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Ryll MJ, Zodl A, Weingarten TN, Rabinstein AA, Warner DO, Schroeder DR, Sprung J. Predicting Hospital Survival in Patients Admitted to ICU with Pulmonary Embolism. J Intensive Care Med 2024; 39:455-464. [PMID: 37964551 PMCID: PMC10935623 DOI: 10.1177/08850666231212875] [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] [Indexed: 11/16/2023]
Abstract
OBJECTIVE The Pulmonary Embolism Severity Index (PESI) and simplified PESI (sPESI) predict mortality for patients with PE. We compared PESI/sPESI to the Acute Physiology and Chronic Health Evaluation IV (APACHE-IV) in predicting mortality in patients with PE admitted to the intensive care unit (ICU). Additionally, we assessed the performance of a novel ICU-sPESI score created by adding three clinical variables associated with acuity of PE presentation (intubation, confusion [altered mental status], use of vasoactive infusions) to sPESI. MATERIALS AND METHODS Using the eICU Collaborative Research Database from 2014 to 2015, we conducted a large retrospective cohort study of adult patients admitted to the ICU with a primary diagnosis of PE. We calculated APACHE-IV, PESI, sPESI, and ICU-sPESI scores and compared their performance for predicting in-hospital mortality using area under the receiver operating characteristic (AUROC) curve. Score thresholds for >99% negative predictive values (NPV) were calculated for each score. Survival was estimated using the Kaplan-Meier method. RESULTS We included 1424 PE cases. In-hospital mortality was 6.3% [95% CI: 5.1%-7.6%]. AUROC for APACHE-IV, PESI, and sPESI were 0.870, 0.848, and 0.777, respectively. APACHE-IV and PESI outperformed sPESI (P < 0.01 for both comparisons), while APACHE-IV and PESI demonstrated similar performance (P = 0.322). The ICU-sPESI performance was similar to APACHE-IV and PESI (AUROC = 0.847; AUROC comparison: APACHE-IV vs ICU-sPESI: P = 0.396; PESI vs ICU-sPESI: P = 0.945). Hospital mortality for ICU-sPESI scores 0-2 was 1.1%, and for scores 3, 4, 5, 6, and ≥7 was 8.6%, 11.7%, 29.2%, 37.5%, and 76.9%, respectively. Score thresholds for >99% NPV were ≤48 for APACHE-IV, ≤115 for PESI, and 0 points for sPESI and ICU-sPESI. CONCLUSIONS By accounting for severity of PE presentation, our newly proposed ICU-sPESI score provided improved PE mortality prediction compared to the original sPESI score and offered excellent discrimination of mortality risk.
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Affiliation(s)
- Martin J. Ryll
- Faculty of Medicine, Ludwig Maximilian University of Munich, Munich, Germany
| | - Aurelia Zodl
- Faculty of Medicine, Ludwig Maximilian University of Munich, Munich, Germany
| | - Toby N. Weingarten
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic College of Medicine and Science, Rochester, Minnesota, USA
| | | | - David O. Warner
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic College of Medicine and Science, Rochester, Minnesota, USA
| | - Darrell R. Schroeder
- Health Sciences Research, Division of Epidemiology, Mayo Clinic College of Medicine and Science, Rochester, Minnesota, USA
| | - Juraj Sprung
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic College of Medicine and Science, Rochester, Minnesota, USA
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Zhang Y, Chen Y, Chen H, Dong C, Hu X, Xu X, Zhu L, Cheng Z, Wang D, Zhang Z, Xie W, Wan J, Yang P, Wang S, Wang C, Zhai Z. Performance of the Simplified Pulmonary Embolism Severity Index in predicting 30-day mortality after acute pulmonary embolism: Validation from a large-scale cohort. Eur J Intern Med 2024:S0953-6205(24)00044-X. [PMID: 38350784 DOI: 10.1016/j.ejim.2024.01.037] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/03/2023] [Revised: 01/18/2024] [Accepted: 01/30/2024] [Indexed: 02/15/2024]
Abstract
BACKGROUND The performance of existing prognostic scores including the simplified Pulmonary Embolism Severity Index (sPESI) for short-term mortality of non-high-risk PE in Chinese population has not been widely validated. METHODS Non-high-risk patients were included from the prospective cohort of the China pUlmonary Thromboembolism REgistry Study (CURES). The sPESI, RIETE, Geneva, modified FAST, and Bova score were validated. The discriminatory performance was measured by the area under the curve (AUC). We also compared the sensitivity, odds ratio, specificity, positive predictive value and negative predictive value of these scores. RESULTS A total of 6,873 non-high-risk patients with acute PE were included and 241 (3.5 %) patients died within 30 days. Compared to the Geneva, modified FAST, and Bova score, the AUCs for predicting 30-day death of sPESI and RIETE score were higher at 0.712 (95 % CI, 0.680, 0.743) and 0.723 (95 % CI, 0.691, 0.755) respectively. The sPESI demonstrated the highest sensitivity at 0.809, while the RIETE score, Geneva, Modified FAST and BOVA score showed sensitivities of 0.622, 0.568, 0.477 and 0.502 respectively. A sPESI ⩾1 point was associated with a 4.7-fold increased risk of 30-day all-cause mortality (95 % CI, 3.427, 6.563, p < 0.001), while a RIETE score of ⩾1 point was associated with a 4.5-fold increased risk (95 % CI, 3.127, 6.341, p < 0.001). The Geneva score, modified FAST and Bova score showed inferior performance. CONCLUSIONS The implementation of the fewer-parameter, easier-to-calculate sPESI in Chinese patients with PE can help to discriminate patients with extremely low risk of short-term mortality for home treatment or early discharge.
