Risk stratification of normotensive pulmonary embolism based on the sPESI — Does it work for all patients?

Hellenkamp, Kristian; Kaeberich, Anja; Schwung, Johanna; Konstantinides, Stavros; Lankeit, Mareike

doi:10.1016/j.ijcard.2015.06.065

Cited by 22 publications

(10 citation statements)

References 10 publications

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“…Of note, because hsTnT and NT-proBNP were measured in all patients, the number of patients reclassified from low risk to intermediate-low risk might have been higher than in real-world scenarios [19]. Although routine performance of imaging or laboratory testing in the presence of a sPESI of 0 is not considered necessary by current ESC guidelines [1], evidence is accumulating that especially younger PE patients with fewer comorbidities might be misclassified as low risk if further assessment of RV (dys)function is withheld [20]. Thus, risk stratification of PE patients for guidance of the therapeutic strategy should be based on an assessment of the disease-specific prognosis (e.g.…”

Section: Normotensive Patients With Acute Pe N=843mentioning

confidence: 99%

Prognostic impact of copeptin in pulmonary embolism: a multicentre validation study

Hellenkamp¹,

Pruszczyk

Jiménez

et al. 2018

Eur Respir J

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To externally validate the prognostic impact of copeptin, either alone or integrated in risk stratification models, in pulmonary embolism (PE), we performed a analysis of 843 normotensive PE patients prospectively included in three European cohorts.Within the first 30 days, 21 patients (2.5%, 95% CI 1.5-3.8) had an adverse outcome and 12 (1.4%, 95% CI 0.7-2.5) died due to PE. Patients with copeptin ≥24 pmol·L had a 6.3-fold increased risk for an adverse outcome (95% CI 2.6-15.5, p<0.001) and a 7.6-fold increased risk for PE-related death (95% CI 2.3-25.6, p=0.001). Risk classification according to the 2014 European Society of Cardiology (ESC) guideline algorithm identified 248 intermediate-high-risk patients (29.4%) with 5.6% (95% CI 3.1-9.3) at risk of adverse outcomes. A stepwise biomarker-based risk assessment strategy (based on high-sensitivity troponin T, N-terminal pro-brain natriuretic peptide and copeptin) identified 123 intermediate-high-risk patients (14.6%) with 8.9% (95% CI 4.5-15.4) at risk of adverse outcomes. The identification of patients at higher risk was even better when copeptin was measured on top of the 2014 ESC algorithm in intermediate-high-risk patients (adverse outcome OR 11.1, 95% CI 4.6-27.1, p<0.001; and PE-related death OR 13.5, 95% CI 4.2-43.6, p<0.001; highest risk group all other risk groups). This identified 85 patients (10.1%) with 12.9% (95% CI 6.6-22.0) at risk of adverse outcomes and 8.2% (95% CI 3.4-16.2) at risk of PE-related deaths.Copeptin improves risk stratification of normotensive PE patients, especially when identifying patients with an increased risk of an adverse outcome.

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Section: Normotensive Patients With Acute Pe N=843mentioning

confidence: 99%

Prognostic impact of copeptin in pulmonary embolism: a multicentre validation study

Hellenkamp¹,

Pruszczyk

Jiménez

et al. 2018

Eur Respir J

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“…The updated 2016 ACCP guidelines suggest that LRPE patients with adequate home circumstances can be treated at home or with an abbreviated hospital stay [ 8 ]. The European Society of Cardiology advocates for the risk stratification of PE patients and the consideration of an outpatient management option for LRPE patients [ 9 , 10 ]. While treatment of LRPE patients in outpatient settings is widely practiced in European countries, physicians in the US have not widely adopted an outpatient or observation management strategy.…”

