scholarly journals Risk factors associated with the development of death events during the first year of follow-up after pulmonary thromboembolism

2019 ◽  
pp. 80-85
Author(s):  
S. A. Berns ◽  
E. A. Schmidt ◽  
A. G. Neeshpapa ◽  
A. A. Potapenko ◽  
K. V. Smirnov ◽  
...  

Purpose: to identify the factors associated with the development of death events during the year follow-up after hospitalization for pulmonary embolism (PE). Materials and methods: 93 patients with PE discharged to the outpatient stage of observation were studied. 45 (61,6%) patients were female with an average age of 66 years. The examination of patients at the stage of inclusion in the study consisted of standard methods of examination for this pathology. The diagnosis was confirmed by multislice computed tomography. Follow-up was 12 months. Statistical analysis was performed using the MedCalc Version 16.2.1. Results: during the one-year follow-up period 62 (66,7%) patients with PE were alive but 11 patients (11,8%) died, and no information was obtained about 20 patients. The causes of death were as follows: the development of recurrent PE – 4 (36,4%) patients, cancer – 3 patients (27,3%), stroke – 2 (18,1%), one patient (9,1%) died due to severe heart failure and one – myocardial infarction. A comparative analysis in the groups of alive patients (n = 62) and patients with a fatal events (n = 11) showed that the dead patients were older (78 (68; 81) vs. 65 (49; 75) years; p = 0,003), had a higher PESI score (119,0 (99,7; 137,2) vs. 88,0 (68,0; 108,0); p = 0,016) and were less compliant to prolonged anticoagulant therapy during the one year of observation (45,5% of patients (n = 5) vs. 82,3% ( = 51); p = 0,015). The ROC curve determined that a high risk of death during the one year after PE is associated with age over 70 years (p = 0,0001) and more than 95 points by PESI in the hospital period (p = 0,0001). Conclusion: The death events were developed in 11,8% of cases in patients with pulmonary embolism during the first year of follow-up. The death outcomes were significantly associated with elderly age, intermediate and high risk by PESI in the hospital period and low compliance to anticoagulant therapy extended during the year after pulmonary embolism.

Blood ◽  
2015 ◽  
Vol 126 (23) ◽  
pp. 4381-4381
Author(s):  
Haiwen Huang ◽  
Qiangli Wang ◽  
Ting Xu ◽  
Xiaochen Chen ◽  
Zhengming Jin ◽  
...  