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Affiliation(s)
- Yu Zhang
- China-Japan Friendship Hospital, Capital Medical University, Beijing, China; National Center for Respiratory Medicine, State Key Laboratory of Respiratory Health and Multimorbidity, National Clinical Research Center for Respiratory Diseases, Institute of Respiratory Medicine, Chinese Academy of Medical Sciences, Department of Pulmonary and Critical Care Medicine, Center of Respiratory Medicine, China-Japan Friendship Hospital, Beijing, China
| | - Yinong Chen
- National Center for Respiratory Medicine, State Key Laboratory of Respiratory Health and Multimorbidity, National Clinical Research Center for Respiratory Diseases, Institute of Respiratory Medicine, Chinese Academy of Medical Sciences, Department of Pulmonary and Critical Care Medicine, Center of Respiratory Medicine, China-Japan Friendship Hospital, Beijing, China; Peking University China-Japan Friendship School of Clinical Medicine, Beijing, China
| | - Hong Chen
- Department of Pulmonary and Critical Care Medicine, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Chunling Dong
- Department of Pulmonary and Critical Care Medicine, The Second Hospital of Jilin University, Changchun, China
| | - Xiaoyun Hu
- Department of Pulmonary and Critical Care Medicine, The First Hospital of Shanxi Medical University, Taiyuan, China
| | - Xiaomao Xu
- Department of Pulmonary and Critical Care Medicine, Beijing Hospital, Beijing, China
| | - Ling Zhu
- Department of Pulmonary and Critical Care Medicine, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, China
| | - Zhe Cheng
- Department of Pulmonary and Critical Care Medicine, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Dingyi Wang
- National Center for Respiratory Medicine, State Key Laboratory of Respiratory Health and Multimorbidity, National Clinical Research Center for Respiratory Diseases, Institute of Respiratory Medicine, Chinese Academy of Medical Sciences, Department of Pulmonary and Critical Care Medicine, Center of Respiratory Medicine, China-Japan Friendship Hospital, Beijing, China; Data and Project Management Unit, Institute of Clinical Medical Sciences, China-Japan Friendship Hospital, Beijing, China
| | - Zhu Zhang
- National Center for Respiratory Medicine, State Key Laboratory of Respiratory Health and Multimorbidity, National Clinical Research Center for Respiratory Diseases, Institute of Respiratory Medicine, Chinese Academy of Medical Sciences, Department of Pulmonary and Critical Care Medicine, Center of Respiratory Medicine, China-Japan Friendship Hospital, Beijing, China
| | - Wanmu Xie
- National Center for Respiratory Medicine, State Key Laboratory of Respiratory Health and Multimorbidity, National Clinical Research Center for Respiratory Diseases, Institute of Respiratory Medicine, Chinese Academy of Medical Sciences, Department of Pulmonary and Critical Care Medicine, Center of Respiratory Medicine, China-Japan Friendship Hospital, Beijing, China
| | - Jun Wan
- Department of Pulmonary and Critical Care Medicine, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Peiran Yang
- State Key Laboratory of Respiratory Health and Multimorbidity, Department of Physiology, Institute of Basic Medical Sciences, Chinese Academy of Medical Sciences and School of Basic Medicine, Peking Union Medical College, Beijing, China
| | - Shengfeng Wang
- Department of Epidemiology & Biostatistics, School of Public Health, Peking University Health Science Center, Beijing, China
| | - Chen Wang
- China-Japan Friendship Hospital, Capital Medical University, Beijing, China; National Center for Respiratory Medicine, State Key Laboratory of Respiratory Health and Multimorbidity, National Clinical Research Center for Respiratory Diseases, Institute of Respiratory Medicine, Chinese Academy of Medical Sciences, Department of Pulmonary and Critical Care Medicine, Center of Respiratory Medicine, China-Japan Friendship Hospital, Beijing, China; Peking University China-Japan Friendship School of Clinical Medicine, Beijing, China.
