule-out (ADD-RS ≤ 1 and aCRs-absent) applied to 766 patients (74.4%), including 15 with AAS (31.3% of cases). CONCLUSIONS CR integration with clinical probability assessment showed modest rule-in efficiency and insufficient sensitivity for conclusive rule-out.
Collapse
Affiliation(s)
- Peiman Nazerian
- Department of Emergency Medicine Careggi University Hospital Firenze Italy
| | - Emanuele Pivetta
- S.C.U. Medicina d'Urgenza Department of Emergency Medicine Molinette Hospital A.O.U. Città della Salute e della Scienza Torino Italy
| | - Simona Veglia
- Radiology Department Molinette HospitalA.O.U. Città della Salute e della Scienza Torino Italy
| | - Edoardo Cavigli
- Radiology Department Careggi University Hospital Firenze Italy
| | - Christian Mueller
- Cardiovascular Research Institute Basel (CRIB) and Department of Cardiology University Hospital BaselUniversity of Basel Basel Switzerland
| | - Alexandre Soeiro
- Emergency Care Unit Heart Institute University of São Paulo São Paulo Brazil
| | - Bernd A. Leidel
- Department of Emergency Medicine Campus Benjamin FranklinCharité–Universitätsmedizin Berlin Germany
| | - Enrico Lupia
- S.C.U. Medicina d'Urgenza Department of Emergency Medicine Molinette Hospital A.O.U. Città della Salute e della Scienza Torino Italy
| | - Claudia Rutigliano
- Clinic of Radiology and Nuclear Medicine University Hospital of Basel Basel Switzerland
| | - Desiree Wussler
- Clinic of Radiology and Nuclear Medicine University Hospital of Basel Basel Switzerland
| | - Stefano Grifoni
- Department of Emergency Medicine Careggi University Hospital Firenze Italy
| | - Fulvio Morello
- S.C.U. Medicina d'Urgenza Department of Emergency Medicine Molinette Hospital A.O.U. Città della Salute e della Scienza Torino Italy
| | | |
Collapse
|
27
|
Morello F, Mueller C, Soeiro ADM, Leidel BA, Salvadeo SAT, Nazerian P. Response by Morello et al to Letters Regarding Article, "Diagnostic Accuracy of the Aortic Dissection Detection Risk Score Plus D-Dimer for Acute Aortic Syndromes: The ADvISED Prospective Multicenter Study". Circulation 2019; 138:448-449. [PMID: 30571366 DOI: 10.1161/circulationaha.118.034861] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Fulvio Morello
- S.C.U. Medicina d'Urgenza, A.O.U. Città della Salute e della Scienza, Molinette Hospital, Torino, Italy (F.M.)
| | - Christian Mueller
- Cardiovascular Research Institute, University Hospital of Basel, Switzerland (C.M.)
| | | | - Bernd A Leidel
- Department of Emergency Medicine, Campus Benjamin Franklin, Charité - Universitätsmedizin Berlin, Germany (B.A.L.)
| | | | - Peiman Nazerian
- Department of Emergency Medicine, Careggi University Hospital, Firenze, Italy (P.N.)
| | | |
Collapse
|
28
|
Pavan D, Pitarresi G, Morello F, Monachino F, Sanfilippo A, D’Arienzo A, Camarda L. Does the 5-strand-graft have superior biomechanical behaviour than 4-strand-graft during ACL reconstruction? Muscles Ligaments Tendons J 2019. [DOI: 10.32098/mltj.03.2019.12] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Affiliation(s)
- D. Pavan
- Department of Orthopaedic Surgery, University of Palermo (Di.Chir.On.S), Palermo, Italy
| | - G. Pitarresi
- Department of Industrial and Digital Innovation (DIID) Chemical, Management, Computer, Mechanical Engineering, Viale delle Scienze ed.8, I-90128 Palermo
| | - F. Morello
- Department of Orthopaedic Surgery, University of Palermo (Di.Chir.On.S), Palermo, Italy
| | - F. Monachino
- Department of Orthopaedic Surgery, University of Palermo (Di.Chir.On.S), Palermo, Italy
| | - A. Sanfilippo
- Department of Orthopaedic Surgery, University of Palermo (Di.Chir.On.S), Palermo, Italy
| | - A. D’Arienzo
- Department of Orthopaedic Surgery, University of Pisa, Pisa, Italy
| | - L. Camarda
- Department of Orthopaedic Surgery, University of Palermo (Di.Chir.On.S), Palermo, Italy
| |
Collapse
|
29
|
Camarda L, Bologna E, Pavan D, Morello F, Monachino F, Giacco F, Zingales M. Posterior meniscal root repair: a biomechanical comparison between human and porcine menisci. Muscles Ligaments Tendons J 2019. [DOI: 10.32098/mltj.01.2019.03] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Affiliation(s)
- L. Camarda
- Department of Orthopaedic Surgery, University of Palermo (DiChirOnS), Palermo, Italy
| | - E. Bologna
- Dipartimento di Ingegneria Civile, Ambientale, Aerospaziale, dei Materiali (DICAM), Palermo, Italy
- Bio/NanoMechanics for Medical Sciences Laboratory, Advanced Technology Network (ATeN)-Center, Palermo, Italy
| | - D. Pavan
- Department of Orthopaedic Surgery, University of Palermo (DiChirOnS), Palermo, Italy
| | - F. Morello
- Department of Orthopaedic Surgery, University of Palermo (DiChirOnS), Palermo, Italy
| | - F. Monachino
- Department of Orthopaedic Surgery, University of Palermo (DiChirOnS), Palermo, Italy
| | - F. Giacco
- Department of Orthopaedic Surgery, IRCCS Istituto Ortopedico Galeazzi, Milano, Italy
| | - M. Zingales
- Dipartimento di Ingegneria Civile, Ambientale, Aerospaziale, dei Materiali (DICAM), Palermo, Italy
- Bio/NanoMechanics for Medical Sciences Laboratory, Advanced Technology Network (ATeN)-Center, Palermo, Italy
| |
Collapse
|
30
|
Pivetta E, Goffi A, Nazerian P, Castagno D, Tozzetti C, Tizzani P, Tizzani M, Porrino G, Ferreri E, Busso V, Morello F, Paglieri C, Masoero M, Cassine E, Bovaro F, Grifoni S, Maule MM, Lupia E. Lung ultrasound integrated with clinical assessment for the diagnosis of acute decompensated heart failure in the emergency department: a randomized controlled trial. Eur J Heart Fail 2019; 21:754-766. [PMID: 30690825 DOI: 10.1002/ejhf.1379] [Citation(s) in RCA: 111] [Impact Index Per Article: 22.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2018] [Revised: 10/14/2018] [Accepted: 11/06/2018] [Indexed: 12/17/2022] Open
Abstract
AIMS Although acute decompensated heart failure (ADHF) is a common cause of dyspnoea, its diagnosis still represents a challenge. Lung ultrasound (LUS) is an emerging point-of-care diagnostic tool, but its diagnostic performance for ADHF has not been evaluated in randomized studies. We evaluated, in patients with acute dyspnoea, accuracy and clinical usefulness of combining LUS with clinical assessment compared to the use of chest radiography (CXR) and N-terminal pro-B-type natriuretic peptide (NT-proBNP) in conjunction with clinical evaluation. METHODS AND RESULTS This was a randomized trial conducted in two emergency departments. After initial clinical evaluation, patients with acute dyspnoea were classified by the treating physician according to presumptive aetiology (ADHF or non-ADHF). Patients were subsequently randomized to continue with either LUS or CXR/NT-proBNP. A new diagnosis, integrating the results of both initial assessment and the newly obtained findings, was then recorded. Diagnostic accuracy and clinical usefulness of LUS and CXR/NT-proBNP approaches were calculated. A total of 518 patients were randomized. Addition of LUS had higher accuracy [area under the receiver operating characteristic curve (AUC) 0.95] than clinical evaluation alone (AUC 0.88) in identifying ADHF (P < 0.01). In contrast, use of CXR/NT-proBNP did not significantly increase the accuracy of clinical evaluation alone (AUC 0.87 and 0.85, respectively; P > 0.05). The diagnostic accuracy of the LUS-integrated approach was higher then that of the CXR/Nt-proBNP-integrated approach (AUC 0.95 vs. 0.87, p < 0.01). Combining LUS with the clinical evaluation reduced diagnostic errors by 7.98 cases/100 patients, as compared to 2.42 cases/100 patients in the CXR/Nt-proBNP group. CONCLUSION Integration of LUS with clinical assessment for the diagnosis of ADHF in the emergency department seems to be more accurate than the current diagnostic approach based on CXR and NT-proBNP.
