<scp>d</scp>-Dimer Assessment Improves the Simplified Pulmonary Embolism Severity Index for In-Hospital Risk Stratification in Acute Pulmonary Embolism

Kozłowska, Marta; Pływaczewska, Magdalena; Koć, Marcin; Pacho, Szymon; Wyzgał, Anna; Zdończyk, Olga; Furdyna, Aleksandra; Ciurzyński, Michał; Kurnicka, Katarzyna; Jankowski, Krzysztof; Lipińska, Anna; Palczewski, Piotr; Bienias, Piotr; Pruszczyk, Piotr

doi:10.1177/1076029618776799

Cited by 8 publications

(6 citation statements)

References 25 publications

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“…There was a relationship between increased D-Dimer concentrations and clot burden, thrombus localization, major bleeding and RV dysfunction (18)(19)(20). Studies of D-Dimer in patients with PE have demonstrated various data regarding the severity of PE and early risk stratification (22)(23).…”

Section: Discussionmentioning

confidence: 99%

Prognostic Value of D-Dimer in Younger Patients with Pulmonary Embolism

Jovanović

Subota

Subotić

et al. 2023

Experimental and Applied Biomedical Research (EABR)

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In patients with pulmonary embolism (PE), the D-Dimer assay is commonly utilized as part of the diagnostic workup, but data on D-Dimer for early risk stratification and short-term mortality prediction are limited. The purpose of this study was to determine D-Dimer levels as a predictive biomarker of PE outcomes in younger (<50 years of age) compared to older patients. We conducted retrospective analysis for 930 patients diagnosed with PE between 2015 and 2019 as part of the Serbian University Multicenter Pulmonary Embolism Registry (SUPER).All patients had D-Dimer levels measured within 24 hours of hospital admission. The primary outcome was mortality at 30 days or during hospitalization. Patients were categorized into two groups based on age (≤ 50 and >50 years of age). Younger patients constituted 20.5% of the study cohort. Regarding all-cause mortality, 5.2% (10/191)of patients died in group under the 50 years of age; the short-term all-causemortality was 12.4% (92/739) in older group.We have found that there was significant difference in plasma D-Dimer level between patients ≤ 50 years of age and older group (>50), p= 0.006.D-Dimer plasma level had good predictive value for the primary outcome in younger patients (c-statistics 0.710; 95% CI, 0.640-0.773; p<0.031). The optimal cutoff level for D-Dimer to predict PE-cause death in patients aged > 50 years was found to be 8.8 mg/l FEU(c-statistics 0,580; 95% CI 0.544-0.616; p=0.049). In younger PE patients, D-Dimer levels have good prognostic performance for 30-day all-cause mortalityand concentrations above 6.3 mg/l FEU are associated with increased risk of death. D-Dimer in patients aged over 50 years does not have predictive ability for all-caused short-term mortality. The relationship between D-Dimer and age in patients with PE may need further evaluation.

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Section: Discussionmentioning

confidence: 99%

Prognostic Value of D-Dimer in Younger Patients with Pulmonary Embolism

Jovanović

Subota

Subotić

et al. 2023

Experimental and Applied Biomedical Research (EABR)

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“…More recently, Kozlowska and colleagues studied 270 consecutive patients with acute PE. 41 In Cox's proportional hazard regression analysis, an hs-cTnT value > 14 ng/L was found to be associated with a nearly 10-fold higher risk (HR, 9.5; 95% CI, 1.8-70.4) of developing in-hospital adverse events (i.e., hemodynamic deterioration, need for rescue thrombolysis or cardiopulmonary resuscitation, mortality).…”

Section: Review Of Clinical Evidence Of the Role Of Hs-ctn In Pulmonamentioning

confidence: 98%

Measurement of High-Sensitivity Cardiac Troponin in Pulmonary Embolism: Useful Test or a Clinical Distraction

Lippi

Favaloro

Kavsak

2019

Semin Thromb Hemost

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The ability to predict death or other unfavorable outcomes after an acute pulmonary embolism (PE) is challenging, with current available risk score models having relatively unsatisfactory prognostic performance in this area. For example, the simplified pulmonary embolism severity index (sPESI), the most frequently used stratification tool, misclassifies a significant percentage of low- and high-risk patients. This gap in care, along with the increasing clinical availability of high-sensitivity cardiac troponin (hs-cTn) laboratory tests and the recent emphasis on detecting myocardial injury, may foster further evaluation of hs-cTn testing in patients with acute PE. Our analysis of the current scientific literature on hs-cTn in patients with acute PE identified that hs-cTn testing may provide valuable information for predicting future adverse outcomes and mortality, independently from baseline clinical risk assessment. Although the risk of an adverse event is indeed higher in patients with higher sPESI scores, cTns retain their prognostic value also in those at low risk, suggesting that a combination of hs-cTn with sPESI may provide an incremental value over assessment of either variable alone. Accordingly, the future development of updated risk stratification models, with the inclusion of laboratory tests such as hs-cTn, may represent an enhanced approach for risk stratification in patients with acute PE. Additional research, however, is needed to verify whether the combination of cTns, specifically as measured with hs-cTn assays, with other biomarkers may further improve the current capacity to efficiently manage patients with acute PE.

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“…Hemodinamik olarak stabil olgularda düşük mortalite nedeniyle BNP veya NT-pro BNP yüksekliği olmayan hastaların erken taburcu olabileceği veya ayaktan tedavi edilebileceği ileri sürülmektedir (30) . (31) . Yüksek > 6 (prevalans %74) > 2…”

Section: Kardiyak Biyobelirteçlerunclassified

Pulmonary Embolism

Karalezli¹

2018

GGHS

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Pulmoner emboli (PE) acil kliniklerinde sık karşılaşılan ve mortalitesi yüksek bir durumdur. Ayaktan hastalarda olduğu kadar hastanede yatan hastalarda da mortalite oranı yüksektir. Pulmoner emboli tanısı koymak her zaman kolay olmayabilir. Böbrek fonksiyon bozuklukları ve gebelik nedeniyle tanıda altın standart olarak kabul edilen bilgisayarlı tomografi anjiyografi (BTA) çekilmesinde yaşanılan güçlükler, tanıda yaşanılan zorlukların başında gelmektedir. PE'nin ağırlığına göre yakınmalarda farklılıklar vardır. Büyük, hayatı tehdit eden PE'lilerde hipotansiyon, şok olabilir. Fibrin yıkım ürünü olan D-dimer, PE şüpheli birçok hasta için ilk başvurulan testtir. Hastanın klinik bulguları kadar kardiyak biyobelirteçler de tedavi şeklimizi belirlemede son derece önemlidir. Kardiyak fonksiyonları değerlendirmek için sadece EKO değil, onun yerine BTA'de önerilmektedir. V/Q SPECT/ CT kombinasyonu da tanıda duyarlılık ve özgüllüğü artırmıştır. Bu bölümde "mortalitesi yüksek" ve "orta-yüksek" PE olgularındaki tanı tedavi klinik deneyim ve literatür bilgileriyle anlatılmıştır.

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d-Dimer Assessment Improves the Simplified Pulmonary Embolism Severity Index for In-Hospital Risk Stratification in Acute Pulmonary Embolism

Cited by 8 publications

References 25 publications

Prognostic Value of D-Dimer in Younger Patients with Pulmonary Embolism

Prognostic Value of D-Dimer in Younger Patients with Pulmonary Embolism

Measurement of High-Sensitivity Cardiac Troponin in Pulmonary Embolism: Useful Test or a Clinical Distraction

Pulmonary Embolism

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