| | - Zhenguo Zhai
- China-Japan Friendship Hospital, Capital Medical University, Beijing, China; National Center for Respiratory Medicine, State Key Laboratory of Respiratory Health and Multimorbidity, National Clinical Research Center for Respiratory Diseases, Institute of Respiratory Medicine, Chinese Academy of Medical Sciences, Department of Pulmonary and Critical Care Medicine, Center of Respiratory Medicine, China-Japan Friendship Hospital, Beijing, China; Peking University China-Japan Friendship School of Clinical Medicine, Beijing, China.
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Bumroongkit C, Limsukon A, Liwsrisakun C, Deesomchok A, Pothirat C, Theerakittikul T, Trongtrakul K, Tajarernmuang P, Niyatiwatchanchai N, Inchai J, Chaiwong W. Validation of the Pulmonary Embolism Severity Index Risk Classification and the 2019 European Society of Cardiology Risk Stratification in the Southeast Asian Population with Acute Pulmonary Embolism. J Atheroscler Thromb 2023; 30:1601-1611. [PMID: 36967130 PMCID: PMC10627767 DOI: 10.5551/jat.64094] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2022] [Accepted: 02/02/2023] [Indexed: 06/18/2023] Open
Abstract
AIM To date, no studies representing the Southeast Asian population have validated the Pulmonary Embolism Severity Index (PESI) and 2019 European Society of Cardiology (ESC) risk stratification. Therefore, this study aimed to validate the PESI score, simplified PESI (sPESI), PESI risk classification, and 2019 ESC risk stratification in Southeast Asian patients with acute pulmonary embolism (APE). METHODS The present study is a 10-year cross-sectional study. Here, risk regressions were conducted to identify the PESI risk classification, sPESI, and 2019 ESC risk stratification as predictors for 30-day all-cause and PE-related mortalities. Receiver operating characteristic (ROC) curves were constructed to determine the diagnostic ability of the PESI score, sPESI score, PESI risk classification, and 2019 ESC risk stratification to predict 30-day mortality. RESULTS A total of 696 patients (male, 286; female, 410; mean age, 57.7±15.7 years) were included in this study from 2011 to 2020. The risk of 30-day all-cause mortality progressively increased with the 2019 ESC risk stratification, being approximately 6-fold higher in the high-risk than in the low-risk class [risk ratio: 6.24 (95% confidence interval (CI), 3.12, 12.47), P<0.001]. The risk of 30-day all-cause mortality with the PESI risk classification also increased with the risk classes, being approximately 6-fold higher in class V than in class I [adjusted risk ratio: 5.91 (95% CI, 2.25, 15.51), P<0.001]. The highest area under the receiver operating characteristic curve (AuROC) of the predictive model was the PESI score [AuROC=0.733 (95% CI, 0.685, 0.782)]. CONCLUSION Our study represents a good validation of the PESI and 2019 ESC risk stratification to predict 30-day mortality after APE diagnosis in the Southeast Asian population.
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Affiliation(s)
- Chaiwat Bumroongkit
- Division of Pulmonary, Critical Care and Allergy, Department of Internal Medicine, Faculty of Medicine, Chiangmai University, Chiang Mai, Thailand
| | - Atikun Limsukon
- Division of Pulmonary, Critical Care and Allergy, Department of Internal Medicine, Faculty of Medicine, Chiangmai University, Chiang Mai, Thailand
| | - Chalerm Liwsrisakun
- Division of Pulmonary, Critical Care and Allergy, Department of Internal Medicine, Faculty of Medicine, Chiangmai University, Chiang Mai, Thailand
| | - Athavudh Deesomchok
- Division of Pulmonary, Critical Care and Allergy, Department of Internal Medicine, Faculty of Medicine, Chiangmai University, Chiang Mai, Thailand
| | - Chaicharn Pothirat
- Division of Pulmonary, Critical Care and Allergy, Department of Internal Medicine, Faculty of Medicine, Chiangmai University, Chiang Mai, Thailand
| | - Theerakorn Theerakittikul
- Division of Pulmonary, Critical Care and Allergy, Department of Internal Medicine, Faculty of Medicine, Chiangmai University, Chiang Mai, Thailand
| | - Konlawij Trongtrakul
- Division of Pulmonary, Critical Care and Allergy, Department of Internal Medicine, Faculty of Medicine, Chiangmai University, Chiang Mai, Thailand
| | - Pattraporn Tajarernmuang
- Division of Pulmonary, Critical Care and Allergy, Department of Internal Medicine, Faculty of Medicine, Chiangmai University, Chiang Mai, Thailand
| | - Nutchanok Niyatiwatchanchai
- Division of Pulmonary, Critical Care and Allergy, Department of Internal Medicine, Faculty of Medicine, Chiangmai University, Chiang Mai, Thailand
| | - Juthamas Inchai