Collapse
Affiliation(s)
- Emanuele Pivetta
- Cancer Epidemiology Unit, Department of Medical Sciences, University of Turin, Italy.,Division of Emergency Medicine and High Dependency Unit, AOU Città della Salute e della Scienza di Torino, Turin, Italy
| | - Alberto Goffi
- Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, Canada.,Department of Medicine, Division of Respirology (Critical Care), University Health Network, Toronto, Canada.,Department of Medicine, University of Toronto, Toronto, Canada
| | - Peiman Nazerian
- Department of Emergency Medicine, Careggi University Hospital, Florence, Italy
| | - Davide Castagno
- Division of Cardiology, Department of Medical Sciences, University of Turin, Turin, Italy
| | - Camilla Tozzetti
- Division of Internal Medicine, Department of Emergency Medicine, Careggi University Hospital, Florence, Italy
| | - Pietro Tizzani
- Division of Emergency Medicine and High Dependency Unit, AOU Città della Salute e della Scienza di Torino, Turin, Italy.,Residency Program in Internal Medicine, University of Turin, Turin, Italy
| | - Maria Tizzani
- Division of Emergency Medicine and High Dependency Unit, AOU Città della Salute e della Scienza di Torino, Turin, Italy
| | - Giulio Porrino
- Division of Emergency Medicine and High Dependency Unit, AOU Città della Salute e della Scienza di Torino, Turin, Italy
| | - Enrico Ferreri
- Division of Emergency Medicine and High Dependency Unit, AOU Città della Salute e della Scienza di Torino, Turin, Italy
| | - Valeria Busso
- Division of Emergency Medicine and High Dependency Unit, AOU Città della Salute e della Scienza di Torino, Turin, Italy
| | - Fulvio Morello
- Division of Emergency Medicine and High Dependency Unit, AOU Città della Salute e della Scienza di Torino, Turin, Italy
| | - Cristina Paglieri
- Division of Emergency Medicine and High Dependency Unit, AOU Città della Salute e della Scienza di Torino, Turin, Italy
| | - Monica Masoero
- Residency Program in Emergency Medicine, University of Turin, Turin, Italy
| | - Elisa Cassine
- School of Medicine, University of Turin, Turin, Italy
| | - Federica Bovaro
- Residency Program in Emergency Medicine, University of Turin, Turin, Italy
| | - Stefano Grifoni
- Department of Emergency Medicine, Careggi University Hospital, Florence, Italy
| | - Milena M Maule
- Cancer Epidemiology Unit, Department of Medical Sciences, University of Turin, Italy
| | - Enrico Lupia
- Division of Emergency Medicine and High Dependency Unit, AOU Città della Salute e della Scienza di Torino, Turin, Italy.,Department of Medical Sciences, University of Turin, Turin, Italy
| | | |
Collapse
|
31
|
Morello F, Oddi M, Cavalot G, Ianniello A, Giachino F, Nazerian P, Battista S, Magnino C, Tizzani M, Settanni F, Mengozzi G, Lupia E. Prospective diagnostic and prognostic study of copeptin in suspected acute aortic syndromes. Sci Rep 2018; 8:16713. [PMID: 30425269 PMCID: PMC6233166 DOI: 10.1038/s41598-018-35016-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2018] [Accepted: 10/03/2018] [Indexed: 01/16/2023] Open
Abstract
Acute aortic syndromes (AAS) are cardiovascular emergencies with unmet diagnostic needs. Copeptin is released upon stress conditions and is approved for rule-out of myocardial infarction (MI). As MI and AAS share presenting symptoms, stress mechanisms and necessity for rapid diagnosis, copeptin appears as an attractive biomarker also for AAS. We thus performed a diagnostic and observational study in Emergency Department (ED) outpatients. Inclusion criteria were chest/abdominal/back pain, syncope and/or perfusion deficit, plus AAS in differential diagnosis. Blood samples were obtained in the ED. 313 patients were analyzed and 105 (33.5%) were diagnosed with AAS. Median copeptin was 38.91 pmol/L (interquartile range, IQR, 16.33-173.4) in AAS and 7.51 pmol/L (IQR 3.58-15.08) in alternative diagnoses (P < 0.001). Copeptin (≥10 pmol/L) had a sensitivity of 80.8% (95% confidence interval, CI, 72.2-87.2) and a specificity of 63.6% (CI 56.9-69.9) for AAS. Within 6 hours, the sensitivity and specificity were 88.7% (CI 79.3-94.2) and 52.4% (CI 42.9-61.8) respectively. Combination with D-dimer did not increase the diagnostic yield. Furthermore, copeptin ≥25 pmol/L predicted mortality in patients with alternative diagnoses but not with AAS. In conclusion, copeptin increases in most patients with AAS within the first hours, but the accuracy of copeptin for diagnosis AAS is suboptimal.