Abstract Purpose We present the result of a comparison study between conventional chemotherapy and HCT for Peripheral T-cell lymphomas (PTCLs) in our center, especially the comparison between allo-HCT and auto-HCT. Patients and Methods From July 2007 to July 2014, 112 cases were analyzed retrospectively. All 112 patients were high risk group (IPI®3-4), 52 patients received conventional chemotherapy alone and 60 patients underwent HCT. In HCT group, Twenty-one (36.5%) patients received allo-HCT and thirty-nine patients (63.5%) received auto-HCT. Before receiving transplantation, 40 patients were in complete remission (CR), 2 patients were in partial remission (PR) and 18 patients were in refractory or relapse (NR). In the 18 NR patients, 11 patients accepted allo-HCT and 7 patients accepted auto-HCT. Patients¡¯ baseline characteristics were listed in Table 1 and Table 2. Results In this study, the longest follow-up time was 76 months and the shortest follow-up time was only two months. After chemotherapy, 31/52 patients achieved complete remission (CR)£¬5/52 patients achieved PR and 16/52 patients were not remission£¡§NR). The overall response rate was 69.2%. However, 14 patients suffered relapse in 36 responding patients, the recurrence rate was close to 50%. In allo-HCT group, 19/21 patients achieved CR and 2/21 patients died of severe infection within 100 days after HCT. In auto-HCT patients, 35/39 patients achieved CR and 4/39 patients were in NR. 7 patients experienced relapse after auto-HCT. After a median follow-up of 33.5 months, the K-M analysis showed that the 5-year PFS for HCT and chemotherapy were 60% and 30% (p =0.006), the 5-year OS were 65% and 33% (p =0.007). The difference between the two groups was significant The 5-year PFS for auto-HCT and allo-HCT were 61% and 60% (p=0.724). The 5-year OS were 62% and 61% (p=0.724). In transplant group, the 5-year OS for patients who were CR or NR before transplantation were 81% and 53% (p=0.303). The one-year cumulative TRM of allo-HCT and auto-HCT were 22.5% and 7.8% (p=0.250). For patients whose ages are below 50, the 2-year PFS for HCT and chemotherapy were 62.7% and 34.8% (p=0.017), the 3-year OS were 71.2% and 36.7% (p=0.033). The one-year TRM of HCT and chemotherapy were 15.5% and 12.4% (p=0.203). For patients more than 50 years old, the 1-year OS for HCT and chemotherapy were 85.7% and 66.5% (p=0.384). And the one-year TRM of HCT and chemotherapy were 28.6% and 33.3% (p=0.352). Conclusion The majorities of PTCL patients are at high risk and have a high recurrence rate after conventional chemotherapy alone. Our results suggest that HCT is superior to conventional chemotherapy in long-term survival for PTCLs and HCT is feasible for high-risk patients with low TRM, especially in the young patients. Therefore, HCT should be considered to be the first-line therapy in high risk PTCL patients. As to PFS and OS, there seems to be no difference between auto-HCT and allo-HCT. While before transplantation, there are more NR and relapsed patients in allo-HCT group, we recommend allo-HCT for refractory and relapsed patients. Table 1. Patient characteristics Parameters Chemotherapy HCT p value Number 52 60 Gender(female/male) 16/36 16/44 0.521 Median Age 45 29 0.003 Histological subtypes N PTCL-NOS 9 17 ALK-negative ALCL 15 15 AITL 15 17 NK/T 13 11 High risk factors B-symptoms 27 25 0.436 IPI score ®3 52 60 1.000 Ann Arbor III-IV stage 40 40 0.376 Evaluated LDH 40 42 0.546 Response to chemotherapy N CR 31 40 PR 5 2 NR 16 18 Responses to transplantation N N CR 54 PR 0 NR 4 Uncertain 2 Table 2. Patient characteristics of transplantation group Parameters Auto-HCT Allo-HCT Number 39 21 Histological subtypes PTCL-NOS 12 4 ALK-negative ALCL 13 4 AITL 7 9 NK/T 7 4 Conditioning regimen BEAM 39 0 BUCY 0 11 TBI+BUCY 0 10 Donor source N Matched unrelated donor 8 Matched sibling donor 4 Haploid donor 8 Cord blood 1 Disease status before HCT CR 30 10 PR 2 0 NR 7 11 Disease status after HCT CR 35 19 PR 0 0 NR 4 0 uncertain 0 2 Disclosures No relevant conflicts of interest to declare.


PLoS ONE ◽  
2021 ◽  
Vol 16 (3) ◽  
pp. e0248603
Author(s):  
Cuilian Weng ◽  
Xincai Wang ◽  
Long Huang ◽  
Xingsheng Lin ◽  
Qinghua Liu

Introduction Patients at intermediate-high risk of developing a pulmonary embolism (PE) are very likely to experience adverse outcomes, such as cardiovascular instability and death. The role of thrombolytic therapy in intermediate-high-risk PE remains controversial. Objectives This study aimed to determine the efficacy and safety of low-dose urokinase (UK) thrombolytic therapy for intermediate-high-risk PE. Patients and methods This retrospective study included 81 consecutive patients with intermediate-high-risk PE from two centers. Patients received low-dose UK or low-molecular-weight heparin (anticoagulant therapy group). The efficacy outcomes were mortality, computed tomography pulmonary angiography (CTPA)-confirmed absorption, and dyspnea. Safety was assessed as the incidence of bleedings. Results The in-hospital mortality, 9-month mortality, and long-term mortality at the last follow-up were comparable for the low-dose UK group and the anticoagulant therapy group (6.45% vs. 0%, p = 0.144, 9.68% vs. 8.16%, p = 0.815, and 12.90% vs. 12.24%, p = 0.931, respectively). CTPA-confirmed absorption at one month after admission was higher in the low-dose UK group than in the anticoagulant therapy group (p = 0.016). The incidences of short-term dyspnea at discharge and long-term dyspnea at the last follow-up were lower in the low-dose UK group than in the anticoagulant therapy group (27.59% vs. 52%, p = 0.035, 33.33% vs. 58.14%, p = 0.043, respectively). No major bleeding occurred. The incidence of minor bleeding was not significantly different between the two groups (3.23% vs. 6%, p = 0.974). Conclusion In intermediate-high-risk PE, a low-dose UK might increase CTPA-confirmed absorption and improve short-term and long-term dyspnea without affecting mortality or increasing the bleeding risk.