- Division of Pulmonary, Critical Care and Allergy, Department of Internal Medicine, Faculty of Medicine, Chiangmai University, Chiang Mai, Thailand
| | - Warawut Chaiwong
- Division of Pulmonary, Critical Care and Allergy, Department of Internal Medicine, Faculty of Medicine, Chiangmai University, Chiang Mai, Thailand
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Janisset L, Castan M, Poenou G, Lachand R, Mismetti P, Viallon A, Bertoletti L. Cardiac Biomarkers in Patients with Acute Pulmonary Embolism. Medicina (Kaunas) 2022; 58:medicina58040541. [PMID: 35454379 PMCID: PMC9025162 DOI: 10.3390/medicina58040541] [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] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/06/2022] [Revised: 04/10/2022] [Accepted: 04/13/2022] [Indexed: 12/15/2022]
Abstract
Pulmonary embolism is a frequent and potentially fatal disease. The major challenge of initial management lies in prognostic stratification. Since 2014, the European recommendations on the diagnosis and management of acute pulmonary embolism are based on assessing the risk stratification regarding hemodynamic status first, then on a combined risk assessment model using a clinical score, an imaging evaluation of right heart size and the concentration of a serum cardiac biomarker. Usual biomarkers cover cardiac ischemia (troponin and derivates) and dilatation (BNP and derivates). The aim of this review is to offer a practical update on the role of the Troponins and BNPs families of biomarkers and the prognosis of pulmonary embolism, and furthermore, to provide a brief overview of their place in current management.
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Affiliation(s)
- Luc Janisset
- Service des Urgences, CHU de St-Etienne, F-42055 Saint-Etienne, France; (L.J.); (M.C.); (A.V.)
- INSERM, UMR1059, Equipe Dysfonction Vasculaire et Hémostase, Université Jean-Monnet, F-42055 Saint-Etienne, France;
| | - Maxime Castan
- Service des Urgences, CHU de St-Etienne, F-42055 Saint-Etienne, France; (L.J.); (M.C.); (A.V.)
| | - Géraldine Poenou
- Service de Médecine Vasculaire et Thérapeutique, CHU de St-Etienne, F-42055 Saint-Etienne, France;
| | - Raphael Lachand
- Service de Médecine Intensive et Réanimation, CHU de St-Etienne, F-42055 Saint-Etienne, France;
| | - Patrick Mismetti
- INSERM, UMR1059, Equipe Dysfonction Vasculaire et Hémostase, Université Jean-Monnet, F-42055 Saint-Etienne, France;
- Service de Médecine Vasculaire et Thérapeutique, CHU de St-Etienne, F-42055 Saint-Etienne, France;
| | - Alain Viallon
- Service des Urgences, CHU de St-Etienne, F-42055 Saint-Etienne, France; (L.J.); (M.C.); (A.V.)
| | - Laurent Bertoletti
- INSERM, UMR1059, Equipe Dysfonction Vasculaire et Hémostase, Université Jean-Monnet, F-42055 Saint-Etienne, France;
- Service de Médecine Vasculaire et Thérapeutique, CHU de St-Etienne, F-42055 Saint-Etienne, France;
- INSERM, CIC-1408, CHU Saint-Etienne, F-42055 Saint-Etienne, France
- Correspondence: ; Tel.: +33-477-827-771; Fax: +33-477-820-482
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Slajus B, Brailovsky Y, Darwish I, Fareed J, Darki A. Utility of Blood Cellular Indices in the Risk Stratification of Patients Presenting with Acute Pulmonary Embolism. Clin Appl Thromb Hemost 2021; 27:10760296211052292. [PMID: 34846193 PMCID: PMC8649084 DOI: 10.1177/10760296211052292] [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] [Indexed: 11/16/2022] Open
Abstract
Pulmonary embolism (PE) clinical manifestations vary widely, and that scope is not fully captured by current all-cause mortality risk models. PE is associated with inflammatory, coagulation, and hemostatic imbalances so blood cellular indices may be prognostically useful. Complete blood count (CBC) data may improve current risk models like the simplified pulmonary embolism severity index (sPESI) for all-cause mortality, offering greater accuracy and analytic ability. Acute PE patients (n = 228) with confirmatory diagnostic imaging were followed for all-cause mortality. Blood cellular indices were assessed for association to all-cause mortality and were supplemented into sPESI using multivariate logistic regression. Multiple blood cellular indices were found to be significantly associated with all-cause mortality in acute PE. sPESI including red cell distribution width, hematocrit and neutrophil-lymphocyte ratio had better predictive ability as compared to sPESI alone (AUC: 0.852 vs 0.754). Blood cellular indices contribute an inflammatory and hemodynamic perspective not currently included in sPESI. CBC with differential is a widely used, low-cost test that can augment current risk stratification tools for all-cause mortality in acute PE patients.