Collapse
Affiliation(s)
- Fulvio Morello
- S.C.U. Medicina d'Urgenza, A.O.U. Città della Salute e della Scienza, Molinette Hospital, Torino, Italy.
| | - Matteo Oddi
- S.C.U. Medicina d'Urgenza, A.O.U. Città della Salute e della Scienza, Molinette Hospital, Torino, Italy
| | - Giulia Cavalot
- S.C.U. Medicina Interna 2, A.O.U. Città della Salute e della Scienza, Molinette Hospital, Torino, Italy
| | - Alice Ianniello
- S.C. Biochimica Clinica, A.O.U. Città della Salute e della Scienza, Molinette Hospital, Torino, Italy
| | - Francesca Giachino
- S.C.U. Medicina d'Urgenza, A.O.U. Città della Salute e della Scienza, Molinette Hospital, Torino, Italy
| | | | - Stefania Battista
- S.C.U. Medicina d'Urgenza, A.O.U. Città della Salute e della Scienza, Molinette Hospital, Torino, Italy
| | - Corrado Magnino
- S.C.U. Medicina d'Urgenza, A.O.U. Città della Salute e della Scienza, Molinette Hospital, Torino, Italy
| | - Maria Tizzani
- S.C.U. Medicina d'Urgenza, A.O.U. Città della Salute e della Scienza, Molinette Hospital, Torino, Italy
| | - Fabio Settanni
- S.C. Biochimica Clinica, A.O.U. Città della Salute e della Scienza, Molinette Hospital, Torino, Italy
| | - Giulio Mengozzi
- S.C. Biochimica Clinica, A.O.U. Città della Salute e della Scienza, Molinette Hospital, Torino, Italy
| | - Enrico Lupia
- S.C.U. Medicina d'Urgenza, A.O.U. Città della Salute e della Scienza, Molinette Hospital, Torino, Italy
| |
Collapse
|
32
|
Li M, Sala V, De Santis MC, Cimino J, Cappello P, Pianca N, Di Bona A, Margaria JP, Martini M, Lazzarini E, Pirozzi F, Rossi L, Franco I, Bornbaum J, Heger J, Rohrbach S, Perino A, Tocchetti CG, Lima BH, Teixeira MM, Porporato PE, Schulz R, Angelini A, Sandri M, Ameri P, Sciarretta S, Lima-Júnior RCP, Mongillo M, Zaglia T, Morello F, Novelli F, Hirsch E, Ghigo A. Phosphoinositide 3-Kinase Gamma Inhibition Protects From Anthracycline Cardiotoxicity and Reduces Tumor Growth. Circulation 2018; 138:696-711. [DOI: 10.1161/circulationaha.117.030352] [Citation(s) in RCA: 133] [Impact Index Per Article: 22.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Affiliation(s)
- Mingchuan Li
- Department of Molecular Biotechnology and Health Sciences, Molecular Biotechnology Center, University of Torino, Italy (M.L., V.S., M.C.D.S., J.C., J.P.M., M.M., F.P., L.R., I.F., A.P., P.E.P., R.C.P.L.-J., E.H., A.G.)
| | - Valentina Sala
- Department of Molecular Biotechnology and Health Sciences, Molecular Biotechnology Center, University of Torino, Italy (M.L., V.S., M.C.D.S., J.C., J.P.M., M.M., F.P., L.R., I.F., A.P., P.E.P., R.C.P.L.-J., E.H., A.G.)
- A.O.U. Città della Salute e della Scienza di Torino, S.C. Emergency Medicine, Torino, Italy (V.S., F.M.)
| | - Maria Chiara De Santis
- Department of Molecular Biotechnology and Health Sciences, Molecular Biotechnology Center, University of Torino, Italy (M.L., V.S., M.C.D.S., J.C., J.P.M., M.M., F.P., L.R., I.F., A.P., P.E.P., R.C.P.L.-J., E.H., A.G.)
| | - James Cimino
- Department of Molecular Biotechnology and Health Sciences, Molecular Biotechnology Center, University of Torino, Italy (M.L., V.S., M.C.D.S., J.C., J.P.M., M.M., F.P., L.R., I.F., A.P., P.E.P., R.C.P.L.-J., E.H., A.G.)
| | - Paola Cappello
- Center for Experimental Research and Medical Studies, Azienda Ospedaliera Universitaria Città della Salute e della Scienza di Torino, Italy (P.C., F.N.)
| | - Nicola Pianca
- Department of Biomedical Sciences, University of Padova, Italy (N.P., A.D.B., M.S., M.M., T.Z.)
- Venetian Institute of Molecular Medicine, Padova, Italy (N.P., A.D.B., M.S., M.M., T.Z.)
| | - Anna Di Bona
- Department of Biomedical Sciences, University of Padova, Italy (N.P., A.D.B., M.S., M.M., T.Z.)
- Venetian Institute of Molecular Medicine, Padova, Italy (N.P., A.D.B., M.S., M.M., T.Z.)
- Department of Cardiac, Thoracic, and Vascular Sciences, University of Padova, Italy (A.D.B., A.A., T.Z.)
| | - Jean Piero Margaria
- Department of Molecular Biotechnology and Health Sciences, Molecular Biotechnology Center, University of Torino, Italy (M.L., V.S., M.C.D.S., J.C., J.P.M., M.M., F.P., L.R., I.F., A.P., P.E.P., R.C.P.L.-J., E.H., A.G.)
| | - Miriam Martini
- Department of Molecular Biotechnology and Health Sciences, Molecular Biotechnology Center, University of Torino, Italy (M.L., V.S., M.C.D.S., J.C., J.P.M., M.M., F.P., L.R., I.F., A.P., P.E.P., R.C.P.L.-J., E.H., A.G.)
| | - Edoardo Lazzarini
- Department of Internal Medicine, Cardiovascular Biology Laboratory, University of Genova and IRCCS Policlinic Hospital San Martino, Italy (E.L., P.A.)
| | - Flora Pirozzi
- Department of Molecular Biotechnology and Health Sciences, Molecular Biotechnology Center, University of Torino, Italy (M.L., V.S., M.C.D.S., J.C., J.P.M., M.M., F.P., L.R., I.F., A.P., P.E.P., R.C.P.L.-J., E.H., A.G.)
- Department of Translational Medical Sciences, Division of Internal Medicine, Federico II University, Napoli, Italy (F.P., C.G.T.)
| | - Luca Rossi
- Department of Molecular Biotechnology and Health Sciences, Molecular Biotechnology Center, University of Torino, Italy (M.L., V.S., M.C.D.S., J.C., J.P.M., M.M., F.P., L.R., I.F., A.P., P.E.P., R.C.P.L.-J., E.H., A.G.)
| | - Irene Franco
- Department of Molecular Biotechnology and Health Sciences, Molecular Biotechnology Center, University of Torino, Italy (M.L., V.S., M.C.D.S., J.C., J.P.M., M.M., F.P., L.R., I.F., A.P., P.E.P., R.C.P.L.-J., E.H., A.G.)
| | - Julia Bornbaum
- Institut für Physiologie, Justus Liebig University Giessen, Germany (J.B., J.H., S.R., R.S.)
| | - Jacqueline Heger
- Institut für Physiologie, Justus Liebig University Giessen, Germany (J.B., J.H., S.R., R.S.)
| | - Susanne Rohrbach
- Institut für Physiologie, Justus Liebig University Giessen, Germany (J.B., J.H., S.R., R.S.)
| | - Alessia Perino
- Department of Molecular Biotechnology and Health Sciences, Molecular Biotechnology Center, University of Torino, Italy (M.L., V.S., M.C.D.S., J.C., J.P.M., M.M., F.P., L.R., I.F., A.P., P.E.P., R.C.P.L.-J., E.H., A.G.)
| | - Carlo G. Tocchetti
- Department of Translational Medical Sciences, Division of Internal Medicine, Federico II University, Napoli, Italy (F.P., C.G.T.)
