Predictive Value of Cellular Blood Indices for All-Cause Mortality in Acute Pulmonary Embolism

Introduction: Pulmonary embolism (PE) contributes to more than 100,000 annual deaths in the United States and is the third most common cause of cardiovascular death. Short-term all-cause mortality rates differ widely, from 2% among low risk normotensive patients to 95% among those experiencing cardiac arrest. Prognostic models for PE help clinicians facilitate decision making but have suboptimal predictive values. The most widely used tool is the simplified Pulmonary Embolism Severity Index (sPESI) - a scoring system which utilizes 6 clinical variables to predict death. Cellular indices, like platelet-lymphocyte ratio (PLR) and neutrophil-lymphocyte ratio (NLR), have been shown to be markers of systemic inflammation and are associated with worsened prognosis in acute PE. Other ratios, such as lymphocyte-monocyte ratio (LMR) and platelet-neutrophil ratio (PNR), have not been fully explored. Given the need to further improve sPESI to better manage PE patients, we sought to determine the association of PLR, NLR, LMR, and PNR with all-cause mortality in patients presenting with acute PE. We also evaluated the additive effect of these cellular indices on the predictive value of sPESI. Methods: We retrospectively investigated patients who were consecutively diagnosed and treated between March 2016 and June 2019 at Loyola Medical Center in Maywood, Illinois and Gottlieb Memorial Hospital in Melrose Park, Illinois. Diagnosis of PE was made using CT pulmonary angiography or ventilation perfusion (VQ) scan. Patients were excluded if there was presence of infection, sepsis, ongoing cancer treatment, or a chronic inflammatory condition at the time of PE diagnosis. Clinical characteristics were collected using the electronic medical record system. Differential complete blood count data was collected within 24 hours prior to PE diagnosis. Mann Whitney U and Chi-Square tests were used to determine associations between all-cause mortality and clinical data. ROC curves were constructed to illustrate the sensitivity and specificity of cellular indices to predict all-cause mortality. Optimal ratio cutoffs were determined using Youden J Index. A composite sPESI score was created using cellular blood indices cutoff values. One point was added to the sPESI score for every additional condition met. Results: Among the 228 PE patients, 48 (21%) were non-survivors with median follow up period of 56 days (IQR: 17-182). Elevated PLR and NLR, as well as decreased LMR, were associated with all-cause mortality (all p < 0.01). PNR was not associated with all-cause mortality (p > 0.62). PLR > 256.7 was predictive of mortality (p < 0.01) with sensitivity 54.2% and specificity 85.6%. NLR > 5.5 was predictive of mortality (p < 0.01) with sensitivity 66.7% and specificity 68.3%. LMR < 1.6 was predictive of mortality (p < 0.01) with sensitivity 66.7% and specificity 70.8%. sPESI was predictive of mortality (p < 0.01) with sensitivity 72.9% and specificity 64.0%. A composite model including sPESI, PLR, NLR, and LMR had further improved predictive abilities for all-cause mortality with sensitivity 85.4% and specificity 66.3% as compared to sPESI alone (AUC: 0.82, 95% CI: 0.76-0.89 vs AUC 0.75, 95% CI: 0.68-0.83). Conclusion: This study demonstrated an association between PLR, NLR, and LMR and all-cause mortality in PE patients. Our findings were consistent with past literature and contribute to the argument that these routine laboratory tests can supplement existing risk prediction models. Lymphopenia as well as elevated neutrophil count are associated with pro-inflammatory states during cardiopulmonary events, which may increase risk for thrombotic events. Platelets, a key component of thrombosis, are significantly decreased immediately after a thrombotic event. The composite sPESI model, including PLR, NLR, and LMR exhibited higher sensitivity which allows for improved detection of patients who are at high risk for death. Future studies are required to assess the predictive value of other routine blood tests on all-cause mortality in this patient population to further optimize sPESI and other predictive tools. Disclosures No relevant conflicts of interest to declare.

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Sex Differences in Risk Factors, Clinical Presentation, Treatment and Outcomes of Patients Presenting with Acute Pulmonary Embolism

Blood ◽

10.1182/blood-2019-131090 ◽

2019 ◽

Vol 134 (Supplement_1) ◽

pp. 2429-2429

Author(s):

Rachel P Rosovsky ◽

Islam Y Elgendy ◽

Suzanne C Cannegieter ◽

Menno V Huisman ◽

David Jimenez ◽

...