2020 ◽  
Vol 66 (12) ◽  
pp. 1645-1650
Author(s):  
Caglar Ozmen ◽  
Onur Sinan Deveci ◽  
Muhammet Bugra Karaaslan ◽  
Oya Baydar ◽  
Anil Akray ◽  
...  

SUMMARY OBJECTIVE: Early diagnosis and risk stratification may provide a better prognosis in pulmonary embolism (PE). Copeptin has emerged as a valuable predictive biomarker in various cardiovascular diseases. The aim of this study was to determine the levels of copeptin in patients with acute PE and to evaluate its relationship with disease severity and PE-related death. METHODS: Fifty-four patients and 60 healthy individuals were included in this study. Copeptin concentrations and right ventricular dysfunction were analyzed. The correlation between copeptin levels and hemodynamic and echocardiographic parameters was examined. After these first measurements, patients were evaluated with PE-related mortality at the one-year follow-up. RESULTS: The copeptin levels were higher in PE patients than in the control group (8.3 ng/mL vs 3.8 ng/mL, p<0.001). Copeptin levels were found to be significantly higher in patients with PE-related death and right ventricular dysfunction (10.2 vs 7.5 ng/ml, p=0.001; 10.5 vs 7.5 ng/ml, p=0.002, respectively). When the cut-off value of copeptin was ≥5.85, its sensitivity and specificity for predicting PE were 71.9% and 85.0%, respectively (AUC=0.762, 95% CI=0.635-0.889, p<0.001). CONCLUSIONS: The copeptin measurement had moderate sensitivity and specificity in predicting the diagnosis of PE, and the copeptin level was significantly higher in patients with PE-related death at the one-year follow-up. Copeptin may be a useful new biomarker in predicting diagnosis, risk stratification, and prognosis of PE.


Blood ◽  
2015 ◽  
Vol 126 (23) ◽  
pp. 5514-5514
Author(s):  
Jing Bo Wang ◽  
Xin Hong Fei ◽  
Yu Ming Yin ◽  
Hao Yu Cheng ◽  
Wei Jie Zhang ◽  
...  

Abstract Objective To retrospectively evaluate the results of allogeneic halpo-identical hematopoietic stem cell transplantation for high-risk leukemia. Methods From June 2012 to January 2015, total 60 patients with high-risk leukemia were enrolled, including 18 cases of ALL, 37cases of AML and 5 case of CML-BP. Including criterions: 1) ≥CR1; 2) relapse within 6 months after remisson. The average leukemia burden was 53% in bone marrow. All patients received HLA haplo-identical stem cells transplantation from parent or sibling donors. Myeloablative conditioning regimens consist of 7cases of BuCy, 26 cases of TBI/FLAG, 15 cases of TBI/Cy, and 12 cases of FLAG that followed by reduced-intensified BUCY. All patients received cyclosporine A, MMF and methotrexate for GVHD prophylaxis. Analyzed outcomes were hematological engraftment, incidence of acute and chronic GVHD, incidence of relapse, and nonrelapse mortality (NRM), Overall survival (OS) and Disease-free survival (DFS). Results The median mononuclear cells and CD34+ for transfusion were 9.08(7.02-24.4)*108/Kg and 3.42(0.8-12.1)*106/Kg. All 60 patients achieved stable engraftment. The median time of ANC≥0.5*10^9/L was 16 (8-23) days. And for platelet ≥20*10^9/L, the median was 22 (8-150) days. 38 patients developed acute GVHD, the accumulative incidence of aGVHD was 66.4%, the accumulative incidence of II-IV grade aGVHD was 35%, and the accumulative incidence of III-IV grade aGVHD was 15%. 26 patients developed cGVHD (12 patients extensive, 14 patients limited), the accumulative incidence of cGVHD was 88.2% and for extensive type, the accumulative incidence was 67.4%. The accumulative incidence of CMV infection was 54.1%, and the accumulative incidence of EBV infection was 16.3%. 10 patients developed virus cystitis. The number of Bacterial and fungal infected patients were 51 and 27, respectively. The median follow-up time post transplantation was 11(1-36) months, 14 patients relapsed and the accumulative incidence of relapse was 27%. For AML, ALL and CML-BP patients, the accumulative incidence of relapse were 26.6%, 34.8% and 0%, respectively. The median follow-up time post transplantation was 11months, 21 patients died and the main causes were relapse (11 cases), infection (5 cases), cGVHD (2 cases) and diffuse alveolar hemorrhage (3 cases). Among 60 patients, 39 patients survived. The one-year and two-year accumulative incidences of OS were 61.8% and 49.5%, respectively. The one-year and two-year accumulative incidences of DFS were 53.8% and 47.8%, respectively. For AML, ALL and CML-BP patients, the two-year accumulative incidence were 52.6%, 34.4% and 66.7%, respectively. The non-relapse mortality was 10. The one-year and two-year accumulative incidences of NRM were 19.4% and 28.4%, respectively. Conclusion Our clinical results have shown that the salvaged HSCT is a promising modality for treatment of high-risk AL with high leukemia burden. Disclosures No relevant conflicts of interest to declare.