| | - Braulio H.F. Lima
- Departamento de Bioquímica e Imunologia, Instituto de Ciências Biológicas, Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil (B.H.F.L., M.M.T.)
| | - Mauro M. Teixeira
- Departamento de Bioquímica e Imunologia, Instituto de Ciências Biológicas, Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil (B.H.F.L., M.M.T.)
| | - Paolo E. Porporato
- Department of Molecular Biotechnology and Health Sciences, Molecular Biotechnology Center, University of Torino, Italy (M.L., V.S., M.C.D.S., J.C., J.P.M., M.M., F.P., L.R., I.F., A.P., P.E.P., R.C.P.L.-J., E.H., A.G.)
| | - Rainer Schulz
- Institut für Physiologie, Justus Liebig University Giessen, Germany (J.B., J.H., S.R., R.S.)
| | - Annalisa Angelini
- Department of Cardiac, Thoracic, and Vascular Sciences, University of Padova, Italy (A.D.B., A.A., T.Z.)
| | - Marco Sandri
- Department of Biomedical Sciences, University of Padova, Italy (N.P., A.D.B., M.S., M.M., T.Z.)
- Venetian Institute of Molecular Medicine, Padova, Italy (N.P., A.D.B., M.S., M.M., T.Z.)
| | - Pietro Ameri
- Department of Internal Medicine, Cardiovascular Biology Laboratory, University of Genova and IRCCS Policlinic Hospital San Martino, Italy (E.L., P.A.)
| | - Sebastiano Sciarretta
- Department of Medical and Surgical Sciences and Biotechnologies, University of Rome Sapienza, Latina, Italy (S.S.)
| | - Roberto César P. Lima-Júnior
- Department of Molecular Biotechnology and Health Sciences, Molecular Biotechnology Center, University of Torino, Italy (M.L., V.S., M.C.D.S., J.C., J.P.M., M.M., F.P., L.R., I.F., A.P., P.E.P., R.C.P.L.-J., E.H., A.G.)
- Department of Physiology and Pharmacology, Laboratory of Pharmacology of Inflammation and Cancer, Universidade Federal do Ceará/UFC, Fortaleza, Brazil (R.C.P.L.-J.)
| | - Marco Mongillo
- Department of Biomedical Sciences, University of Padova, Italy (N.P., A.D.B., M.S., M.M., T.Z.)
- Venetian Institute of Molecular Medicine, Padova, Italy (N.P., A.D.B., M.S., M.M., T.Z.)
| | - Tania Zaglia
- Department of Biomedical Sciences, University of Padova, Italy (N.P., A.D.B., M.S., M.M., T.Z.)
- Venetian Institute of Molecular Medicine, Padova, Italy (N.P., A.D.B., M.S., M.M., T.Z.)
- Department of Cardiac, Thoracic, and Vascular Sciences, University of Padova, Italy (A.D.B., A.A., T.Z.)
| | - Fulvio Morello
- A.O.U. Città della Salute e della Scienza di Torino, S.C. Emergency Medicine, Torino, Italy (V.S., F.M.)
| | - Francesco Novelli
- Center for Experimental Research and Medical Studies, Azienda Ospedaliera Universitaria Città della Salute e della Scienza di Torino, Italy (P.C., F.N.)
| | - Emilio Hirsch
- Department of Molecular Biotechnology and Health Sciences, Molecular Biotechnology Center, University of Torino, Italy (M.L., V.S., M.C.D.S., J.C., J.P.M., M.M., F.P., L.R., I.F., A.P., P.E.P., R.C.P.L.-J., E.H., A.G.)
| | - Alessandra Ghigo
- Department of Molecular Biotechnology and Health Sciences, Molecular Biotechnology Center, University of Torino, Italy (M.L., V.S., M.C.D.S., J.C., J.P.M., M.M., F.P., L.R., I.F., A.P., P.E.P., R.C.P.L.-J., E.H., A.G.)
| |
Collapse
|
33
|
Acosta MC, Kundro M, Viloria G, Peressín Paz A, Morello F, Latorre F, Seoane E, Toibaro J, Losso M. The role of brain biopsy in the clinical management of HIV-related focal brain lesions. HIV Med 2018; 19:673-678. [PMID: 30004180 DOI: 10.1111/hiv.12646] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/23/2018] [Indexed: 12/01/2022]
Abstract
OBJECTIVES Up to 20% of HIV-related focal brain lesion (FBL) diagnoses cannot be determined without invasive procedures. In such cases, brain biopsy is an important step in the evaluation algorithm. The aims of this study were to describe the clinical outcomes of patients with FBL, the proportion of diagnoses confirmed by brain biopsies and their aetiologies, and to analyse the proportion of patients in whom the biopsy motivated a change in therapeutic management. METHODS A retrospective cohort study was performed. The data from clinical records of patients with HIV-related FBL admitted between January 2005 and December 2015 were reviewed. RESULTS A total of 137 patients were included in the study. The median age was 39 years [interquartile range (IQR) 33-44.5 years]. The median CD4 count was 54 cells/μL (IQR 21-124 cells/μL). Cerebral brain biopsy was performed in 21.16% of patients (29 of 137); 68.9% of these individuals (20 of 29) were diagnosed by histology, with results of central nervous system (CNS) lymphoma in 20.6% (six of 29), progressive multifocal leucoencephalopathy in 6.8% (two of 29), toxoplasmosis in 6.8% (two of 29), tuberculoma in 6.8% (two of 29), and other diagnoses in 27.6% (eight of 29). In nine patients, the histology was nonspecific. In 75.8% of patients (22 of 29), the result of the biopsy led to a change in the therapeutic management. We did not observe higher rates of mortality related to the procedure. Overall mortality at 30 and 90 days was similar in patients who were and were not biopsied. CONCLUSIONS In this retrospective cohort study, cerebral biopsy was associated with significant adjustments in therapeutic management for a high percentage of patients.