Keyword(s):

Pulmonary Embolism ◽

Sex Differences ◽

Venous Thromboembolism ◽

Major Bleeding ◽

Research Funding ◽

Clinical Presentation ◽

The United States ◽

Categorical Variables ◽

All Cause Mortality ◽

Acute Pe

Background Pulmonary embolism (PE) is a major cause of morbidity and mortality in both the United States and worldwide. There is a paucity of contemporary clinical registry data regarding sex differences in the clinical presentation, treatment and outcomes of patients with acute PE. Methods Patients with PE from the RIETE (Registro Informatizado Enfermedad Trombo Embólica), a multicenter international prospective registry of patients with venous thromboembolism, were included. Patient characteristics between groups were compared using t-tests for continuous variables and chi-square tests for categorical variables. Multivariable logistic regression adjusting for baseline characteristics, clinical presentation and therapies was used to compare outcomes between both sexes. Outcomes included all-cause mortality, recurrent venous thromboembolism (VTE), and major bleeding through 30 days after initiation of PE treatment as well as all-cause mortality through 90 days. Results From January 2001 through June 2019, 41,477 patients with an acute PE were enrolled, of whom 22,057 (53%) were women. Women were older (mean age +/- standard deviation: 69 +/- 18 years versus 65 +/- 16 years), had higher body mass index (BMI) and were less likely to have cancer than men (Table 1). Women were also less likely to have prior VTE, chronic lung disease, history of MI or angina or an unprovoked PE but more likely to have recent immobilization, chronic heart failure, arterial hypertension, leg varicosities and depression. Women smoked less and fewer women tested positive for an inherited thrombophilia compared to men. Initial presentation: Women presented more frequently with hypotension, tachycardia, dyspnea, syncope and altered mental status than men but women reported less frequently hemoptysis, cough or chest pain. The location of PE was similar between the sexes. Similarly, there was no difference in the initial medical treatment such as unfractionated heparin (UFH) between men and women. However, more men underwent embolectomy and had inferior vena cava filters (IVCF) placed. During the course of anticoagulation (mean duration: 311 days for women and 315 days for men), women received a higher mean dose of low molecular weight heparin (181 [+/-41] International Units (IU)/kilogram (kg)/day versus 178 [+/-40] IU/kg/day, p <0.001) compared to men. For the long-term therapy, women were less likely to receive a direct oral anticoagulant (DOAC). Follow up: Women were less likely to die at 30-days (OR 0.81; 95% CI 0.67-0.97, p <0.05) and 90-days, (OR 0.83; 95% CI 0.74-0.94, p <0.01) and less likely to have recurrent DVT (OR 0.61; 95% CI 0.41-0.91, p <0.05), but more likely to suffer from major bleeding (OR 1.31; 95% CI 1.07-1.61, p <0.01) compared with men. There was no difference in the rates of recurrent PE (OR 1.16; 95% CI 0.83-1.61; Table 2). Conclusion In this international multicenter registry including >40,000 patients with an acute PE, we found that despite presenting with more signs and symptoms of severe PE, women were more likely to be alive at 30 and 90 days and had fewer DVT recurrences but more major bleeds than men. Disclosures Rosovsky: Dova Pharmaceuticals: Consultancy; Bristol-Myers Squibb: Research Funding; Janssen Pharmaceuticals: Consultancy, Research Funding.

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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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Performance of the Quantitative Latex Immunoturbidimetric D-dimer Assay for the Diagnosis of Acute Pulmonary Embolism at Rafik Hariri University Hospital

International journal of epidemiologic research ◽

10.34172/ijer.2020.22 ◽

2020 ◽

Vol 7 (3) ◽

pp. 125-128

Author(s):

Rida Salman ◽

Mira Alsheikh ◽

Rim Ismail

Keyword(s):