2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
C Pihl ◽  
J Norsk ◽  
A.S Sillesen ◽  
R.O.B Voegg ◽  
H Boyd ◽  
...  

Abstract Background Ventricular septal defect (VSD) is one of the most common congenital heart defects. Some VSDs close spontaneously while persistence of the VSD may result in heart failure and, at long term, irreversible pulmonary hypertension. Consequently, identification of factors associated with spontaneous closure are important to ensure relevant clinical follow up of those at risk of a persistent VSD. Purpose We aimed to assess the rate of spontaneous closure in a population-based cohort of newborns with VSD and to identify significant predictors for spontaneous closure. Methods The study is part of a large-scale population-based study, focusing on cardiac structure and function, including newborns born from 1st April 2016 to 31st October 2018. Newborns with a VSDs at baseline were followed with echocardiography at 3, 6 and 12 months (+30 days) of age. Cox proportional hazard model was used to determine significant predictors of spontaneous closure Results Based on echocardiographies of 25.750 newborn, 850 newborns (3.3%) with a VSD were identified. The majority of newborns with VSDs were born at term (88.7%) and the mean age at inclusion was 11.7±8.1 days. VSDs were more frequent in females (57.1%, p&lt;0.001). Of all VSDs, 787l (92.6%) were of a muscular type, 60 (7.0%) of perimembranous type and 3 (0.4%) were of subarterial type. Multiple VSDs were found in 98 (11.5%) cases and all were of a muscular type. Muscular VSDs were significantly smaller than perimembranous VSDs (1.9±0.7 mm vs. 3.7±1.8 mm, p&lt;0.0001). During the follow up period, seven (0.8%) children underwent surgical repair: five (5 of 56) children with perimembranous VSDs and two (two of three) children with subarterial VSDs. Follow-up was complete in 89.4% of all children. After one year 82.6% (601 of 727) VSDs had closed spontaneously. The prevalence of VSD in one-year old children was thus 0.5%. The majority of VSD closed spontaneously during the first 6 months of life (57.6% (419/727)). Muscular VSDs showed significantly higher rate of spontaneous closure compared with perimembranous VSDs (86.9% (582 /670) vs. 46.2% (25/54), p=0.0001) during the first year of life. No subarterial VSDs closed spontaneously during follow-up. Muscular type (p=0.002), size (p&lt;0.001) and presence of one VSD as opposed to multiple (p&lt;0.0025) were associated to spontaneous closure. Sex did not significantly influence spontaneous closure rate (p=0.65). Conclusion In a population study including more than 25,000 newborns we found that the vast majority, i.e. almost 9/10 of all VSDs, closed spontaneously during the first year of life, ultimately resulting in a prevalence of VSD in one-year old children of 0.5%. The identified factors associated with spontaneous closure – anatomical location, size and presence of multiple VSDs are of use for future management of VSDs in newborns. Funding Acknowledgement Type of funding source: Other. Main funding source(s): The Danish Heart Foundation


