The prognostic efficacy of beta2-microglobulin in acute pulmonary embolism

2017 ◽  
Vol 16 (2) ◽  
pp. 52-59
Author(s):  
Sotirios Kakavas ◽  
◽  
Aggeliki Papanikolaou ◽  
Evangelos Balis ◽  
Evgenios Metaxas ◽  
...  
Keyword(s):  
Pulmonary Embolism ◽  
Acute Pulmonary Embolism ◽  
C Reactive Protein ◽  
Reactive Protein ◽  
Risk Of Death ◽  
Increased Risk ◽  
Preliminary Study ◽  
Wbc Count ◽  
A Prospective Study ◽  
Acute Pe

Our aim was to prospectively assess the prognostic value of beta2- microglobulin (b2-M) in patients with acute pulmonary embolism (PE). We conducted a prospective study of 109 patients admitted in a pulmonary clinic due to acute PE. A panel of inflammatory markers including b2-M white blood cell (WBC) count and C-reactive protein (CRP) was determined for each patient. In this preliminary study, baseline b2-M levels significantly correlated with the impairment of oxygenation and with all the parameters that are used for the early risk stratification of patients. In multivariate analysis, patients’ age and baseline b2-M levels were significantly associated with an increased risk of death. These findings require further prospective validation.

P5588Early versus delayed oral anticoagulation in patients with acute pulmonary embolism: determinants and outcome

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
C Becattini ◽  
L A Cimini ◽  
M Lankeit ◽  
P Pruszczyk ◽  
S Vanni ◽  
...  
Keyword(s):  
Pulmonary Embolism ◽  
Oral Anticoagulation ◽  
Acute Pulmonary Embolism ◽  
Oral Anticoagulants ◽  
Hospital Death ◽  
Intermediate Risk ◽  
Right Ventricle Dysfunction ◽  
Risk Of Death ◽  
Risk Patients ◽  
Acute Pe

Abstract Background Whether early oral anticoagulant treatment is appropriate for patients with acute pulmonary embolism (PE) regardless of PE severity is undefined. The aim of this study in patients with acute PE at intermediate risk of death were: I) to assess the determinants for the use of early vs delayed vs no oral anticoagulants in patients with acute PE and II) to assess the association between timing of oral anticoagulation and in-hospital mortality. Methods Prospective cohorts of patients with acute PE at intermediate risk of death according to the European Society of Cardiology Guidelines 2014 were merged in a collaborative database. The initiation of oral anticoagulation was classified as early (≤3 days) or delayed (between day 3 and 10 from diagnosis). Patients treated with parenteral anticoagulants for longer than 10 days were also included. In-hospital death was the primary study outcome. Results Overall, 557 patients were included in the study, 23 received thrombolytic treatment during the hospital stay. The mean duration of parenteral anticoagulation was 7±8 days (5 median), 348 patients were initiated on a direct oral anticoagulant and 79 on a vitamin K antagonist during the hospital stay. Initiation of oral anticoagulants occurred early or delayed in 209 (37%) and 218 (39%) patients, respectively and never occurred during the first 30 days in 130 (23%). Intermediate-low risk patients more commonly received early and intermediate high delayed oral anticoagulation. Simplified PESI score of zero (OR 1.9, 95% CI 1.3–2.7) was independently associated with early oral anticoagulation; among sPESI components absence of cancer (OR 5.9, 95% CI 3.3–10) and heart rate <110 (OR 1.8, 95% CI 1.01–3.16) were independent predictors of early initiation of oral anticoagulants. The presence of both right ventricle dysfunction and injury was associated with delayed initiation of oral anticoagulants. The incidence of death was 5.5%. Death occurred in 32 patients and was not related to the duration of parenteral anticoagulation (OR 1.01 per day, 95% CI 0.98–1.06) nor to right ventricle dysfunction but to sPESI 1 (OR 3.32, 95% CI 1.14–9.66). These results were partially confirmed in the 435 intermediate risk patients without cancer (OR 1.03, 95% CI 0.99–1.08 for days of parenteral treatment; OR 4.17, 95% CI 0.95–18 for sPESI 1). Conclusion The clinical severity of PE and not the timing of initiation of oral anticoagulants are associated with in-hospital death in patients with intermediate risk PE. Randomized studies are needed to definitively assess the role of heparin lead-in in patients with PE at intermediate risk for death.