Pulmonary Embolism ◽

Negative Predictive Value ◽

Ct Angiography ◽

Sensitivity And Specificity ◽

Predictive Value ◽

Retrospective Chart Review ◽

Latex Agglutination ◽

University Hospital ◽

Acute Pe ◽

D Dimer

Background and aims: The diagnostic workup for pulmonary embolism (PE) includes D-dimer assay and computed tomographic angiography. Several D-dimer assays have been approved for PE diagnosis with different sensitivity and specificity. We aimed to study the sensitivity and specificity of the quantitative latex agglutination D-dimer assay used in a referral teaching hospital in Lebanon for the diagnosis of acute PE. Methods: Using a retrospective chart review, we studied 300 patients who had D-dimer test at Rafik Hariri University Hospital in the period between January 1, 2012 and December 31, 2013. Accordingly, 93 patients had a CT angiography after being suspected to have acute PE. A statistical table 2*2 was used to compare the results of CT angiography and D-dimer test. Results: Thirteen patients (13.97%) had PE and 60 patients (64.51%) had positive D-dimer test. Quantitative latex agglutination D-dimer assay had a sensitivity of 69%, specificity of 36%, and negative predictive value of 88%. False positive ratio was also 64%. Moreover, the receiver operating characteristic (ROC) curve was obtained with an area under the curve measuring 0.527. Conclusion: Quantitative latex agglutination D-dimer assay has a high negative predictive value; thus, it can exclude a PE diagnosis if it is associated with low clinical pretest probability.

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Association of anaemia and mortality in patients with acute pulmonary embolism

Thrombosis and Haemostasis ◽

10.1160/th09-01-0003 ◽

2009 ◽

Vol 102 (07) ◽

pp. 153-158 ◽

Cited By ~ 5

Author(s):

Carlos Escobar ◽

David Martí ◽

Gema Díaz ◽

Jesús César ◽

Ángel García-Avello ◽

...

Keyword(s):

Pulmonary Embolism ◽

Inferior Vena ◽

Independent Predictor ◽

Vena Cava ◽

Female Gender ◽

All Cause Mortality ◽

Diagnosis Of Cancer ◽

The Relationship ◽

Mortality Hazard Ratio ◽

Acute Pe

SummaryThis study aimed to evaluate the relationship between anaemia and pulmonary embolism (PE) prognosis. We analysed a cohort of 764 patients with acute PE referred to a single center for diagnosis and management. Patients were divided into groups by quartiles of haemoglobin (Hb): Hb < 11.7 g/dl; Hb 11.7 to 12.9 g/dl; Hb 13.0 to 14.1 g/dl; Hb > 14.1 g/dl. Patients had a mean Hb of 12.9 g/dl, and values ranged from to 4.3 to 19.5 g/dl. Lower Hb was associated with recent bleeding, an impaired haemodynamic profile and higher creatinine. Patients in the lower Hb quartiles more commonly had female gender (p < 0.001), a diagnosis of cancer (p < 0.001), and an indication for an inferior vena cava (IVC) filter (p < 0.002), compared to patients in the higher Hb quartiles. Patients in higher Hb quartiles had higher survival at three months (75%, 86%, 90% and 91% for lowest to highest quartiles, respectively). On multivariate analysis, adjusting for known PE prognostic factors, low Hb proved to be an independent predictor of mortality (hazard ratio [HR] 1.16, 95% confidence interval [CI] 1.05 to 1.28 for each decrease of 1 g/dl). Hb level remained an independent predictor of all-cause mortality when cancer patients were excluded from the analysis (adjusted HR 0.81; 95% CI, 0.66 to 0.99; p = 0.04). Moreover, patients with anaemia showed a higher risk of fatal PE (unadjusted HR 1.19, 95% CI 1.04 to 1.37). In conclusion, in patients with acute symptomatic PE, anaemia severity is associated with worsened survival.

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Atrial fibrillation in acute pulmonary embolism: prognostic considerations

Emergency Medicine Journal ◽

10.1136/emermed-2012-202089 ◽

2013 ◽

Vol 31 (4) ◽

pp. 308-312 ◽

Cited By ~ 21

Author(s):

Sérgio Nuno Craveiro Barra ◽

Luís Vilardouro Paiva ◽

Rui Providência ◽

Andreia Fernandes ◽

António Leitão Marques

Keyword(s):

