Assessment of renal dysfunction improves troponin-based short-term prognosis in patients with acute symptomatic pulmonary embolism

SummaryThough studies have identified clinical variables that predict adverse events in patients with acute pulmonary embolism (PE), they have typically not differentiated short-term from long-term predictors.This multicenter prospective cohort study included consecutive outpatients with objectively confirmed symptomatic acute PE.We analyzed the incidence and time course of death, venous thromboembolism (VTE) recurrence, and major bleeding, and we compared event rates during short-term (first week) and long-term (3 months) follow-up after the diagnosis of PE.We also assessed risk factors for short-term mortality. During the first three months after diagnosis of PE, 142 of 1,338 (10.6%) patients died.Thirty-six deaths (2.7%) occurred during the first week after diagnosis of PE,and 61.1% of these were due to PE.Thirty-eight patients (2.8%) had recurrent VTE during the three-month follow-up, though none of the recurrences occurred during the first week after diagnosis of PE. During the three-month follow-up, major bleeding occurred in 48 patients (3.6%). Twenty-one (1.6%) major bleeds occurred during the first week of follow-up,and nine of these were fatal. Short-term mortality was significantly increased in patients who initially presented with systolic arterial hypotension (odds ratio [OR] 3.35; 95% CI, 1.51-5.41) or immobilization due to a medical illness (OR 2.89; 95% confidence interval [CI], 1.31-6.39).In con-clusion,during the first week after the diagnosis of PE, death and major bleeding occur more frequently than recurrent VTE. Patients with systolic arterial hypotension and immobilization at the time of PE diagnosis had an increased isk of short-term mortality.

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Sex differences in the characteristics and short-term prognosis of patients presenting with acute symptomatic pulmonary embolism

PLoS ONE ◽

10.1371/journal.pone.0187648 ◽

2017 ◽

Vol 12 (11) ◽

pp. e0187648 ◽

Cited By ~ 18

Author(s):

Deisy Barrios ◽

Raquel Morillo ◽

Ina Guerassimova ◽

Esther Barbero ◽

Héctor Escobar-Morreale ◽

...

Keyword(s):

Pulmonary Embolism ◽

Sex Differences ◽

Short Term ◽

Symptomatic Pulmonary Embolism

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The Role of a Decision Rule in Symptomatic Pulmonary Embolism Patients with a Non-high Probability Ventilation-perfusion Scan

Thrombosis and Haemostasis ◽

10.1055/s-0038-1657630 ◽

1997 ◽

Vol 78 (02) ◽

pp. 794-798 ◽

Cited By ~ 2

Author(s):

Bowine C Michel ◽

Philomeen M M Kuijer ◽

Joseph McDonnell ◽

Edwin J R van Beek ◽

Frans F H Rutten ◽

...

Keyword(s):

Pulmonary Embolism ◽

Decision Rule ◽

Predictive Value ◽

Patient Population ◽

High Probability ◽

Characteristic Curve ◽

Stepwise Logistic Regression ◽

Pulmonary Angiogram ◽

Symptomatic Pulmonary Embolism ◽

Perfusion Scan

Summary Background: In order to improve the use of information contained in the medical history and physical examination in patients with suspected pulmonary embolism and a non-high probability ventilation-perfusion scan, we assessed whether a simple, quantitative decision rule could be derived for the diagnosis or exclusion of pulmonary embolism. Methods: In 140 consecutive symptomatic patients with a non- high probability ventilation-perfusion scan and an interpretable pulmonary angiogram, various clinical and lung scan items were collected prospectively and analyzed by multivariate stepwise logistic regression analysis to identify the most informative combination of items. Results: The prevalence of proven pulmonary embolism in the patient population was 27.1%. A decision rule containing the presence of wheezing, previous deep venous thrombosis, recently developed or worsened cough, body temperature above 37° C and multiple defects on the perfusion scan was constructed. For the rule the area under the Receiver Operating Characteristic curve was larger than that of the prior probability of pulmonary embolism as assessed by the physician at presentation (0.76 versus 0.59; p = 0.0097). At the cut-off point with the maximal positive predictive value 2% of the patients scored positive, at the cut-off point with the maximal negative predictive value pulmonary embolism could be excluded in 16% of the patients. Conclusions: We derived a simple decision rule containing 5 easily interpretable variables for the patient population specified. The optimal use of the rule appears to be in the exclusion of pulmonary embolism. Prospective validation of this rule is indicated to confirm its clinical utility.