Collapse
Affiliation(s)
- M C Acosta
- HIV Unit, JM Ramos Mejía Hospital, Buenos Aires, Argentina
| | - M Kundro
- HIV Unit, JM Ramos Mejía Hospital, Buenos Aires, Argentina
| | - G Viloria
- HIV Unit, JM Ramos Mejía Hospital, Buenos Aires, Argentina
| | - A Peressín Paz
- Neurosurgery Unit, JM Ramos Mejía Hospital, Buenos Aires, Argentina
| | - F Morello
- Neurosurgery Unit, JM Ramos Mejía Hospital, Buenos Aires, Argentina
| | - F Latorre
- Neurosurgery Unit, JM Ramos Mejía Hospital, Buenos Aires, Argentina
| | - E Seoane
- Neurosurgery Unit, JM Ramos Mejía Hospital, Buenos Aires, Argentina
| | - J Toibaro
- HIV Unit, JM Ramos Mejía Hospital, Buenos Aires, Argentina
| | - M Losso
- HIV Unit, JM Ramos Mejía Hospital, Buenos Aires, Argentina
| |
Collapse
|
34
|
Sala V, Li M, Margaria J, Sciarretta S, Morello F, Sandri M, Mongillo M, Zaglia T, Hirsch E, Ghigo A. Doxorubicin-induced mitochondrial damage activates PI3Kgamma and inhibits protective cardiac autophagy. J Mol Cell Cardiol 2018. [DOI: 10.1016/j.yjmcc.2018.05.101] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
|
35
|
Bova C, Vanni S, Prandoni P, Morello F, Dentali F, Bernardi E, Mumoli N, Bucherini E, Barbar S, Picariello C, Enea I, Pesavento R, Bottino F, Jiménez D. A prospective validation of the Bova score in normotensive patients with acute pulmonary embolism. Thromb Res 2018; 165:107-111. [PMID: 29631073 DOI: 10.1016/j.thromres.2018.04.002] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2018] [Revised: 03/17/2018] [Accepted: 04/02/2018] [Indexed: 11/17/2022]
Abstract
BACKGROUND The Bova score has shown usefulness in the identification of intermediate-high risk patients with acute pulmonary embolism (PE), but lacks prospective validation. The aim of this study was to prospectively validate the Bova score in different settings from the original derivation cohort. METHODS Consecutive, normotensive patients with acute PE recruited at 13 academic or general hospitals were stratified, using their baseline data, into the three Bova risk stages (I-III). The primary outcome was the 30-day composite of PE-related mortality, hemodynamic collapse and non-fatal PE recurrences in the three risk categories. RESULTS In the study period, 639 patients were enrolled. The primary end point occurred in 45 patients (7.0%; 95% Confidence Intervals, 5.2%-9.3%). Risk stage correlated with the PE-related complication rate (stage I, 2.9%; stage II, 17%; stage III, 27%). Patients classified as stage III by the Bova score had a 6.5-fold increased risk for adverse outcomes (3.1-13.5, p < 0.001) compared with stages I and II combined. Rescue thrombolysis increased from stage I to stage III (0.6%, 12% and 15% respectively). All-cause mortality (5.3%) did not substantially differ among the stages. CONCLUSIONS The Bova score accurately stratifies normotensive patients with acute PE into stages of increasing risk of 30-day PE-related complications.
Collapse
Affiliation(s)
- Carlo Bova
- Department of Internal Medicine, Azienda Ospedaliera (Coordinating Center), Cosenza, Italy.
| | - Simone Vanni
- Emergency Department, Azienda Ospedaliero-Universitaria Careggi, Firenze, Italy
| | - Paolo Prandoni
- Department of Cardiovascular Sciences, Vascular Medicine Unit, University of Padua, Italy
| | - Fulvio Morello
- Emergency Department, A.O.U. Città della Salute e della Scienza di Torino, Ospedale Molinette, Torino, Italy
| | - Francesco Dentali
- Department of Clinical and Experimental Medicine, Insubria University, Varese, Italy
| | - Enrico Bernardi
- Department of Emergency Medicine, ULSS n.7, Conegliano, TV, Italy
| | - Nicola Mumoli
- Department of Internal Medicine, Ospedale Civile Livorno, Italy
| | | | - Sofia Barbar
- Department of Internal and Emergency Medicine, Civic Hospital of Camposampiero (PD), Italy
| | - Claudio Picariello
- Unit of Cardiology, Santa Maria della Misericordia Hospital, Rovigo, Italy
| | - Iolanda Enea
- Emergency Care Department, Anna e S. Sebastiano Hospital, Caserta, Italy
| | | | | | - David Jiménez
- Respiratory Department, Ramón y Cajal Hospital, IRYCIS, Alcalá de Henares University, Madrid, Spain
| |
Collapse
|
36
|
Li M, Sala V, Pianca N, Sciarretta S, Morello F, Sandri M, Mongillo M, Zaglia T, Hirsch E, Ghigo A. P318Phosphoinositide 3-kinase gamma inhibition as a novel strategy to reactivate targeted autophagy and limit Doxorubicin-induced cardiotoxicity. Cardiovasc Res 2018. [DOI: 10.1093/cvr/cvy060.233] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- M Li
- University of Turin, Department of Molecular Biotechnology and Health Sciences, Molecular Biotechnology Center, Turin, Italy
| | - V Sala
- University of Turin, Department of Molecular Biotechnology and Health Sciences, Molecular Biotechnology Center, Turin, Italy
| | - N Pianca
- University of Padova, Department of Biomedical Sciences and Venetian Institute of Molecular Medicine, Padua, Italy
| | - S Sciarretta
- Sapienza University of Rome, Department of Medical and Surgical Sciences and Biotechnologies, Latina, Italy
| | - F Morello
- Hospital 'Città della Salute e della Scienza di Torino', S.C. Emergency Medicine, Turin, Italy
| | - M Sandri
- University of Padova, Department of Biomedical Sciences and Venetian Institute of Molecular Medicine, Padua, Italy
| | - M Mongillo
- University of Padova, Department of Biomedical Sciences and Venetian Institute of Molecular Medicine, Padua, Italy
| | - T Zaglia
- University of Padova, Department of Biomedical Sciences and Venetian Institute of Molecular Medicine, Padua, Italy
| | - E Hirsch
- University of Turin, Department of Molecular Biotechnology and Health Sciences, Molecular Biotechnology Center, Turin, Italy
| | - A Ghigo
- University of Turin, Department of Molecular Biotechnology and Health Sciences, Molecular Biotechnology Center, Turin, Italy
| |
Collapse
|
37
|
Li M, Sala V, De Santis M, Cimino J, Cappello P, Pianca N, Martini M, Lazzarini E, Pirozzi F, Tocchetti C, Sandri M, Ameri P, Sciarretta S, Mongillo M, Zaglia T, Morello F, Novelli F, Hirsch E, Ghigo A. PI3Kγ inhibition protects from anthracycline-induced heart failure and reduces tumor growth. Vascul Pharmacol 2018. [DOI: 10.1016/j.vph.2017.12.035] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
|
38
|
Nazerian P, Mueller C, Soeiro ADM, Leidel BA, Salvadeo SAT, Giachino F, Vanni S, Grimm K, Oliveira MT, Pivetta E, Lupia E, Grifoni S, Morello F, Capretti E, Castelli M, Gualtieri S, Trausi F, Battista S, Bima P, Carbone F, Tizzani M, Veglio MG, Badertscher P, Boeddinghaus J, Nestelberger T, Twerenbold R. Diagnostic Accuracy of the Aortic Dissection Detection Risk Score Plus D-Dimer for Acute Aortic Syndromes. Circulation 2018; 137:250-258. [DOI: 10.1161/circulationaha.117.029457] [Citation(s) in RCA: 141] [Impact Index Per Article: 23.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/12/2017] [Accepted: 09/29/2017] [Indexed: 12/31/2022]
Affiliation(s)
- Peiman Nazerian
- Department of Emergency Medicine, Careggi University Hospital, Firenze, Italy (P.N., S.V., S.G.)
| | - Christian Mueller
- Cardiovascular Research Institute, University Hospital of Basel, Switzerland (C.M., K.G.)
| | | | - Bernd A. Leidel
- Department of Emergency Medicine, Campus Benjamin Franklin, Charité–Universitätsmedizin Berlin, Germany (B.A.L.)
| | | | - Francesca Giachino
- S.C. Medicina d’Urgenza, A.O.U. Città della Salute e della Scienza, Molinette Hospital, Torino, Italy (F.G., E.P., E.L., F.M.)
| | - Simone Vanni
- Department of Emergency Medicine, Careggi University Hospital, Firenze, Italy (P.N., S.V., S.G.)
| | - Karin Grimm
- Cardiovascular Research Institute, University Hospital of Basel, Switzerland (C.M., K.G.)
| | | | - Emanuele Pivetta
- Cancer Epidemiology Unit and CPO Piemonte, Department of Medical Sciences, Università degli Studi di Torino, Italy (E.P.)