Acute pulmonary embolism during warfarin therapy and long-term risk of recurrent fatal pulmonary embolism

2013 ◽  
Vol 110 (09) ◽  
pp. 523-533 ◽  
Author(s):  
John Paul Moutzouris ◽  
Vincent Chow ◽  
Tommy Chung ◽  
Jennifer Curnow ◽  
Leonard Kritharides ◽  
...  
Keyword(s):  
Pulmonary Embolism ◽  
Heart Disease ◽  
Acute Pulmonary Embolism ◽  
Total Mortality ◽  
Post Discharge ◽  
Tertiary Institution ◽  
Risk Of Death ◽  
Increased Risk ◽  
Prognostic Importance

SummaryThe clinical characteristics and long-term outcomes of patients presenting with acute pulmonary embolism (PE) during treatment with warfarin have not been described. Clinical details of all patients admitted to a tertiary institution from 2000-2007 with acute PE were retrieved retrospectively, baseline warfarin status and the international normalised ratio (INR) were recorded, and their outcomes tracked using a statewide death registry. Of 923 patients with clearly documented warfarin status included in this study, 83 (9%) were taking warfarin. Mean (± standard deviation) day-1 INR of those taking warfarin was 2.3 ± 0.9, with 67% of patients therapeutically anti-coagulated (INR ≥2.0) at presentation (49 patients with INR <2.5 and 34 with INR ≥2.5). Patients taking warfarin on admission were more likely to have heart failure, atrial fibrillation and valvular heart disease, with similar prevalence of malignancy and ischaemic heart disease, compared to patients not on warfarin. Total mortality of the cohort (mean follow-up 4.0 ± 2.5 years) was 31.6% (in-hospital mortality 1.5%), and was similar between warfarin and no warfarin groups. There was however a greater than four-fold increased risk of post-discharge death due to recurrent PE for the patients taking warfarin on admission (hazard ratio [HR] 4.43, 95% confidence interval [CI] 1.36-14.42, p=0.01). Among patients taking warfarin on admission, day-1 INR <2.5 significantly increased long-term all-cause mortality compared to INR ≥2.5 (adjusted HR 2.51, 95% CI 1.08-5.86, p=0.03). In conclusion, patients presenting with PE during treatment with warfarin have an increased risk of death from recurrent PE. Admission INR appears to have independent long-term prognostic importance in these patients.

scholarly journals Biomarkers Associated with Death After Initiating Treatment for Tuberculosis and HIV in Patients with Very Low CD4 Cells

2018 ◽  
Vol 3 (1) ◽  
pp. 46 ◽  
Author(s):  
Fred Richard Sattler ◽  
Daniel Chelliah ◽  
Xingye Wu ◽  
Alejandro Sanchez ◽  
Michelle A. Kendall ◽  
...  
Keyword(s):  
Proportional Hazards ◽  
Cox Proportional Hazards ◽  
C Reactive Protein ◽  
Retrospective Case ◽  
Reactive Protein ◽  
Risk Of Death ◽  
Cox Proportional Hazards Models ◽  
Increased Risk ◽  
Treatment Naïve ◽  
Low Bmi

