Prognostic Value of Renal Dysfunction Indicators in Normotensive Patients With Acute Pulmonary Embolism

Altınsoy, Bülent; Öz, İbrahim İlker; Örnek, Tacettin; Erboy, Fatma; Tanrıverdi, Hakan; Uygur, Fırat; Altıntaş, Nejat; Atalay, Figen; Tor, Meltem

doi:10.1177/1076029616637440

Cited by 16 publications

(9 citation statements)

References 39 publications

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“…Similarly, Altınsoy et al demonstrated that the elevated BUN levels, which is also a contributor to plasma osmolality, may have a predictive value for in-hospital and early mortality among patients admitted with APE. 15 Moreover, in a recent study that consisted of 252 consecutive APE patients, the researchers revealed that an admission BUN levels above 34.5 mg/dL is a predictor of in-hospital mortality among these patients. 9 Besides that, in an experimental study, the pulmonary effects of the hypernatremia were investigated.…”

Section: Discussionmentioning

confidence: 99%

The predictive value of plasma osmolality for in‐hospital mortality in patients with acute pulmonary embolism

Öztaş¹,

Çınar²,

Hayıroğlu³

et al. 2019

Clinical Respiratory J

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Introduction and Objectives Prior studies demonstrated that plasma osmolality may have a predictive value for in‐hospital mortality in patients with heart failure and acute coronary syndrome. In addition, plasma glucose and blood urea nitrogen (BUN) levels, the components of plasma osmolality, have been shown to be an important contributor for in‐hospital mortality in acute pulmonary embolism (APE) patients. Hence, the objective of the current study is to evaluate the effect of plasma osmolality upon admission with in‐hospital mortality in patients with APE. Methods A total of 245 consecutive intermediate or high risk APE patients were enrolled into the study. The study population was divided into three tertile groups (T1, T2 and T3) based on the increased plasma osmolality. The in‐hospital mortality was the primary end‐point. Results After adjusting for all risk factors, in‐hospital mortality was significantly higher in the T3 group compared to T1 and T2 groups (OR: 3.6, 95% CI: 1.3 to 18.8, P < .001). In addition, the incidence of asystolia, hypotension and cardiogenic shock were significantly higher in the T3 group. An area under the receiver operating characteristic curve value of plasma osmolality for the in‐hospital mortality was 0.76 with sensitivity 67.2% and specificity 74.1% 95% CI: (0.66‐0.87, P < .001). Conclusion This is the first study to demonstrate that elevated levels of plasma osmolality may have a predictive value for in‐hospital mortality in APE patients. Our findings are novel and deserve further studies whether the treatment of higher plasma osmolality may reduce the risk of in‐hospital mortality in APE patients.

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Section: Discussionmentioning

confidence: 99%

The predictive value of plasma osmolality for in‐hospital mortality in patients with acute pulmonary embolism

Öztaş¹,

Çınar²,

Hayıroğlu³

et al. 2019

Clinical Respiratory J

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“…Patients with APE classified to intermediate-risk class are the most heterogeneous group, although the previous attempt to divide this broad category into two subgroups, intermediate-high and intermediate-low risk [ 2 ], was unsuccessful to distinguish a group of higher mortality. Altinsoy et al [ 30 ] presented in the multivariate analysis that GFR estimated by CKD-EPI or MDRD together with positive troponin concentration are independent predictors of adverse outcome in normotensive patients with APE. Moreover, eGFR was correlated with RV dysfunction.…”

Section: Discussionmentioning

confidence: 99%

A Comparison of GFR Calculated by Cockcroft-Gault vs. MDRD Formula in the Prognostic Assessment of Patients with Acute Pulmonary Embolism