Atrial Fibrillation ◽

Pulmonary Embolism ◽

Previous History ◽

Mortality Prediction ◽

Prognostic Role ◽

Prediction Ability ◽

All Cause Mortality ◽

Increase Risk ◽

History Of ◽

Acute Pe

AimsAlthough it is accepted that atrial fibrillation (AF) may be both the contributing factor and the consequence of pulmonary embolism (PE), data on the prognostic role of AF in patients with acute venous thromboembolism are scarce. Our aim was to study whether AF had a prognostic role in patients with acute PE.MethodsRetrospective cohort study involving 270 patients admitted for acute PE. Collected data: past medical history, analytic/gasometric parameters, admission ECG and echocardiogram, thoracic CT angiography. Patients followed for 6 months. An analysis was performed in order to clarify whether history of AF, irrespective of its timing, helps predict intrahospital, 1-month and 6-month all-cause mortality.ResultsPatients with history of AF, irrespective of its timing (n=57, 21.4%), had higher intrahospital (22.8% vs 13.1%, p=0.052, OR 2.07, 95% CI 0.98 to 4.35), 1-month (35.1% vs 16.9%, p=0.001, OR 3.16, 95% CI 1.61 to 6.21) and 6-month (45.6% vs 17.4%, p<0.001, OR 4.67, 95% CI 2.37 to 9.21) death rates. The prognostic power of AF was independent of age, NT-proBNP values, renal function and admission blood pressure and heart rate and additive to mortality prediction ability of simplified PESI (AF: p=0.021, OR 2.31, CI 95% 1.13 to 4.69; simplified PESI: p=0.002, OR 1.47, CI 95% 1.15 to 1.89). The presence of AF at admission added prognostic value to previous history of AF in terms of 1-month and 6-month all-cause mortality prediction, although it did not increase risk for intrahospital mortality.ConclusionsThe presence of AF, irrespective of its timing, may independently predict mortality in patients with acute PE. These data should be tested and validated in prospective studies using larger cohorts.

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Dysregulation of Hemostatic Biomarkers, Inflammatory Biomarkers, and Alteration of Cellular Indices As Predictors of Adverse Outcomes in Pulmonary Embolism Patients

Blood ◽

10.1182/blood-2019-126876 ◽

2019 ◽

Vol 134 (Supplement_1) ◽

pp. 2408-2408

Author(s):

Iman Darwish ◽

Yevgeniy Brailovsky ◽

Amir Darki ◽

Debra Hoppensteadt ◽

Brett Slajus ◽

...

Keyword(s):