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Sex as a prognostic factor for mortality in adults with acute symptomatic pulmonary embolism

Cochrane Database of Systematic Reviews ◽

10.1002/14651858.cd013835 ◽

2021 ◽

Author(s):

Jesús López-Alcalde ◽

Elena C Stallings ◽

Javier Zamora ◽

Alfonso Muriel ◽

Sander van Doorn ◽

...

Keyword(s):

Pulmonary Embolism ◽

Prognostic Factor ◽

Symptomatic Pulmonary Embolism

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Renal function improves mortality prediction in acute pulmonary embolism: results of a multicentre cohort study with external validation in the RIETE registry

European Heart Journal ◽

10.1093/ehjci/ehaa946.2239 ◽

2020 ◽

Vol 41 (Supplement_2) ◽

Author(s):

R Chopard ◽

D Jimenez ◽

G Serzian ◽

F Ecarnot ◽

N Falvo ◽

...

Keyword(s):

Pulmonary Embolism ◽

Renal Function ◽

High Risk ◽

Renal Dysfunction ◽

External Validation ◽

Mortality Prediction ◽

Model Fit ◽

Funding Source ◽

Risk Of Death ◽

Acute Pe

Abstract Background Renal dysfunction may influence outcomes after pulmonary embolism (PE). We determined the incremental value of adding renal function impairment (estimated glomerular filtration rate, eGFR <60 ml/min/1.73m2) on top of the 2019 ESC prognostic model, for the prediction of 30-day all-cause mortality in acute PE patients from a prospective, multicenter cohort. Methods and results We identified which of three eGFR formulae predicted death most accurately. Changes in global model fit, discrimination, calibration and net reclassification index (NRI) were evaluated with addition of eGFR. We prospectively included consecutive adult patients with acute PE diagnosed as per ESC guidelines. Among 1,943 patients, (mean age 67.3±17.1, 50.4% women), 107 (5.5% (95% CI 4.5–6.5%)) died during 30-day follow-up. The eGFRMDRD4 formula was the most accurate for prediction of death. The observed mortality rate was higher for intermediate-low risk (OR 1.8, 95% CI 1.1–3.4) and high-risk PE (OR 10.3, 95% CI 3.6–17.3), and 30-day bleeding was significantly higher (OR 2.1, 95% CI 1.3–3.5) in patients with vs without eGFRMDRD4 <60 ml/min/1.73m2. The addition of eGFRMDRD4 information improved model fit, discriminatory capacity, and calibration of the ESC models. NRI was significantly improved (p<0.001), with 18% reclassification of predicted mortality, specifically in intermediate and high-risk PE. External validation using data from the RIETE registry confirmed our findings (Table). Conclusion Addition of eGFRMDRD4-derived renal dysfunction on top of the ESC prognostic algorithm yields significant reclassification of risk of death in intermediate and high-risk PE. Impact on therapy remains to be determined. Funding Acknowledgement Type of funding source: Private grant(s) and/or Sponsorship. Main funding source(s): BMS-Pfizer Alliance, Bayer Healthcare

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Computed Tomography Pulmonary Perfusion for Prediction of Short-Term Clinical Outcome in Acute Pulmonary Embolism

TH Open ◽

10.1055/s-0041-1723782 ◽

2021 ◽

Vol 05 (01) ◽

pp. e66-e72

Author(s):

Lisette F. van Dam ◽

Lucia J. M. Kroft ◽

Menno V. Huisman ◽

Maarten K. Ninaber ◽

Frederikus A. Klok

Keyword(s):