Background: The risk of short-term death for treatment naive patients dually infected with Mycobacterium tuberculosis and HIV may be reduced by early anti-retroviral therapy. Of those dying, mechanisms responsible for fatal outcomes are unclear. We hypothesized that greater malnutrition and/or inflammation when initiating treatment are associated with an increased risk for death.Methods: We utilized a retrospective case-cohort design among participants of the ACTG A5221 study who had baseline CD4 < 50 cells/mm3. The case-cohort sample consisted of 51 randomly selected participants, whose stored plasma was tested for C-reactive protein, cytokines, chemokines, and nutritional markers. Cox proportional hazards models were used to assess the association of nutritional, inflammatory, and immunomodulatory markers for survival.Results: The case-cohort sample was similar to the 282 participants within the parent cohort with CD4 < 50 cells/mm3. In the case cohort, 7 (14%) had BMI < 16.5 (kg/m2) and 17 (33%) had BMI 16.5-18.5(kg/m2). Risk of death was increased per 1 IQR width higher of log10 transformed level of C-reactive protein (adjusted hazard ratio (aHR) = 3.42 [95% CI = 1.33-8.80],P = 0.011), interferon gamma (aHR = 2.46 [CI = 1.02-5.90], P = 0.044), MCP-3 (3.67 [CI = 1.08-12.42], P = 0.037), and with IL-15 (aHR = 2.75 [CI = 1.08-6.98], P = 0.033) and IL-17 (aHR = 3.99 [CI = -1.06-15.07], P = 0.041). BMI, albumin, hemoglobin, and leptin levels were not associated with risk of death.Conclusions: Unlike patients only infected with M. tuberculosis for whom malnutrition and low BMI increase the risk of death, this relationship was not evident in our dually infected patients. Risk of death was associated with significant increases in markers of global inflammation along with soluble biomarkers of innate and adaptive immunity.

Prevalence of thrombocytosis in critically ill patients and its association with symptomatic acute pulmonary embolism

2013 ◽  
Vol 109 (02) ◽  
pp. 272-279 ◽  
Author(s):  
Shaila Chavan ◽  
Kwok Ho
Keyword(s):  
Pulmonary Embolism ◽  
Intensive Care ◽  
Platelet Count ◽  
Critically Ill ◽  
Critically Ill Patients ◽  
Acute Pulmonary Embolism ◽  
Increased Risk ◽  
Wide Range ◽  
The Relationship ◽  
Acute Pe

SummaryIt is uncertain whether thrombocytosis without underlying myeloproliferative diseases is associated with an increased risk of acute pulmonary embolism (PE). We investigated the relationship between thrombocytosis and risk of symptomatic acute PE, and whether Pulmonary Embolism Severity Index (PESI) was reliable in predicting mortality of acute PE. This multicentre registry study involved a total of 609,367 critically ill patients admitted to 160 intensive care units (ICUs) in Australia or New Zealand between 2006 and 2011. Forward stepwise logistic regression was used to assess the relationship between risk of acute PE and platelet counts on intensive care unit (ICU) admission. Acute PE (n=3387) accounted for 0.9% of all emergency ICU admissions. Over 20% of all PE required mechanical ventilation, 4.2% had cardiac arrest, and the mortality was high (14.8%). Thrombocytosis, defined by a platelet count >500×109 per litre, occurred in 2.1% of the patients and was more common in patients with acute PE than other diagnoses (3.4 vs. 2.0%). The platelet counts explained about 4.5% of the variability and had a linear relationship with the risk of acute PE (odds ratio 1.19 per 100×109 per litre increment in platelet count, 95% confidence interval 1.06–1.34), after adjusting for other covariates. The PESI had a reasonable discriminative ability (area under receiver-operating-characteristic curve = 0.78) and calibration to predict mortality across a wide range of severity of acute PE. In summary, thrombocytosis was associated with an increased risk of symptomatic acute PE. PESI was useful in predicting mortality across a wide range of severity of acute PE.

scholarly journals A Single Imaging Modality in the Diagnosis, Severity, and Prognosis of Pulmonary Embolism

2014 ◽  
Vol 2014 ◽  
pp. 1-10
Author(s):  
Hadice Selimoglu Sen ◽  
Özlem Abakay ◽  
Mehmet Güli Cetincakmak ◽  
Cengizhan Sezgi ◽  
Süreyya Yilmaz ◽  
...  
Keyword(s):  
Pulmonary Embolism ◽  
Pulmonary Artery ◽  
Risk Evaluation ◽  
Systolic Pressure ◽  
Left Ventricular ◽  
Pulmonary Artery Systolic Pressure ◽  
Risk Of Death ◽  
Prediction Of Mortality ◽  
Increased Risk ◽  
Acute Pe