- S.C. Medicina d’Urgenza, A.O.U. Città della Salute e della Scienza, Molinette Hospital, Torino, Italy (F.G., E.P., E.L., F.M.)
| | - Enrico Lupia
- S.C. Medicina d’Urgenza, A.O.U. Città della Salute e della Scienza, Molinette Hospital, Torino, Italy (F.G., E.P., E.L., F.M.)
| | - Stefano Grifoni
- Department of Emergency Medicine, Careggi University Hospital, Firenze, Italy (P.N., S.V., S.G.)
| | - Fulvio Morello
- S.C. Medicina d’Urgenza, A.O.U. Città della Salute e della Scienza, Molinette Hospital, Torino, Italy (F.G., E.P., E.L., F.M.)
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
39
|
Abstract
PURPOSE OF REVIEW Heart Failure with preserved Ejection Fraction (HFpEF) is a prevalent disease with considerable individual and societal burden. HFpEF patients often suffer from multiple pathological conditions thatcomplicate management and adversely affect outcome, including pulmonary hypertension and chronic obstructive pulmonary disease (COPD). To date, no treatment proved to be fully effective in reducing morbidity and mortality in HFpEF, possibly due to an incomplete understanding of the underlying molecular mechanisms. RECENT FINDINGS The emerging view proposes chronic systemic inflammation, leading to endothelial dysfunction and interstitial fibrosis, as a prominent cause of HFpEF, rather than a mere co-existent disease. In the last decade, efforts from pharmaceutical companies attempted to target pharmacologically enzymes which play key roles in systemic and lung inflammation, such as the cyclic nucleotide-degrading enzymes phosphodiesterases (PDEs) and phosphoinositide-3 phosphate kinases (PI3Ks), especially to limit COPD. In this review, we will summarize major successes and drawbacks of hitting these enzymes to tackle inflammation in HFpEF-associated co-morbidities, with a major focus on the results of completed and ongoing clinical trials. Finally, we will discuss the potential of repurposing and/or developing new PDE and PI3K inhibitors for HFpEF therapy.
Collapse
Affiliation(s)
- Valentina Sala
- Department of Molecular Biotechnology, Molecular Biotechnology Center, University of Torino, Torino, Italy
- S.C. Medicina d'Urgenza, A.O.U. Città della Salute e della Scienza, Molinette Hospital, Torino, Italy
| | - Jean Piero Margaria
- Department of Molecular Biotechnology, Molecular Biotechnology Center, University of Torino, Torino, Italy
| | - Alessandra Murabito
- Department of Molecular Biotechnology, Molecular Biotechnology Center, University of Torino, Torino, Italy
| | - Fulvio Morello
- S.C. Medicina d'Urgenza, A.O.U. Città della Salute e della Scienza, Molinette Hospital, Torino, Italy
| | - Alessandra Ghigo
- Department of Molecular Biotechnology, Molecular Biotechnology Center, University of Torino, Torino, Italy
| | - Emilio Hirsch
- Department of Molecular Biotechnology, Molecular Biotechnology Center, University of Torino, Torino, Italy.
| |
Collapse
|
40
|
Morello F, Li M, Cimino J, De Santis M, Pianca N, Franco I, Sciarretta S, Sandri M, Zaglia T, Mongillo M, Hirsch E, Ghigo A. P6263Phosphoinositide 3-kinase gamma inhibition protects against anthracycline-induced cardiomyopathy by boosting cardiac autophagy. Eur Heart J 2017. [DOI: 10.1093/eurheartj/ehx493.p6263] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
|
41
|
Vanni S, Nazerian P, Bova C, Bondi E, Morello F, Pepe G, Paladini B, Liedl G, Cangioli E, Grifoni S, Jiménez D. Comparison of clinical scores for identification of patients with pulmonary embolism at intermediate-high risk of adverse clinical outcome: the prognostic role of plasma lactate. Intern Emerg Med 2017; 12:657-665. [PMID: 27350628 DOI: 10.1007/s11739-016-1487-6] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2016] [Accepted: 06/09/2016] [Indexed: 10/21/2022]
Abstract
To compare the prognostic accuracy of the 2014 risk model of the European Society of Cardiology (ESC) and of Bova and TELOS scores for identification of normotensive patients with pulmonary embolism (PE) at high risk for short-term adverse events (i.e., intermediate-high risk patients), we retrospectively applied these tests to a prospective cohort of 994 normotensive patients with objectively confirmed PE. Sixty-three (6.3 %) patients reached the primary outcome, a composite of hemodynamic collapse and death within 7 days from diagnosis. The Bova and TELOS scores classified the same proportion of patients in intermediate-high risk category (5.9 and 5.7 %, respectively), with a similar primary outcome rate (18.6 and 21.1 %, respectively). The 2014 ESC model classified in the intermediate-high risk category the largest proportion of patients (12.5 %, p < 0.001 vs Bova and TELOS), with the lowest primary outcome rate (13 %, p = ns vs Bova and TELOS). When lactate determination was added to the Bova score, 112 patients (11.2 %) were classified in the intermediate-high risk category (p < 0.05 vs Bova and TELOS), with a slight increase in the primary outcome rate (25.9 %, p = 0.014 vs 2014 ESC model), allowing the recognition of a twofold higher number of patients reaching the primary outcome (29 vs 15, 11 and 12 patients in the 2014 ESC model, Bova and TELOS scores, respectively, p < 0.01 for all). The 2014 ESC model, Bova and TELOS scores identify a small number of intermediate-high risk patients with PE, without differences among tests. Adding plasma lactate to the Bova score significantly improves the identification of intermediate-high risk patients.