Computed Tomography ◽

Pulmonary Embolism ◽

Predictive Value ◽

Acute Pulmonary Embolism ◽

Clinical Presentation ◽

Reperfusion Therapy ◽

Pulmonary Perfusion ◽

Short Term ◽

Acute Pe ◽

Related Mortality

Abstract Background Computed tomography pulmonary angiography (CTPA) is the imaging modality of choice for the diagnosis of acute pulmonary embolism (PE). With computed tomography pulmonary perfusion (CTPP) additional information on lung perfusion can be assessed, but its value in PE risk stratification is unknown. We aimed to evaluate the correlation between CTPP-assessed perfusion defect score (PDS) and clinical presentation and its predictive value for adverse short-term outcome of acute PE. Patients and Methods This was an exploratory, observational study in 100 hemodynamically stable patients with CTPA-confirmed acute PE in whom CTPP was performed as part of routine clinical practice. We calculated the difference between the mean PDS in patients with versus without chest pain, dyspnea, and hemoptysis and 7-day adverse outcome. Multivariable logistic regression analysis and likelihood-ratio test were used to assess the added predictive value of PDS to CTPA parameters of right ventricle dysfunction and total thrombus load, for intensive care unit admission, reperfusion therapy and PE-related death. Results We found no correlation between PDS and clinical symptoms. PDS was correlated to reperfusion therapy (n = 4 with 16% higher PDS, 95% confidence interval [CI]: 3.5–28%) and PE-related mortality (n = 2 with 22% higher PDS, 95% CI: 4.9–38). Moreover, PDS had an added predictive value to CTPA assessment for PE-related mortality (from Chi-square 14 to 19, p = 0.02). Conclusion CTPP-assessed PDS was not correlated to clinical presentation of acute PE. However, PDS was correlated to reperfusion therapy and PE-related mortality and had an added predictive value to CTPA-reading for PE-related mortality; this added value needs to be demonstrated in larger studies.

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Short-term prognosis of pulmonary embolism

Journal of Thrombosis and Haemostasis ◽

10.1111/j.1538-7836.2009.03408.x ◽

2009 ◽

Vol 7 ◽

pp. 318-321 ◽

Cited By ~ 15

Author(s):

D. AUJESKY ◽

R. HUGHES ◽

D. JIMÉNEZ

Keyword(s):

Pulmonary Embolism ◽

Short Term

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Infra-popliteal deep venous thrombi and the risk of symptomatic pulmonary embolism in hospitalized patients

Vascular ◽

10.1258/vasc.2010.oa0252 ◽

2011 ◽

Vol 19 (1) ◽

pp. 29-33 ◽

Cited By ~ 5

Author(s):

Saadi Alhalbouni ◽

Anil Hingorani ◽

Alexander Shiferson ◽

Natalie Marks ◽

Enrico Ascher

Keyword(s):

Pulmonary Embolism ◽

Lower Extremity ◽

Retrospective Review ◽

Lower Limb ◽

Hospitalized Patients ◽

Symptomatic Pulmonary Embolism ◽

Number Of Patients ◽

Significant Difference ◽

Hospital Patients ◽

Made In

Infra-popliteal veins include the tibial and peroneal veins, as well as the soleal and gastrocnemial veins collectively known as the calf muscle veins (CMVs). Acute infra-popliteal deep venous thrombi (DVTs) are often considered insignificant with regard to the risk of pulmonary embolism (PE). A retrospective review of 4035 consecutive lower extremity venous duplex scans were made in 3146 hospital patients at our Intersocietal Commission for the Accreditation of Vascular Laboratories (ICAVL)-accredited vascular lab. Seven hundred sixteen (17.7%) duplex scans were positive for acute DVTs, and 112 (2.8%) were associated with PEs. The breakdown of positive duplexes for acute DVTs was as follows: 202 (28.2%) isolated femoral-popliteal DVTs with PE in 23 (11.4%), 304 (42.5%) isolated infra-popliteal DVTs with PE in 24 (7.9%) and 210 (29.3%) multilevel DVTs involving both vein segments (femoral-popliteal and infra-popliteal) with PE in 38 (18.1%). Of the 304 isolated acute infra-popliteal DVTs, 207 (68.1%) were isolated CMV DVTs with evidence of PE in 12 (5.8%). No statistically significant difference ( P = 0.27) in the risk of PE between isolated femoral-popliteal and isolated infra-popliteal DVTs was noted. A significant number of patients (5.8%) with isolated CMV DVTs developed PE. Lower limb venous scans for DVTs should evaluate the infra-popliteal veins. Hospitalized patients with infra-popliteal DVTs should receive anticoagulation.

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