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Affiliation(s)
- Brett Slajus
- Loyola University Medical Center, Stritch School of Medicine, Maywood, IL, USA
| | - Yevgeniy Brailovsky
- Advanced Heart Failure, Mechanical Circulatory Support, Heart Transplant, Jefferson Heart Institute, Sidney Kimmel School of Medicine, Thomas Jefferson University, Philadelphia, PA, USA
| | - Iman Darwish
- Loyola University Medical Center, Stritch School of Medicine, Maywood, IL, USA
| | - Jawed Fareed
- Cardiovascular Research Institute, Hemostasis and Thrombosis Research Division, 2456Loyola University Chicago, Health Sciences Division, Maywood, IL, USA
| | - Amir Darki
- Loyola University Medical Center, Stritch School of Medicine, Maywood, IL, USA
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Wu HD, Song ZK, Xu XY, Cao HY, Wei Q, Wang JF, Zhang X, Wang XW, Qin L. Combination of D-dimer and simplified pulmonary embolism severity index to improve prediction of hospital death in patients with acute pulmonary embolism. J Int Med Res 2021; 48:300060520962291. [PMID: 33050757 PMCID: PMC7570299 DOI: 10.1177/0300060520962291] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [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] [Indexed: 11/18/2022] Open
Abstract
Objective To investigate whether the combination of D-dimer and simplified pulmonary embolism severity index (sPESI) could improve prediction of in-hospital death from pulmonary embolism (PE). Methods Patients with PE (n = 272) were divided into a surviving group (n = 249) and an in-hospital death group (n = 23). Results Compared with surviving patients, patients who died in hospital had significantly higher rates of hypotension and tachycardia, reduced SaO2 levels, elevated D-dimer and troponin T levels, higher sPESI scores, and were more likely to be classified as high risk. Elevated D-dimer levels and high sPESI scores were significantly associated with in-hospital death. Using thresholds for D-dimer and sPESI of 3.175 ng/mL and 1.5, respectively, the specificity for prediction of in-hospital death was 0.357 and 0.414, respectively, and the area under the receiver operating characteristic curve (AUC) was 0.665 and 0.668, respectively. When D-dimer and sPESI were considered together, the specificity for prediction of in-hospital death increased to 0.838 and the AUC increased to 0.74. Conclusions D-dimer and sPESI were associated with in-hospital death from PE. Considering D-dimer levels together with sPESI can significantly improve the specificity of predicting in-hospital death for patients with PE.
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Affiliation(s)
- Hai-Di Wu
- Department of Cardiology, The First Hospital of Jilin University, Changchun, China
| | - Zi-Kai Song
- Department of Cardiology, The First Hospital of Jilin University, Changchun, China
| | - Xiao-Yan Xu
- Department of Cardiology, The First Hospital of Jilin University, Changchun, China
| | - Hong-Yan Cao
- Department of Cardiology, The First Hospital of Jilin University, Changchun, China
| | - Qi Wei
- Department of Cardiology, The First Hospital of Jilin University, Changchun, China
| | - Jun-Feng Wang
- Department of Cardiology, The First Hospital of Jilin University, Changchun, China
| | - Xue Zhang
- Department of Cardiology, The First Hospital of Jilin University, Changchun, China
| | - Xing-Wen Wang
- Department of Cardiology, The First Hospital of Jilin University, Changchun, China
| | - Ling Qin
- Department of Cardiology, The First Hospital of Jilin University, Changchun, China
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Morillo R, Jiménez D, Bikdeli B, Rodríguez C, Tenes A, Yamashita Y, Morimoto T, Kimura T, Vidal G, Ruiz-Giménez N, Espitia O, Monreal M. Refinement of a modified simplified Pulmonary Embolism Severity Index for elderly patients with acute pulmonary embolism. Int J Cardiol 2021; 335:111-117. [PMID: 33621625 DOI: 10.1016/j.ijcard.2021.02.039] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [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: 12/06/2020] [Revised: 01/25/2021] [Accepted: 02/12/2021] [Indexed: 11/19/2022]
Abstract
OBJECTIVE To evaluate the utility of a modified (i.e., without the variable "Age >80 years") simplified Pulmonary Embolism Severity Index (sPESI) in elderly patients with acute symptomatic pulmonary embolism (PE), and to derive and validate a refined version of the sPESI for identification of elderly patients at low risk of adverse events. METHODS The study included normotensive patients aged >80 years with acute PE enrolled in the RIETE registry. We used multivariable logistic regression analysis to create a new risk score to predict 30-day all-cause mortality. We externally validated the new risk score in elderly patients from the COMMAND VTE registry. RESULTS Multivariable logistic regression identified four predictors for mortality: high-risk sPESI, immobilization, coexisting deep vein thrombosis (DVT), and plasma creatinine >2 mg/dL. In the RIETE derivation cohort, the new model classified fewer patients as low risk (4.0% [401/10,106]) compared to the modified sPESI (35% [3522/10,106]). Low-risk patients based on the new model had a lower 30-day mortality than those based on the modified sPESI (1.2% [95% CI, 0.4-2.9%] versus 4.7% [95% CI, 4.0-5.4%]). In the COMMAND VTE validation cohort, 1.5% (3/206) of patients were classified as having low risk of death according to the new model, and the overall 30-day mortality of this group was 0% (95% CI, 0-71%), compared to 5.9% (95% CI, 3.1-10.1%) in the high-risk group. CONCLUSIONS For predicting short-term mortality among elderly patients with acute PE, this study suggests that the new model has a substantially higher sensitivity than the modified sPESI. A minority of these patients might benefit from safe outpatient therapy of their disease.