Pulmonary Embolism ◽

Patient Outcomes ◽

White Cell ◽

Inflammatory Biomarkers ◽

Positive Trend ◽

Pronounced Increase ◽

Lymphocyte Ratio ◽

Cell Counts ◽

All Cause Mortality ◽

D Dimer

Background: Pulmonary Embolism (PE) is a condition that affects a multitude of individuals worldwide. The pathophysiology of PE is multifactorial and complex. Measuring levels of biomarkers in PE patient plasma may be predictive of patient outcomes in terms of survival, and such biomarkers could be correlated to other parameters such as white cell counts and their ratios. Adhesion molecules, such as selectins, have been predicted to play a role in the pathophysiology of PE, however their relationship to other cellular parameters is not fully explored. P-selectin is found on platelets, and is involved in the gathering of platelets in thrombotic states. Meanwhile, E and L-selectin contribute to cellular rolling that occurs in states of inflammation. White blood cell counts are routinely obtained from patient blood analysis. Selectins, including Platelet (P), Endothelial (E), and Leukocyte (L) Selectins may possess relationships to the white cell profiles including neutrophil-lymphocyte ratio (NLR), platelet-lymphocyte ratio (PLR), platelet-neutrophil ratio (PNR), lymphocyte-monocyte ratio (LMR), and monocyte-neutrophil ratio (MNR). Selectins can also be correlated to total platelet and white cell counts. Mortality outcomes in PE patients may be associated with altered levels of hemostatic and inflammatory biomarkers such as selectins. Materials and Methods: Blood samples were acquired from 100 patients diagnosed with acute PE between March 2016 and June 2019 at Loyola University Medical Center in Maywood, IL. Enzyme Linked Immunosorbent Assays (ELISA) were used to quantify levels of P, E, and L selectins in the plasma of PE patients. Other coagulation and inflammatory biomarkers, including Tumor Necrosis Factor Alpha (TNFa), D-dimer, Plasminogen Activating Inhibitor-1 (PAI-1), Matrix Metalloprotease-9 (MMP-9), C-Reactive Protein (CRP), micro particles, and alpha-2-antiplasmin were also quantified. Patient chart review was conducted assessing for levels of platelets, neutrophils, lymphocytes, and monocytes. Appropriate cellular ratios were calculated. Patient outcomes in the form of mortality were noted. Spearman non-parametric analysis and Wilcoxon-Mann-Whitney Tests were conducted using Graphpad PRISM software. Results: All of the biomarkers studied exhibited an increase in PE patient plasma, ranging from 2 fold to 34.6 fold increase, with the exception of alpha-2-antiplasmin, E-selectin, and L-selectin, as shown in Table 1. D-dimer, MMP-9, and CRP show the most pronounced increase in PE patients. No statistically significant correlations were noted between P, E, and L-selectins and NLR, PLR, PNR, LMR, or MNR. P-selectin was positively correlated with platelet count (r=.22, p=.032, 95% CI=0.01293 to 0.4084, n=95). L-selectin was not found to be significantly correlated with white count, but a positive trend was still evident (r=.13, p=.22, CI= -0.08329 to 0.3250, n=95). Within the patient pool, 12% of patients were deceased, while 88% survived. L-selectin and all-cause mortality were significantly correlated at an alpha level of .05 (p=.04). Conclusion: These studies demonstrate the marked dysregulation of hemostatic and inflammatory biomarkers associated with alterations of cellular indices. In particular, P and L selectin demonstrated some relationship to platelets and white count. L-selectin levels are significantly correlated to all-cause mortality. Measuring levels of L-selectin in PE patients may provide insight into mortality outcomes for pulmonary embolism patients. Our results are suggestive of the positive predictive value of L-selectin in PE patients. Profiling of various biomarkers, in particular selectins, may be helpful in the risk stratification of PE patients. Adding such a parameter to patient analysis may provide better prognostic information, which may be helpful in their clinical management. Disclosures No relevant conflicts of interest to declare.

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Predictive values of neutrophil-to-lymphocyte ratio on disease severity and mortality in COVID-19 patients: a systematic review and meta-analysis

10.21203/rs.3.rs-71611/v1 ◽

2020 ◽

Author(s):

Xiaoming Li ◽

Chao Liu ◽

Zhi Mao ◽

Minglu Xiao ◽

Li Wang ◽

...

Keyword(s):

Systematic Review ◽

Disease Severity ◽

Predictive Value ◽

Meta Analysis ◽

Neutrophil To Lymphocyte Ratio ◽

Global Public Health ◽

China National Knowledge Infrastructure ◽

Predictive Values ◽

Lymphocyte Ratio ◽

Registration Number

Abstract Background：Coronavirus disease 2019 (COVID-19), a highly infectious disease, has been rapidly spreading all over the world and posted a great threat to global public health. Patients diagnosed with severe or critical cases have a poor prognosis. Hence, it is crucial for us to identify potential severe or critical cases early, and give timely treatments for the targeted patients. In the clinical practice of treating COVID-19 patients, we have observed that the neutrophil-to-lymphocyte ratio (NLR) of severe patients is higher than that in mild patients. We performed this systematic review and meta-analysis to evaluate the predictive values of NLR on disease severity and mortality in COVID-19 patients. Methods: We searched PubMed, EMBASE, China National Knowledge Infrastructure (CNKI) and Wanfang databases to identify eligible studies (up to August 11, 2020). Two authors independently screened studies and extracted data. The methodological quality of the included studies was assessed by Quality Assessment of Diagnostic Accuracy Studies 2 (QUADAS-2).Results: Thirteen studies involving 1579 patients reported the predictive value of NLR on disease severity. The pooled sensitivity (SEN), specificity (SPE) and area under curve (AUC) were 0.78 (95% CI 0.70-0.84), 0.78 (95% CI 0.73-0.83) and 0.85 (95% CI 0.81-0.88), respectively. Ten studies involving 2967 patients reported the predictive value of NLR on mortality. The pooled SEN, SPE and AUC were 0.83 (95% CI 0.75-0.89), 0.83 (95% CI 0.74-0.89) and 0.90 (95% CI 0.87-0.92), respectively. Conclusions: NLR has good predictive values on disease severity and mortality in COVID-19 patients. Evaluating NLR can help clinicians identify potentially severe cases early, conduct early triage and initiate effective management in time, which may reduce the overall mortality of COVID-19. Moreover, we can better allocate scarce medical resources in this unprecedented time. Trial registration: This meta-analysis was prospectively registered on PROSPERO database (Registration number: CRD42020203612).