et al. 2021

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Introduction. Risk stratification is mandatory for optimal management of patients with acute pulmonary embolism (APE). Previous studies indicated that renal dysfunction predicts outcome and can improve risk assessment in APE. Aim. The aim of the study was a comparison of estimated glomerular filtration rate (eGFR) formulas, MDRD, and Cockcroft-Gault (CG), in the prognostic assessment of patients with APE. Materials and Methods. Data from 2274 (1147 M/1127 F, median 71 years) hospitalised patients with APE prospectively included in a multicenter, observational, cohort study were analysed. A serum creatinine measurement as a routine laboratory parameter at the cooperating centers and eGFR calculation were performed on admission. Patients were followed for 180 days. The primary outcome was death from any cause within 30 days. Results. The eGFR levels assessed by both, MDRD (eGFRMDRD) and CG formula (eGFRCG), were highest in patients with low-risk APE and lowest in high-risk APE. The eGFR (using both methods) was significantly lower in nonsurvivors compared to survivors. Using a threshold of <60 ml/min/1.73 m2, eGFRMDRD revealed the primary outcome with sensitivity 67%, specificity 52%, PPV 8%, and NPV 97%, while eGFRCG had a sensitivity 62%, specificity 62%, PPV 8.6%, and NPV 96%. The area under the ROC curve for eGFRCG tended to be higher than that for eGFRMDRD: 0.658 (95% CI: 0.608-0.709) vs. 0.631 (95% CI: 0.578-0.683), p = 0.12 . A subanalysis of ROC curves in a population above 65 yrs showed a higher AUC for eGFRCG than based on MDRD. Kaplan-Meier analysis showed a worse long-term outcome in patients with impaired renal function. Conclusion. eGFRMDRD and eGFRCG assessed on admission significant short- and long-term mortality predictors in patients with APE. The eGFRCG seems to be a slightly better 30-day mortality predictor than eGFRMDRD in the elderly.

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“…As with similar evaluation of registry data, there are inherent limitations to this type of study, mainly related to known or unknown confounding factors. Finally, our study used the MDRD formula in order to estimate eGFR although the CKD-EPI formula showed its superiority in analyzing the prognosis of normotensive patients with APE in a previous study [23].…”

Section: Discussionmentioning

confidence: 99%

Assessment of Renal Dysfunction Improves the Simplified Pulmonary Embolism Severity Index (sPESI) for Risk Stratification in Patients with Acute Pulmonary Embolism

Trimaille

Marchandot

Girardey

et al. 2019

JCM

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Background: Whereas the major strength of the simplified pulmonary embolism severity index (sPESI) lies in ruling out an adverse outcome in patients with sPESI of 0, the accuracy of sPESI ≥ 1 in risk assessment remains questionable. In acute pulmonary embolism (APE), the estimated glomerular filtration rate (eGFR) can be viewed as an integrate marker reflecting not only previous chronic kidney disease (CKD) damage but also comorbid conditions and hemodynamic disturbances associated with APE. We sought to determine whether renal dysfunction assessment by eGFR improves the sPESI score risk stratification in patients with APE. Methods: 678 consecutive patients with APE were prospectively enrolled. Renal dysfunction (RD) at diagnosis of APE was defined by eGFR < 60 mL/min/1.73 m2 and acute kidney injury (AKI) by elevation of creatinine level >25% during in-hospital stay. Results: RD was observed in 26.9% of the cohort. AKI occurred in 18.8%. A stepwise increase in 30-day mortality, cardiovascular mortality and overall mortality was evident with declining renal function. Multivariate analysis identified RD and CRP (C-reactive protein) level but not sPESI score as independent predictors of 30-day mortality. AKI, 30-day mortality, overall mortality, and cardiovascular mortality were at their highest level in patients with eGFR < 60 mL/min/1.73 m2 and sPESI ≥1. Conclusion: in patients with APE, the addition of RD to the sPESI score identifies a specific subset of patients at very high mortality.

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Prognostic Value of Renal Dysfunction Indicators in Normotensive Patients With Acute Pulmonary Embolism

Abstract: There is a close relationship between RD and APE prognosis. We conclude eGFR is a potential prognostic marker for risk stratification in normotensive patients with APE.

Cited by 16 publications

References 39 publications

The predictive value of plasma osmolality for in‐hospital mortality in patients with acute pulmonary embolism

The predictive value of plasma osmolality for in‐hospital mortality in patients with acute pulmonary embolism

A Comparison of GFR Calculated by Cockcroft-Gault vs. MDRD Formula in the Prognostic Assessment of Patients with Acute Pulmonary Embolism

Assessment of Renal Dysfunction Improves the Simplified Pulmonary Embolism Severity Index (sPESI) for Risk Stratification in Patients with Acute Pulmonary Embolism

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