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Affiliation(s)
- Raquel Morillo
- Respiratory Department, Hospital Ramón y Cajal (IRYCIS), Madrid, Spain
| | - David Jiménez
- Respiratory Department, Hospital Ramón y Cajal (IRYCIS), Madrid, Spain; Medicine Department, Universidad de Alcala (IRYCIS), Madrid, Spain; CIBER de Enfermedades Respiratorias (CIBERES), Instituto de Salud Carlos III, Madrid, Spain.
| | - Behnood Bikdeli
- Cardiovascular Medicine Division, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Carmen Rodríguez
- Respiratory Department, Hospital Ramón y Cajal (IRYCIS), Madrid, Spain
| | - Andrés Tenes
- Respiratory Department, Hospital Ramón y Cajal (IRYCIS), Madrid, Spain
| | - Yugo Yamashita
- Department of Cardiovascular Medicine, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Takeshi Morimoto
- Department of Clinical Epidemiology, Hyogo College of Medicine, Nishinomiya, Japan
| | - Takeshi Kimura
- Department of Cardiovascular Medicine, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Gemma Vidal
- Department of Internal Medicine, Corporación Sanitaria Parc Taulí, Barcelona, Spain
| | - Nuria Ruiz-Giménez
- Department of Internal Medicine, Hospital Universitario de La Princesa, Madrid, Spain
| | | | - Manuel Monreal
- CIBER de Enfermedades Respiratorias (CIBERES), Instituto de Salud Carlos III, Madrid, Spain; Department of Internal Medicine, Hospital Universitari Germans Trias i Pujol, Badalona, Barcelona, Spain; Universidad Autónoma de Barcelona, Barcelona, Spain
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8
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Song ZK, Wu H, Xu X, Cao H, Wei Q, Wang J, Wang X, Zhang X, Tang M, Yang S, Liu Y, Qin L. Association Between D-Dimer Level and In-Hospital Death of Pulmonary Embolism Patients. Dose Response 2020; 18:1559325820968430. [PMID: 33335457 PMCID: PMC7724417 DOI: 10.1177/1559325820968430] [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: 12/10/2019] [Revised: 06/01/2020] [Accepted: 06/05/2020] [Indexed: 11/15/2022] Open
Abstract
To investigate whether D-dimer level could predict pulmonary embolism (PE) severity and in-hospital death, a total of 272 patients with PE were divided into a survival group (n = 249) and a death group (n = 23). Comparisons of patient characteristics between the 2 groups were performed using Mann-Whitney U test. Significant variables in univariate analysis were entered into multivariate logistic regression analysis. Receiver operating characteristic (ROC) curve analysis was performed to determine the predictive value of D-dimer level alone or together with the simplified Pulmonary Embolism Severity Index (sPESI) for in-hospital death. Results showed that patients in the death group were significantly more likely to have hypotension (P = 0.008), tachycardia (P = 0.000), elevated D-dimer level (P = 0.003), and a higher sPESI (P = 0.002) than those in the survival group. Multivariable logistic regression analysis showed that D-dimer level was an independent predictor of in-hospital death (OR = 1.07; 95% CI, 1.003-1.143; P = 0.041). ROC curve analysis showed that when D-dimer level was 3.175 ng/ml, predicted death sensitivity and specificity were 0.913 and 0.357, respectively; and when combined with sPESI, specificity (0.838) and area under the curve (0.740) were increased. Thus, D-dimer level is associated with in-hospital death due to PE; and the combination with sPESI can improve the prediction level.