Introduction. This study aimed to investigate the currency of computerized tomography pulmonary angiography-based parameters as pulmonary artery obstruction index (PAOI), as well as right ventricular diameters for pulmonary embolism (PE) risk evaluation and prediction of mortality and intensive care unit (ICU) requirement.Materials and Methods. The study retrospectively enrolled 203 patients hospitalized with acute PE. PAOI was calculated according to Qanadli score.Results. Forty-three patients (23.9%) were hospitalized in the ICU. Nineteen patients (10.6%) died during the 30-day follow-up period. The optimal cutoff value of PAOI for PE 30th day mortality and ICU requirement were found as 36.5% in ROC curve analysis. The pulmonary artery systolic pressure had a significant positive correlation with right/left ventricular diameter ratio (r=0.531,P<0.001), PAOI (r=0.296,P<0.001), and pulmonary artery diameter (r=0.659,P<0.001). The patients with PAOI values higher than 36.5% have a 5.7-times increased risk of death.Conclusion. PAOI is a fast and promising parameter for risk assessment in patients with acute PE. With greater education of clinicians in this radiological scoring, a rapid assessment for diagnosis, clinical risk evaluation, and prognosis may be possible in emergency services without the need for echocardiography.

C-Reactive Protein in Acute Pulmonary Embolism

2011 ◽  
Vol 59 (1) ◽  
pp. 8-14 ◽  
Author(s):  
Yasin Abul ◽  
Sait Karakurt ◽  
Beste Ozben ◽  
Ahmet Toprak ◽  
Turgay Celikel
Keyword(s):  
Pulmonary Embolism ◽  
Acute Pulmonary Embolism ◽  
C Reactive Protein ◽  
Reactive Protein

scholarly journals Low Intracellular Water, Overhydration, and Mortality in Hemodialysis Patients

2020 ◽  
Vol 9 (11) ◽  
pp. 3616
Author(s):  
Carolina Gracia-Iguacel ◽  
Emilio González-Parra ◽  
Ignacio Mahillo ◽  
Alberto Ortiz
Keyword(s):  
Proportional Hazards ◽  
Hemodialysis Patients ◽  
Cox Proportional Hazards ◽  
Intracellular Water ◽  
C Reactive Protein ◽  
Reactive Protein ◽  
Risk Of Death ◽  
Cox Proportional Hazards Models ◽  
Increased Risk ◽  
Over Time

Background: In hemodialysis patients, extracellular water (ECW) overload predicts all-cause and cardiovascular mortality. The primary aim of the present study was to analyze changes in post-dialysis (i.e., following removal of excess ECW) ECW, intracellular water (ICW), and the overhydration (OH) parameter over time. Additionally, the association of these parameters with mortality was explored. Patients and methods: Prospective study of prevalent hemodialysis patients (n = 124) followed for a median of 20 (interquartile range (IQR) 8–31) months. In three visits, inflammation (C-reactive protein) and post-dialysis fluid status (bioimpedance, BIS) were assessed. Results: During follow-up, the overhydration (OH) parameter increased (−0.696 ± 1.6 vs. 0.268 ± 1.7 L; p = 0.007) at the expense of a decrease in intracellular water (ICW) (19.90 ± 4.5 vs. 18.72 ± 4.1 24 L; p = 0.006) with a non-significant numerical increase in ECW/ICW ratio (0.795 ± 0.129 vs. 0.850 ± 0.143; p = 0.055). Baseline ICW positively correlated with muscle mass and energy intake and negatively with C-reactive protein and it was lower in those who died than in survivors (15.09 ± 2.36 vs. 18.87 ± 4.52 L; p = 0.004). In Kaplan–Meier analysis, patients with low baseline ICW (≤17 L) and high ECW/ICW ratio (≥0.84) were at an increased risk of death. Baseline ICW was also associated with the risk of death in adjusted Cox proportional hazards models (HR 0.62 (0.40–0.98) p = 0.04). Conclusions: In hemodialysis patients, the post-dialysis OH parameter increased over time while ICW decreased, without changes in ECW. Low baseline post-dialysis ICW correlated with muscle wasting and inflammation and was an independent risk factor for mortality.