Section: Introductionmentioning

confidence: 99%

Benefit of early discharge among patients with low-risk pulmonary embolism

et al. 2017

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Clinical guidelines recommend early discharge of patients with low-risk pulmonary embolism (LRPE). This study measured the overall impact of early discharge of LRPE patients on clinical outcomes and costs in the Veterans Health Administration population. Adult patients with ≥1 inpatient diagnosis for pulmonary embolism (PE) (index date) between 10/2011-06/2015, continuous enrollment for ≥12 months pre- and 3 months post-index date were included. PE risk stratification was performed using the simplified Pulmonary Embolism Stratification Index. Propensity score matching (PSM) was used to compare 90-day adverse PE events (APEs) [recurrent venous thromboembolism, major bleed and death], hospital-acquired complications (HACs), healthcare utilization, and costs among short (≤2 days) versus long length of stay (LOS). Net clinical benefit was defined as 1 minus the combined rate of APE and HAC. Among 6,746 PE patients, 95.4% were men, 22.0% were African American, and 1,918 had LRPE. Among LRPE patients, only 688 had a short LOS. After 1:1 PSM, there were no differences in APE, but short LOS had fewer HAC (1.5% vs 13.3%, 95% CI: 3.77–19.94) and bacterial pneumonias (5.9% vs 11.7%, 95% CI: 1.24–3.23), resulting in better net clinical benefit (86.9% vs 78.3%, 95% CI: 0.84–0.96). Among long LOS patients, HACs (52) exceeded APEs (14 recurrent DVT, 5 bleeds). Short LOS incurred lower inpatient ($2,164 vs $5,100, 95% CI: $646.8-$5225.0) and total costs ($9,056 vs $12,544, 95% CI: $636.6-$6337.7). LRPE patients with short LOS had better net clinical outcomes at lower costs than matched LRPE patients with long LOS.

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“…Risk classifications have been made for the early mortality risk in APE (4,5). Similarly, some biochemical indicators (troponins, hearttype fatty acid-binding protein, BNP or Nterminal-proBNP), right ventricular dysfunction determined by echocardiography and right ventricular extension determined by computed tomography are significant for mortality risk (6)(7)(8)(9)(10). There are studies that show that myeloperoxidase enzymes and reactive oxygen species (ROS) were elevated in subjects with APE and that the IL-6 level and mortality are correlated in APE (21,22).…”

Section: Discussionmentioning

confidence: 99%

Correlation Between Clot Load Burden with Neutrophil-Lymphocyte and Platelet-Lymphocyte Ratios in Patients with Acute Pulmonary Embolism

Çildağ¹,

Çildağ²

2017

Ulutas Med J

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Background: The correlation between neutrophil-lymphocyte ratio (NLR) and acute pulmonary embolism (APE) related mortality, platelet-lymphocyte ratio (PLR) and clinical severity classification of APE were demostrated. Also clot load burden one of the prognostic criteria of pulmonary embolism.Method: The pulmonary arterial computed tomographic obstruction index ratio (PACTOIR) was calculated in 62 patients diagnosed with APE, retrospectively. Patients were divided into two groups according to their PACTOIR values. NLR and PLR were calculated from the blood samples collected on the day of diagnosis.Results: Mean PACTOIR, NLR and PLR of all patients with APE were calculated as 23.58%, 4.4 and 186.5, respectively. A positive correlation was observed between PACTOIR and NLR and PLR (p<0.001). A statistically significant difference was found between the NLR and PLR levels of low and high PACTOIR groups (p<0.05).Conclusion: A statistically significant correlation was found between PACTOIR and NLR and PLR in patients with APE. According to the findings of our study, NLR and PLR ratios may give an idea about the thrombus load in patients with clinically suspected APE.

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Risk stratification of normotensive pulmonary embolism based on the sPESI — Does it work for all patients?

Cited by 22 publications

References 10 publications

Prognostic impact of copeptin in pulmonary embolism: a multicentre validation study

Prognostic impact of copeptin in pulmonary embolism: a multicentre validation study

Benefit of early discharge among patients with low-risk pulmonary embolism

Correlation Between Clot Load Burden with Neutrophil-Lymphocyte and Platelet-Lymphocyte Ratios in Patients with Acute Pulmonary Embolism

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