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Affiliation(s)
- Zi-Kai Song
- Department of Cardiology, the First Hospital of Jilin
University, Changchun, China
| | - Haidi Wu
- Department of Cardiology, the First Hospital of Jilin
University, Changchun, China
| | - Xiaoyan Xu
- Department of Cardiology, the First Hospital of Jilin
University, Changchun, China
| | - Hongyan Cao
- Department of Cardiology, the First Hospital of Jilin
University, Changchun, China
| | - Qi Wei
- Department of Cardiology, the First Hospital of Jilin
University, Changchun, China
| | - Junfeng Wang
- Department of Cardiology, the First Hospital of Jilin
University, Changchun, China
| | - Xingwen Wang
- Department of Cardiology, the First Hospital of Jilin
University, Changchun, China
| | - Xue Zhang
- Department of Cardiology, the First Hospital of Jilin
University, Changchun, China
| | - Minglong Tang
- Department of Cardiology, the First Hospital of Jilin
University, Changchun, China
| | - Shuo Yang
- Department of Cardiology, the First Hospital of Jilin
University, Changchun, China
| | - Yang Liu
- Department of Cardiology, the First Hospital of Jilin
University, Changchun, China
| | - Ling Qin
- Department of Cardiology, the First Hospital of Jilin
University, Changchun, China
- Ling Qin, PhD, Department of Cardiology, the
First Hospital of Jilin University, 71 Xinmin St., Changchun, Jilin, 130000,
China.
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9
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Affiliation(s)
- Stavros V Konstantinides
- Center for Thrombosis and Hemostasis (CTH), University Medical Center of the Johannes Gutenberg University, Langenbeckstrasse 1, Building 403, 55131 Mainz, Germany.,Department of Cardiology, Democritus University of Thrace, Alexandroupolis, Greece
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10
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Toma C, Khandhar S, Zalewski AM, D'Auria SJ, Tu TM, Jaber WA. Percutaneous thrombectomy in patients with massive and very high-risk submassive acute pulmonary embolism. Catheter Cardiovasc Interv 2020; 96:1465-1470. [PMID: 32866345 DOI: 10.1002/ccd.29246] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [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: 04/18/2020] [Revised: 06/24/2020] [Accepted: 08/02/2020] [Indexed: 11/10/2022]
Abstract
OBJECTIVE Examine FlowTriever thrombectomy feasibility in high-risk PE patients. BACKGROUND The FlowTriever thrombectomy system (Inari Medical, Irvine, CA) can reduce right ventricle (RV) strain in acute submassive pulmonary embolism (PE) patients. This technology has not been studied in higher risk PE patients. METHODS This multicenter retrospective analysis included patients treated with FlowTriever between 2017 and 2019 if they met at least one of the following: vasopressor dependence, PE induced respiratory failure, or decreased cardiac index (CI) measured by right heart catheterization. RESULTS Analysis included 34 patients: 18 massive, four intubated, 12 normotensive but with CI < 1.8. Average age was 56 and their median simplified PE severity index was 2. Patients had high bleeding risk, with 13 having recent surgery, six posttrauma, and four recent strokes. Six patients received cardiopulmonary resuscitation, and two received additional mechanical circulatory support. All patients had RV dilatation and elevated biomarkers. Clot removal was successful in 32/34 patients. CI improved from 2.0 ± 0.1 L/min/m2 before thrombectomy to 2.4 ± 0.1 L/min/m2 after (p = .01). The mean pulmonary artery pressure decreased from 33.2 ± 1.6 mmHg to 25.0 ± 1.5 mmHg (p = .01). The two patients-both with no or minimal thrombus removed-deteriorated during the procedure: one died and the other was successfully stabilized on ECMO. There were no other major complications. All other patients were alive at the time of data collection (mean follow-up of 205 days). CONCLUSION Aspiration thrombectomy appears feasible in higher risk acute PE patients with immediate hemodynamic improvement and low in-hospital mortality.