2021 ◽  
Vol 98 (8) ◽  
pp. 606-611
Author(s):  
V. P. Tyurin ◽  
A. G. Pronin

There is no indication when to perform thrombolytic or anticoagulant therapy in patients with moderate-high risk of early death in accordance with the stratification of the European society of cardiology. The purpose of the study: to establish clinical, laboratory, and instrumental criteria for the choice of therapy volume optimization in patients with moderate-high risk of early death. Material and methods. The study included 154 patients with pulmonary embolism (PE) of high, moderate-high, moderate-low risk of death. An analysis was performed to determine the most significant indications for thrombolytic therapy in PE. Results. The presence of established «undoubted» criteria indicates the need for thrombolytic therapy. These include an increase in the size of the right ventricle compared to the left, paradoxical movement of the interventricular septum, hypokinesia of the right ventricle on еchocardiography. «Questionable» criteria were also identified: more than 50 mm Hg increased pulmonary artery pressure, more than 20 mm dilation of the inferior Vena cava, more than 3 cm dilatation of the right ventricle on еchocardiography, deep SIQIII on ECG, syncopal states in the anamnesis, increased NT-proBNP values, less than 90% arterial blood saturation. Thrombolytic therapy is indicated for patients with a combination of 2 or more of these criteria, in other cases anticoagulant therapy is prescribed. Conclusion. The use of established criteria makes it possible to differentiate treatment of patients with moderate-high risk of early death and reduce the likelihood of developing chronic post-thromboembolic pulmonary hypertension by 2.9 times.


VASA ◽  
2012 ◽  
Vol 41 (2) ◽  
pp. 120-124 ◽  
Author(s):  
Asciutto ◽  
Lindblad

Background: The aim of this study is to report the short-term results of catheter-directed foam sclerotherapy (CDFS) in the treatment of axial saphenous vein incompetence. Patients and methods: Data of all patients undergoing CDFS for symptomatic primary incompetence of the great or small saphenous vein were prospectively collected. Treatment results in terms of occlusion rate and patients’ grade of satisfaction were analysed. All successfully treated patients underwent clinical and duplex follow-up examinations one year postoperatively. Results: Between September 2006 and September 2010, 357 limbs (337 patients) were treated with CDFS at our institution. Based on the CEAP classification, 64 were allocated to clinical class C3 , 128 to class C4, 102 to class C5 and 63 to class C6. Of the 188 patients who completed the one year follow up examination, 67 % had a complete and 14 % a near complete obliteration of the treated vessel. An ulcer-healing rate of 54 % was detected. 92 % of the patients were satisfied with the results of treatment. We registered six cases of thrombophlebitis and two cases of venous thromboembolism, all requiring treatment. Conclusions: The short-term results of CDFS in patients with axial vein incompetence are acceptable in terms of occlusion and complications rates.


Author(s):  
Francisco J.A. Sanchez ◽  
Jose L.A. Martínez ◽  
Mirem A.U. Echezarreta ◽  
Ione V. Garcia ◽  
Jorge R. Alvaro

2021 ◽  
Vol 80 (Suppl 1) ◽  
pp. 914-914
Author(s):  
A. Boteanu ◽  
A. García Fernández ◽  
N. De la Torre ◽  
M. Pavia Pascual ◽  
O. Sanchez Pernaute ◽  
...  

