| Are clinical parameters and biomarkers predictive of severity of acute pulmonary emboli on CTPA? | |
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MedLine Citation:
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PMID: 20040533 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
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BACKGROUND: Previous studies have shown that findings of computed tomography pulmonary angiography (CTPA) relate to outcome in pulmonary embolus (PE). These include clot burden as quantified using an obstruction index and markers of pressure overload such as right ventricle to left ventricle size ratio (RV/LV ratio). Little data exists correlating these findings with clinical presentation and biomarkers. AIM: To explore the link between clinical presentation and biomarkers with CTPA findings. METHODS: Retrospective case note analysis of consecutive cases presenting to a large teaching hospital. An independent radiologist reviewed CTPAs and clot burden quantified using an obstruction index. RESULTS: One hundred and seventy cases were identified and notes retrieved in 137 cases. (i) Clinical presentation: correlation was seen between clot burden and systolic blood pressure (BP) (r = -0.299, P = 0.0006) and heart rate (r = 0.240, P = 0.0056). Median obstruction index was significantly higher in those with a presenting BP <90 mmHg [41.25% (95% CI 30-50) vs. 15% (95% CI 12.5-25), (P = 0.0004)]. Clot burden was significantly higher in patients with temperature of >37.5 degrees C [30% (95% CI 25.0-42.5) vs. 15% (95% CI 12.5-28.3), P = 0.02)] and (ii)Biomarkers: significant correlation between clot burden and D-dimer was seen (r = 0.36, P = 0.0001). Location of thrombus was associated with significant differences in D-dimer level. A subgroup of patients had cardiac biomarkers measured (n = 24). There was a statistically significant correlation between troponin I and clot burden (r = 0.412, P = 0.048) and RV/LV ratio (r = 0.699, P = 0.0013). DISCUSSION: These findings suggest that clinical parameters and biomarkers have a role in predicting the radiological severity of PE. These data support the need for further studies of risk stratification in patients presenting with acute PE. |
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Authors:
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V Jeebun; S J Doe; L Singh; S A Worthy; I A Forrest |
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Publication Detail:
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Type: Journal Article Date: 2009-12-29 |
Journal Detail:
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Title: QJM : monthly journal of the Association of Physicians Volume: 103 ISSN: 1460-2393 ISO Abbreviation: QJM Publication Date: 2010 Feb |
Date Detail:
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Created Date: 2010-01-25 Completed Date: 2010-05-20 Revised Date: - |
Medline Journal Info:
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Nlm Unique ID: 9438285 Medline TA: QJM Country: England |
Other Details:
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Languages: eng Pagination: 91-7 Citation Subset: IM |
Affiliation:
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Department of Respiratory Medicine, Royal Victoria Infirmary, Newcastle upon Tyne NE1 4LP, UK. chinoo@hotmail.co.uk |
Export Citation:
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| MeSH Terms | |
Descriptor/Qualifier:
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Acute Disease Adult Aged Aged, 80 and over Angiography / methods Biological Markers / analysis Blood Pressure Enzyme-Linked Immunosorbent Assay Female Fibrin Fibrinogen Degradation Products / analysis* Heart Rate Heart Ventricles Humans Male Middle Aged Predictive Value of Tests Pulmonary Embolism / mortality, physiopathology, radiography* Retrospective Studies Risk Factors Severity of Illness Index Tomography, X-Ray Computed / methods Young Adult |
| Chemical | |
Reg. No./Substance:
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0/Biological Markers; 0/Fibrin Fibrinogen Degradation Products; 0/fibrin fragment D |
| Comments/Corrections | |
Comment In:
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QJM. 2010 May;103(5):360
[PMID:
20139100
]
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From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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