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Affiliation(s)
- Catalin Toma
- Division of Cardiology, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
| | - Sameer Khandhar
- Division of Cardiology, Penn-Presbyterian Medical Center, Philadelphia, Pennsylvania, USA
| | - Adrian M Zalewski
- Division of Cardiology, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
| | - Stephen J D'Auria
- Division of Cardiology, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
| | | | - Wissam A Jaber
- Division of Cardiology, Emory University School of Medicine, Atlanta, Georgia, USA
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11
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Trevino AR, Perez L, Jerjes-Sanchez C, Rodriguez D, Panneflek J, Ortiz-Ledesma C, Nevarez F, Jimenez V, Valdes F, de Obeso E. Factor Xa inhibition and sPESI failure in intermediate-high-risk pulmonary embolism. Am J Emerg Med 2018; 36:1925.e3-1925.e4. [PMID: 29958743 DOI: 10.1016/j.ajem.2018.06.054] [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] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2018] [Revised: 06/21/2018] [Accepted: 06/21/2018] [Indexed: 01/21/2023] Open
Abstract
We report the case of a 61-year-old man who presented at the Emergency Department (ED), complaining of sudden-onset dyspnea and chest pain after a long flight from Tokyo to Houston. Considering his clinical stability and sPESI 0, enoxaparin 1 mg/kg BID was started for 24 h, and the patient was then considered for early discharge with apixaban 10 mg BID. Direct-factor Xa inhibition did not improve extensive thrombus burden and right ventricular dysfunction despite D-dimer measurement reduction. Because of the treatment failure, we considered thrombolysis. Currently, recommendations to use thrombolysis in patients under non-vitamin K antagonist oral anticoagulants (NOACs) do not exist. Hence, the one dose of apixaban was stopped, and 12 h later, we performed successful thrombolysis. A systematic review from 2007 to 2017 did not identify any cases related to NOACs failure to reduce thrombus burdens in patients with PE and persistent right ventricular dysfunction. We also did not find any evidence of cases that reported strategies for urgent thrombolysis in PE patients on NOACs. To the best of our knowledge, apixaban's failure to reduce thrombus burden, persistent right ventricular dysfunction, and a NOACs-thrombolysis bridge in patients with PE on apixaban has not been previously described. Both the bedside risk stratification and the therapeutic failures should alert clinicians in the ED to the potential limitations of low-molecular-weight heparin, NOACs therapy, and sPESI in the setting of intermediate-high-risk PE.
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Affiliation(s)
- Alejandro R Trevino
- Instituto de Cardiologia y Medicina Vascular, TecSalud, Escuela de Medicina y Ciencias de la Salud, Tecnologico de Monterrey, San Pedro Garza Garcia, Mexico
| | - Luis Perez
- Instituto de Cardiologia y Medicina Vascular, TecSalud, Escuela de Medicina y Ciencias de la Salud, Tecnologico de Monterrey, San Pedro Garza Garcia, Mexico
| | - Carlos Jerjes-Sanchez
- Instituto de Cardiologia y Medicina Vascular, TecSalud, Escuela de Medicina y Ciencias de la Salud, Tecnologico de Monterrey, San Pedro Garza Garcia, Mexico; Centro de Investigacion Biomedica, Hospital Zambrano Hellion, TecSalud, Escuela de Medicina y Ciencias de la Salud, Tecnologico de Monterrey, San Pedro Garza Garcia, Mexico.
| | - David Rodriguez
- Instituto de Cardiologia y Medicina Vascular, TecSalud, Escuela de Medicina y Ciencias de la Salud, Tecnologico de Monterrey, San Pedro Garza Garcia, Mexico; Centro de Investigacion Biomedica, Hospital Zambrano Hellion, TecSalud, Escuela de Medicina y Ciencias de la Salud, Tecnologico de Monterrey, San Pedro Garza Garcia, Mexico
| | - Jathniel Panneflek
- Centro de Investigacion Biomedica, Hospital Zambrano Hellion, TecSalud, Escuela de Medicina y Ciencias de la Salud, Tecnologico de Monterrey, San Pedro Garza Garcia, Mexico
| | - Claudia Ortiz-Ledesma
- Centro de Investigacion Biomedica, Hospital Zambrano Hellion, TecSalud, Escuela de Medicina y Ciencias de la Salud, Tecnologico de Monterrey, San Pedro Garza Garcia, Mexico
| | - Francisco Nevarez
- Centro de Investigacion Biomedica, Hospital Zambrano Hellion, TecSalud, Escuela de Medicina y Ciencias de la Salud, Tecnologico de Monterrey, San Pedro Garza Garcia, Mexico
| | - Vicente Jimenez
- Instituto de Cardiologia y Medicina Vascular, TecSalud, Escuela de Medicina y Ciencias de la Salud, Tecnologico de Monterrey, San Pedro Garza Garcia, Mexico
| | - Felipe Valdes
- Instituto de Cardiologia y Medicina Vascular, TecSalud, Escuela de Medicina y Ciencias de la Salud, Tecnologico de Monterrey, San Pedro Garza Garcia, Mexico
| | - Eduardo de Obeso
- Instituto de Cardiologia y Medicina Vascular, TecSalud, Escuela de Medicina y Ciencias de la Salud, Tecnologico de Monterrey, San Pedro Garza Garcia, Mexico
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