Collapse
Affiliation(s)
- Simone Vanni
- Emergency Department, Azienda Ospedaliero-Universitaria Careggi, Largo Brambilla 3, 50139, Florence, Italy.
| | - Peiman Nazerian
- Emergency Department, Azienda Ospedaliero-Universitaria Careggi, Largo Brambilla 3, 50139, Florence, Italy
| | - Carlo Bova
- Department of Medicine, University Hospital of Cosenza, Cosenza, Italy
| | - Ernesta Bondi
- Emergency Department, Azienda Ospedaliero-Universitaria Careggi, Largo Brambilla 3, 50139, Florence, Italy
| | - Fulvio Morello
- Emergency Department, A.O.U. Città della Salute e della Scienza di Torino, Ospedale Molinette, Turin, Italy
| | - Giuseppe Pepe
- Emergency Department, Azienda Ospedaliero-Universitaria Careggi, Largo Brambilla 3, 50139, Florence, Italy
| | - Barbara Paladini
- Emergency Department, Azienda Ospedaliero-Universitaria Careggi, Largo Brambilla 3, 50139, Florence, Italy
| | - Giovanni Liedl
- Emergency Department, Azienda Ospedaliero-Universitaria Careggi, Largo Brambilla 3, 50139, Florence, Italy
| | - Elisabetta Cangioli
- Emergency Department, Azienda Ospedaliero-Universitaria Careggi, Largo Brambilla 3, 50139, Florence, Italy
| | - Stefano Grifoni
- Emergency Department, Azienda Ospedaliero-Universitaria Careggi, Largo Brambilla 3, 50139, Florence, Italy
| | - David Jiménez
- Respiratory Department, Ramón y Cajal Hospital, IRYCIS, Alcalá de Henares University, Madrid, Spain
| |
Collapse
|
42
|
Morello F, Nazerian P, Mueller C, Soeiro A, Leidel B, Salvadeo S, Giachino F, Vanni S, Grimm K, Tavares De Oliveira M, Veglio M, Gualtieri S, Grifoni S, Lupia E. P6021Rule-out of acute aortic syndrome by integration of the aortic dissection detection risk score plus d-dimer: preliminary data from the ADvISED prospective multicenter study. Eur Heart J 2017. [DOI: 10.1093/eurheartj/ehx493.p6021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- F. Morello
- A.O.U. Città della Salute e della Scienza, Ospedale Molinette, Emergency Department, Torino, Italy
| | | | - C. Mueller
- University Hospital Basel, Cardiovascular Research Institute, Basel, Switzerland
| | - A. Soeiro
- University of São Paulo, Heart Institute, Emergency Care Unit, São Paulo, Brazil
| | - B.A. Leidel
- Charité - Universitätsmedizin Berlin, Campus Benjamin Franklin, Department of Emergency Medicine, Berlin, Germany
| | - S. Salvadeo
- Policlinic Foundation San Matteo IRCCS, Emergency Medicine, Pavia, Italy
| | - F. Giachino
- A.O.U. Città della Salute e della Scienza, Ospedale Molinette, Emergency Department, Torino, Italy
| | - S. Vanni
- A.O.U. Careggi, Emergency, Firenze, Italy
| | - K. Grimm
- University Hospital Basel, Cardiovascular Research Institute, Basel, Switzerland
| | | | - M.G. Veglio
- A.O.U. Città della Salute e della Scienza, Ospedale Molinette, Emergency Department, Torino, Italy
| | | | - S. Grifoni
- A.O.U. Careggi, Emergency, Firenze, Italy
| | - E. Lupia
- A.O.U. Città della Salute e della Scienza, Ospedale Molinette, Emergency Department, Torino, Italy
| | | |
Collapse
|
43
|
Lira K, Balarini L, De Lima S, Azevedo A, De Carvalho A, Paschoal V, Myiamoto S, De Souza A, Rocha P, Zanon T, Serrano E, Duque R, Gavi M, Dinis V, Caser L, Salume F, Dalmaso A, Burian A, Pinto L, Brandão, Polito E, Clemente T, Magalhaes E, Rodrigues L, Morello F, De Oliveira K, Thebit M, Bissoli M, Gouvea S, Assis O, De Moura L, Valim V. VACINAÇÃO ANTI‐AMARÍLICA EM PACIENTES COM DOENÇAS REUMÁTICAS IMUNOMEDIADAS: ANÁLISE RETROSPECTIVA. Revista Brasileira de Reumatologia 2017. [DOI: 10.1016/j.rbr.2017.06.119] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
|
44
|
Abstract
Hypertensive encephalopathy is a syndrome consisting of headache, seizures, visual changes, and other neurologic disturbances in patients with elevated systemic blood pressure. The purpose of this study was to analyse the clinical and neuroradiological findings in nine patients with hypertensive encephalopathy, observed in five years. CT (n = 13), and MR (n = 12), examinations performed in these patients before and after resolution of symptoms were reviewed. Six had the preeclampsia-eclampsia syndrome, and three had hypertensive encephalopathy due to other causes. CT and MR findings in all patients having these examinations were indicative of oedema in the cortex and subcortical white matter in the occipital lobes. Two of the nine patients also had similar findings in the cerebellum and frontal lobes. The findings on the CT and MR studies resolved on follow-up examinations performed after the hypertension was corrected. Our results suggest that the radiological findings associated with hypertensive encephalopathy in the appropriate clinical setting are very useful to achieve an early diagnosis.
Collapse
Affiliation(s)
| | - E. Zanella
- Servizio di Radiologia, Ospedale Civile; Arzignano (VI)
| | | | - G. Loro
- Servizio di Radiologia, Ospedale Civile; Arzignano (VI)
| | - L. Simonetti
- Servizio di Neuroradiologia, Ospedale Bellaria; Bologna
| | - M. Leonardi
- Servizio di Neuroradiologia, Ospedale Bellaria; Bologna
| |
Collapse
|
45
|
Ceccarelli F, Cipriano E, Perricone C, Leccese I, Massaro L, Miranda F, Morello F, Pacucci V, Orefice V, Pendolino M, Pirone C, Spinelli F, Truglia S, Alessandri C, Valesini G, Conti F. FRI0328 A Complete Remission Lasting at Least One Year Influences The Outcome in Patients Affected by SLE: Results from A Large Monocentric Cohort. Ann Rheum Dis 2016. [DOI: 10.1136/annrheumdis-2016-eular.4586] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
|
46
|
Ceccarelli F, Massaro L, Morello F, Perricone C, Palermo A, Spinelli F, Alessandri C, Chistolini A, Valesini G, Conti F. AB0447 Anti-Phospholipid Positivity in Healthy Subjects: Evaluation of Risk for Thrombotic Event after A 5 Years Follow-Up. Ann Rheum Dis 2016. [DOI: 10.1136/annrheumdis-2016-eular.4862] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
|
47
|
Spinelli F, Ceccarelli F, Morello F, Massaro L, Alessandri C, Valesini G, Conti F. THU0290 Twelve Months Survival Rate and Causes of Withdrawal of Belimumab in Systemic Lupus Erythematosus in A Real Life Setting. Ann Rheum Dis 2016. [DOI: 10.1136/annrheumdis-2016-eular.4333] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
|
48
|
Morello F, Nazerian P, Lupia E. Lost in perfusion. Eur J Cardiothorac Surg 2016; 50:586. [PMID: 27141099 DOI: 10.1093/ejcts/ezw097] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/04/2015] [Accepted: 02/26/2016] [Indexed: 11/13/2022] Open
Affiliation(s)
- Fulvio Morello
- Emergency Department, A.O.U. Città della Salute e della Scienza, Turin, Italy
| | | | - Enrico Lupia
- Emergency Department, A.O.U. Città della Salute e della Scienza, Turin, Italy Department of Medical Sciences, Università degli Studi di Torino, Turin, Italy
| |
Collapse
|
49
|