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Predictive values of neutrophil-to-lymphocyte ratio on disease severity and mortality in COVID-19 patients: a systematic review and meta-analysis

Critical Care ◽

10.1186/s13054-020-03374-8 ◽

2020 ◽

Vol 24 (1) ◽

Author(s):

Xiaoming Li ◽

Chao Liu ◽

Zhi Mao ◽

Minglu Xiao ◽

Li Wang ◽

...

Keyword(s):

Systematic Review ◽

Disease Severity ◽

Predictive Value ◽

Meta Analysis ◽

Neutrophil To Lymphocyte Ratio ◽

Global Public Health ◽

China National Knowledge Infrastructure ◽

Predictive Values ◽

Lymphocyte Ratio ◽

Registration Number

Abstract Background Coronavirus disease 2019 (COVID-19), a highly infectious disease, has been rapidly spreading all over the world and remains a great threat to global public health. Patients diagnosed with severe or critical cases have a poor prognosis. Hence, it is crucial for us to identify potentially severe or critical cases early and give timely treatments for targeted patients. In the clinical practice of treating patients with COVID-19, we have observed that the neutrophil-to-lymphocyte ratio (NLR) of severe patients is higher than that in mild patients. We performed this systematic review and meta-analysis to evaluate the predictive values of NLR on disease severity and mortality in patients with COVID-19. Methods We searched PubMed, EMBASE, China National Knowledge Infrastructure (CNKI) and Wanfang databases to identify eligible studies (up to August 11, 2020). Two authors independently screened studies and extracted data. The methodological quality of the included studies was assessed by Quality Assessment of Diagnostic Accuracy Studies 2 (QUADAS-2). Results Thirteen studies involving 1579 patients reported the predictive value of NLR on disease severity. The pooled sensitivity (SEN), specificity (SPE) and area under curve (AUC) were 0.78 (95% CI 0.70–0.84), 0.78 (95% CI 0.73–0.83) and 0.85 (95% CI 0.81–0.88), respectively. Ten studies involving 2967 patients reported the predictive value of NLR on mortality. The pooled SEN, SPE and AUC were 0.83 (95% CI 0.75–0.89), 0.83 (95% CI 0.74–0.89) and 0.90 (95% CI 0.87–0.92), respectively. Conclusions NLR has good predictive values on disease severity and mortality in patients with COVID-19 infection. Evaluating NLR can help clinicians identify potentially severe cases early, conduct early triage and initiate effective management in time, which may reduce the overall mortality of COVID-19. Trial registry This meta-analysis was prospectively registered on PROSPERO database (Registration number: CRD42020203612).

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Long-term mortality after massive, submassive, and low-risk pulmonary embolism

Vascular Medicine ◽

10.1177/1358863x19886374 ◽

2019 ◽

Vol 25 (2) ◽

pp. 141-149 ◽

Cited By ~ 5

Author(s):

Rajesh Gupta ◽

Zaid Ammari ◽

Osama Dasa ◽

Mohammed Ruzieh ◽

Jordan J Burlen ◽

...

Keyword(s):