Background:Patients with inflammatory rheumatic diseases (IRD) infected with SARS-CoV-2 may be at risk to develop a severe course of COVID-19 due to the immune dysregulation or the influence of immunomodulating drugs on the course of the infection. For a better understanding of SARS-CoV-2 infections in patients with IRD and due to the high incidence of COVID-19 in Madrid from the beginning of this pandemic infection in Spain, the Society of Rheumatology from Madrid (SORCOM) established a registry (REUMA-COVID SORCOM) shortly after the beginning of the pandemic in Spain.Objectives:To determine factors associated with severity of infection with SARS-CoV-2 in patients with inflammatory rheumatic diseases in MadridMethods:The REUMA-COVID SORCOM registry is a multicenter, retrospective, observational cohort study conducted in Madrid, a SORCOM initiative. All rheumatology departments from Madrid were invited to participate. The study includes patients with IRD presenting with a confirmed or highly suspected diagnosis of COVID-19 between March 1, 2020, and November 10, 2020. We consider severe infection death or need of hospitalization. Inclusion criteria was having an IRD and at least 1 of the following 4 criteria: (1) a biologically confirmed COVID-19 diagnosis based on a positive result of a SARS-CoV-2 polymerase chain reaction (PCR) test on a nasopharyngeal swab; (2) Detection of IgM or IgG anti SARS-CoV2 in a symptomatic or asymptomatic patients (3)typical thoracic computed tomography (CT) abnormalities (ground-glass opacities) in epidemic areas; (4) COVID19–typical symptoms in an epidemic zone of COVID-19.Results:As of November 10, 2020, 417 patients with IRD were included in the REUMA-COVID SORCOM registry. 5 patients were discharged for incomplete data. Of 412 patients (mean age 57 years, 87.4% Caucasian race, 66.3% female) 174 need hospitalization (42.2%) and 33 patients died (18.4% mortality in hospitalized patients). 82.3% had comorbidities. 234 (56.8%) patients were classified as inflammatory arthropathy, 133 (32.3%) had connective tissue diseases (CTD). 41.1% of the patients had a large history of IRD (> 10 years). 10.4% of patients had previously pulmonary involvement. The study includes 143 patients taking Methotrexate, 89 patients taking anti-TNFα therapy and 27 Rituximab. In the univariant analysis, no differences were seen in the severity of COVID-19 infection in patients taking methotrexate. 63% of the all patients taking Rituximab included in the registry need hospitalization and 22% of them died. Hypertension, COPD or cardiovascular disease was associated with hospitalization.Independent factors associated with COVID-19 hospitalization in the multivariate analysis was: age (>62 years), male sex, IMC >30, previous cardiovascular comorbidities and the IRD disease duration (> 10 years). Independent factors associated with COVID-19 related death was: age (> 62 years), having a CTD diagnose, pulmonary involvement before infection and chronical GC treatment.Conclusion:Patients with IRD represent a population of particular interest in the pandemic context because the baseline immunological alteration and the treated with immunosuppressants agents they receive, comorbidities and the well-known risk of severe infection. Older age, male sex, cardiovascular comorbidities were factors associated with high risk of hospitalization in IRD patients. CTD diseases, previously pulmonary involvement and chronical GC treatment with more than 10mg/day were associated with high risk of death. Neither anti TNF-α treatment nor Methotrexate were risk factor for hospitalization or death COVID-19 related in IRD patients.Disclosure of Interests:None declared


2021 ◽  
Vol 14 (1) ◽  
Author(s):  
Afona Chernet ◽  
Nicole Probst-Hensch ◽  
Véronique Sydow ◽  
Daniel H. Paris ◽  
Niklaus D. Labhardt

Abstract Objective Eritrea is the most frequent country of origin among asylum seekers in Switzerland. On their journey through the desert and across the Mediterranean Sea, Eritrea refugees are often exposed to traumatizing experiences. The aim of this study is to assess the mental health status and resilience of Eritrean migrants in Switzerland upon arrival and one-year post-arrival, using standardized mental health screening and resilience assessment tools. Results At baseline, 107 refugees (11.2% female, median age 25) were interviewed: 52 (48.6%) screened positive for Post-Traumatic Stress Disorder (score ≥ 30), 10.3% for anxiety (≥ 10) and 15.0% for depression (≥ 10); 17.8% scored as risk/hazardous drinkers (≥ 8). The majority (94.4%) had a high resilience score (≥ 65). For one-year follow-up, 48 asylum seekers could be reached. In interviews 18 (38%) of these reported imprisonment in a transit country and 28 (58%) that they had witnessed the death of a close person along the migration route. At the one year assessment, rates of risky/hazardous alcohol use remained unchanged, rates of positive PTSD screening tended to be lower (50.0% (24/48) at baseline vs 25.0% (12/48) at follow-up), as were rates of positive screening for anxiety (8.3% vs 4.2%) and depression (14.6 vs 6.3%).


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