scholarly journals Catheter-directed therapy for acute pulmonary embolism: navigating gaps in the evidence

2019 ◽  
Vol 21 (Supplement_I) ◽  
pp. I23-I30 ◽  
Author(s):  
Romain Chopard ◽  
Fiona Ecarnot ◽  
Nicolas Meneveau
Keyword(s):  
Pulmonary Embolism ◽  
Acute Pulmonary Embolism ◽  
Pressure Overload ◽  
Efficacy And Safety ◽  
Bleeding Events ◽  
Systemic Thrombolysis ◽  
Risk Of Death ◽  
Risk Of Bleeding ◽  
Catheter Directed Thrombolysis ◽  
Acute Pe

Abstract Systemic thrombolysis for acute pulmonary embolism (PE) reduces the risk of death and cardiovascular collapse but is associated with an increased rate of bleeding. The desire to minimize the risk of bleeding events has driven the development of catheter-based strategies for pulmonary reperfusion in PE. These catheter-based strategies utilize lower-dose fibrinolytic regimens or purely mechanical techniques to expedite removal of the embolus. Several devices providing mechanical or suction embolectomy and catheter-directed thrombolysis, with or without facilitation by ultrasound, have been tested. Data are inconsistent regarding the efficacy and safety of mechanical and suction embolectomy. The most comprehensive data on catheter-based techniques stem from trials of ultrasound-facilitated catheter fibrinolysis. Ultrasound-facilitated catheter fibrinolysis relieves right ventricular pressure overload with a lower risk of major bleeding and intracranial haemorrhage than historical rates with systemic fibrinolysis. However, further research is required to determine the optimal application of ultrasound-facilitated catheter fibrinolysis and other catheter-based therapies in patients with acute PE.

scholarly journals Prospective Study of High-Sensitivity C-Reactive Protein as a Determinant of Mortality: Results from the MONICA/KORA Augsburg Cohort Study, 1984–1998

2008 ◽  
Vol 54 (2) ◽  
pp. 335-342 ◽  
Author(s):  
Wolfgang Koenig ◽  
Natalie Khuseyinova ◽  
Jens Baumert ◽  
Christa Meisinger
Keyword(s):  
Chronic Diseases ◽  
Cancer Mortality ◽  
High Sensitivity ◽  
Medical Attention ◽  
C Reactive Protein ◽  
Middle Aged ◽  
Cox Regression Analysis ◽  
Reactive Protein ◽  
Risk Of Death ◽  
Increased Risk

Abstract Background: C-reactive protein (CRP), an exquisitely sensitive systemic marker of inflammation, has emerged as an independent predictor of cardiovascular diseases (CVD). Because other chronic diseases are also associated with an inflammatory response, we sought to assess the association of high-sensitivity CRP (hsCRP) with total and cause-specific mortality in a large cohort of middle-aged men. Methods: We measured hsCRP at baseline in 3620 middle-aged men, randomly drawn from 3 samples of the general population in the Augsburg area (Southern 0Germany) in 1984–85, 1989–90, and 1994–95. Outcome was defined as all deaths, fatal CVD, fatal coronary heart disease (CHD) including sudden cardiac deaths, and cancer deaths. Results: During an average follow-up of 7.1 years, 408 deaths occurred (CVD 196, CHD 129, cancer 127). In multivariable Cox regression analysis, subjects with hsCRP &gt;3 mg/L at baseline showed an almost 2-fold increased risk to die vs those with hsCRP &lt;1 mg/L [hazard ratio (HR) 1.88, 95% CI 1.41–2.52]. HRs were 2.15 (95% CI 1.39–3.34) for fatal CVD, 1.74 (1.04–2.92) for fatal CHD, and 1.65 (1.01–2.68) for cancer mortality. In contrast, neither total nor HDL cholesterol significantly predicted all-cause or cancer mortality, and cholesterol had only modest effects on CVD mortality. Conclusions: Our results suggest that increased circulating hsCRP concentrations are associated with an increased risk of death from several widespread chronic diseases. Persistently increased hsCRP is a sensitive and valuable nonspecific indicator of an ongoing disease process that deserves serious and careful medical attention.

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