Pulmonary Embolism ◽

Mortality Rate ◽

Tertiary Care ◽

Low Risk ◽

All Cause Mortality ◽

Acute Pe ◽

Long Term Mortality ◽

Overall Mortality

Guidelines for management of normotensive patients with acute pulmonary embolism (PE) emphasize further risk stratification on the basis of right ventricular (RV) size and biomarkers of RV injury or strain; however, the prognostic importance of these factors on long-term mortality is not known. We performed a retrospective cohort study of subjects diagnosed with acute PE from 2010 to 2015 at a tertiary care academic medical center. The severity of initial PE presentation was categorized into three groups: massive, submassive, and low-risk PE. The primary endpoint of all-cause mortality was ascertained using the Centers for Disease Control National Death Index (CDC NDI). A total of 183 subjects were studied and their median follow-up was 4.1 years. The median age was 65 years. The 30-day mortality rate was 7.7% and the overall mortality rate through the end of follow-up was 40.4%. The overall mortality rates for massive, submassive, and low-risk PE were 71.4%, 44.5%, and 28.1%, respectively ( p < 0.001). Landmark analysis using a 30-day cutpoint demonstrated that subjects presenting with submassive PE compared with low-risk PE had increased mortality during both the short- and the long-term periods. The most frequent causes of death were malignancy, cardiac disease, respiratory disease, and PE. Independent predictors of all-cause mortality were cancer at baseline, age, white blood cell count, diabetes mellitus, liver disease, female sex, and initial presentation with massive PE. In conclusion, the diagnosis of acute PE was associated with substantial long-term mortality. The severity of initial PE presentation was associated with both short- and long-term mortality.

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Long-term mortality predictors in pulmonary embolism

European Heart Journal Acute Cardiovascular Care ◽

10.1093/ehjacc/zuab020.197 ◽

2021 ◽

Vol 10 (Supplement_1) ◽

Author(s):

R Caldeira Da Rocha ◽

R Fernandes ◽

M Carrington ◽

F Claudio ◽

J Pais ◽

...

Keyword(s):

Pulmonary Embolism ◽

Troponin I ◽

Cox Regression ◽

Imaging Features ◽

All Cause Mortality ◽

History Of ◽

Acute Pe ◽

Long Term Mortality

Abstract Funding Acknowledgements Type of funding sources: None. Introduction Acute Pulmonary embolism(PE)is a common and potentially fatal medical condition.In contemporary adult population,PE is associated with increased long-term mortality. Purpose Identify predictors of long-term all-cause mortality in patients(pts)admitted due to pulmonary embolism. Methods Retrospective single-center study of hospitalized pts with acute PE between 2015 and 2018.We evaluated comorbidities, admission(AD)presentation such as vitals(with hypotension defined as systolic blood pressure(SBP)<90mmHg,and tachycardia as >100ppm),lab analyses during in-hospital period,imaging features. Mortality(long-term >3months)was also assessed using national registry of citizens.We performed uni and multivariate analysis to compare clinical characteristics of pts who died and who survived,using Cox regression and Kaplan-Meier methods.For the predictor age we assessed discrimination power and defined the best cut-off using area under the ROC curve(AUC)method. Results From 2015 to 2018,182 pts were admitted with diagnosis of pulmonary embolism,60% female with a mean age of 74 ± 13years old.Seventy-one(39%)pts died after a median follow-up of 26[10-41]months.Pts who died were older(80 ± 8 vs71 ± 14,p < 0.001).The best cut-off value of age to predict mortality with 70%sensitivity and 61%specificity was 77years old(AUC 0.703;CI95% 0.63-0.78).Pts who died had more frequently history of neoplasia (21%vs 9%,p = 0.009).The remaining comorbidities were similar in both groups.Pts who did not survive were more frequently hypotensive(28% vs 13%, p = 0.008),had higher creatinine(1.1[0.8-1.4] vs 1.0[0.8-1.2], p = 0.002), lactate(2.3[1.8-2.8]vs 1.8[1.5-2.0],p = 0.007)and NT-proBNP(4694[1498-12300]vs2070[492-6660], p < 0.001)at AD.Maximum troponin I (0.176[0.037-0.727]vs0.126[0.050-0.365]ng/mL,p = 0.012) was also higher than in pts who survived. After adjusting for history of neoplasia,ADcreatinine and maximum troponin I,we found that age (HR1.057;95%CI 1.01-1.11,p = 0.021),AD SBP < 90(HR 2.215;95%CI 1.03-4.76,p = 0.041),lactate(HR 1.17;95%CI 1.01-1.36,p = 0.035)and NT-proBNP(HR 1.510;95%CI 1.250-1.780,p < 0.001)were independent predictors of all-cause mortality. Conclusion In our cohort,the long-term all-cause mortality was 39%over a median follow-up of 26[10-41]months.In patients with pulmonary embolism,aside from already identified age(especially when ≥70 years old)and NT-proBNP,lactate should also be considered when evaluating long-term prognosis. Furthermore,hypotension at admission increases by 2fold long-term mortality in patients who suffered acute PE.

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