Matsushita K, Morello F, Zhang Z, Masuda T, Iwanaga S, Steffensen KR, Gustafsson JÅ, Pratt RE, Dzau VJ. Nuclear hormone receptor LXRα inhibits adipocyte differentiation of mesenchymal stem cells with Wnt/beta-catenin signaling. J Transl Med 2016; 96:230-8. [PMID: 26595172 PMCID: PMC4731266 DOI: 10.1038/labinvest.2015.141] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2015] [Revised: 07/31/2015] [Accepted: 08/15/2015] [Indexed: 01/15/2023] Open
Abstract
Nuclear hormone receptor liver X receptor-alpha (LXRα) has a vital role in cholesterol homeostasis and is reported to have a role in adipose function and obesity although this is controversial. Conversely, mesenchymal stem cells (MSCs) are suggested to be a major source of adipocyte generation. Accordingly, we examined the role of LXRα in adipogenesis of MSCs. Adult murine MSCs (mMSCs) were isolated from wild-type (WT) and LXR-null mice. Using WT mMSCs, we further generated cell lines stably overexpressing GFP-LXRα (mMSC/LXRα/GFP) or GFP alone (mMSC/GFP) by retroviral infection. Confluent mMSCs were differentiated into adipocytes by the established protocol. Compared with MSCs isolated from WT mice, MSCs from LXR-null mice showed significantly increased adipogenesis, as determined by lipid droplet accumulation and adipogenesis-related gene expression. Moreover, mMSCs stably overexpressing GFP-LXRα (mMSC/LXRα/GFP) exhibited significantly decreased adipogenesis compared with mMSCs overexpressing GFP alone (mMSC/GFP). Since Wnt/beta-catenin signaling is reported to inhibit adipogenesis, we further examined it. The LXR-null group showed significantly decreased Wnt expression accompanied by a decrease of cellular beta-catenin (vs WT). The mMSC/LXRα/GFP group exhibited significantly increased Wnt expression accompanied by an increase of cellular beta-catenin (vs mMSC/GFP). These data demonstrate that LXRα has an inhibitory effect on adipogenic differentiation in mMSCs with Wnt/beta-catenin signaling. These results provide important insights into the pathophysiology of obesity and obesity-related consequences such as metabolic syndrome and may identify potential therapeutic targets.
Collapse
Affiliation(s)
- Kenichi Matsushita
- Department of Medicine, Duke University Medical Center, GSRB II Bldg., Durham, NC 27710, USA,Second Department of Internal Medicine, Kyorin University School of Medicine, Tokyo 181-8611, Japan
| | - Fulvio Morello
- Department of Medicine, Duke University Medical Center, GSRB II Bldg., Durham, NC 27710, USA
| | - Zhiping Zhang
- Department of Medicine, Duke University Medical Center, GSRB II Bldg., Durham, NC 27710, USA
| | - Tomoko Masuda
- Department of Medicine, Keio University School of Medicine, Tokyo 160-8582, Japan
| | - Shiro Iwanaga
- Department of Cardiology, Saitama Medical University and Saitama International Medical Center, Saitama 350-1298, Japan
| | - Knut R. Steffensen
- Department of Bioscience and Nutrition, Karolinska Institutet, Huddinge, Sweden
| | - Jan-Åke Gustafsson
- Department of Bioscience and Nutrition, Karolinska Institutet, Huddinge, Sweden,Center for Nuclear Receptors and Cell Signaling, Department of Biology and Biochemistry, University of Houston, Houston, TX 77204, USA
| | - Richard E. Pratt
- Department of Medicine, Duke University Medical Center, GSRB II Bldg., Durham, NC 27710, USA
| | - Victor J. Dzau
- Department of Medicine, Duke University Medical Center, GSRB II Bldg., Durham, NC 27710, USA,Institute of Medicine, 500 Fifth St NW, Washington, DC 20001, USA
| |
Collapse
|
50
|
Morello F, Ravetti A, Nazerian P, Liedl G, Veglio MG, Battista S, Vanni S, Pivetta E, Montrucchio G, Mengozzi G, Rinaldi M, Moiraghi C, Lupia E. Plasma Lactate Dehydrogenase Levels Predict Mortality in Acute Aortic Syndromes: A Diagnostic Accuracy and Observational Outcome Study. Medicine (Baltimore) 2016; 95:e2776. [PMID: 26871831 PMCID: PMC4753927 DOI: 10.1097/md.0000000000002776] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/16/2023] Open
Abstract
In acute aortic syndromes (AAS), organ malperfusion represents a key event impacting both on diagnosis and outcome. Increased levels of plasma lactate dehydrogenase (LDH), a biomarker of malperfusion, have been reported in AAS, but the performance of LDH for the diagnosis of AAS and the relation of LDH with outcome in AAS have not been evaluated so far.This was a bi-centric prospective diagnostic accuracy study and a cohort outcome study. From 2008 to 2014, patients from 2 Emergency Departments suspected of having AAS underwent LDH assay at presentation. A final diagnosis was obtained by aortic imaging. Patients diagnosed with AAS were followed-up for in-hospital mortality.One thousand five hundred seventy-eight consecutive patients were clinically eligible, and 999 patients were included in the study. The final diagnosis was AAS in 201 (20.1%) patients. Median LDH was 424 U/L (interquartile range [IQR] 367-557) in patients with AAS and 383 U/L (IQR 331-460) in patients with alternative diagnoses (P < 0.001). Using a cutoff of 450 U/L, the sensitivity of LDH for AAS was 44% (95% confidence interval [CI] 37-51) and the specificity was 73% (95% CI 69-76). Overall in-hospital mortality for AAS was 23.8%. Mortality was 32.6% in patients with LDH ≥ 450 U/L and 16.8% in patients with LDH < 450 U/L (P = 0.006). Following stratification according to LDH quartiles, in-hospital mortality was 12% in the first (lowest) quartile, 18.4% in the second quartile, 23.5% in the third quartile, and 38% in the fourth (highest) quartile (P = 0.01). LDH ≥ 450 U/L was further identified as an independent predictor of death in AAS both in univariate and in stepwise logistic regression analyses (odds ratio 2.28, 95% CI 1.11-4.66; P = 0.025), in addition to well-established risk markers such as advanced age and hypotension. Subgroup analysis showed excess mortality in association with LDH ≥ 450 U/L in elderly, hemodynamically stable and in nonsurgically treated patients.Plasma LDH constitutes a biomarker of poor outcome in patients with AAS. LDH is a rapid and universally available assay that could be used to improve risk stratification and to individualize treatment in patient groups where options are controversial.
Collapse
Affiliation(s)
- Fulvio Morello
- From the S.C. Medicina d'Urgenza (FM, AR, MGV, SB, EP, CM, EL) and Laboratory of Biochemical Chemistry (GMengozzi), A.O.U. Città della Salute e della Scienza, Torino, Italy; Emergency Department, A.O.U. Careggi, Firenze, Italy (PN, GL, SV); and Cancer Epidemiology Unit (EP), Department of Medical Sciences (GMontrucchio, EL), and Division of Cardiac Surgery, Department of Surgical Sciences (MR), Università degli Studi di Torino, Torino, Italy
| | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|