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Renal function as a cofactor for risk stratification and short-term outcome in acute pulmonary embolism.
Exp Gerontol. 2017 12 15; 100:11-16.EG

Abstract

BACKGROUND

In addition to right ventricular dysfunction (RVD) and myocardial injury, impaired renal function is connected with poorer prognosis in pulmonary embolism (PE). We aimed to investigate renal function as a cofactor for risk stratification in PE.

METHODS

Data from 182 patients with PE, treated between May 2006 and June 2011, were analysed retrospectively. PE patients with elevated creatinine were compared with those with normal values. Logistic regression models were calculated to investigate associations between creatinine and myocardial necrosis, RVD and in-hospital death. Prognostic performance of creatinine for prediction of myocardial necrosis and RVD were computed.

RESULTS

Overall, 182 patients (61.5% females,aged 68.5±15.3years) with confirmed PE were included in this study; 142 patients(78.0%) showed normal creatinine, and 40(22.0%) had an elevated creatinine. Patients with elevated creatinine were older (75.9±10.7 vs. 66.5±15.7years, P=0.0003), more frequently female (77.5% vs. 57.0%,P=0.019), and had higher cardiac troponin I (0.19±0.23 vs. 0.11±0.29ng/ml,P=0.0004), systolic pulmonary artery pressure (43.18±16.69 vs. 30.83±17.53mmHG,P=0.0006) and percentage of RVD (77.1% vs. 54.1%,P=0.040). Creatinine was significantly and independently associated with myocardial necrosis (OR 10.192, 95%CI 2.850-36.452, P=0.0004), shock-index≥1.0 (OR 3.265, 95%CI 1.067-9.992, P=0.0381) and RVD (OR 5.172, 95%CI 1.387-19.295, P=0.014). Creatinine>1.25mg/dl indicated for myocardial necrosis (AUC 0.680) and RVD (AUC 0.663).

CONCLUSIONS

Additionally, to RVD and myocardial necrosis, impaired renal function could give further information for risk stratification in PE. Cardio-pulmonary-renal interactions in PE seem to be multi-factorial.

Authors+Show Affiliations

Center for thrombosis and hemostasis, University Medical Center Mainz, Johannes Gutenberg-University Mainz, Mainz, Germany; Cardiology I, Center of Cardiology, University Medical Center Mainz, Johannes Gutenberg-University Mainz, Mainz, Germany. Electronic address: Karsten.Keller@unimedizin-mainz.de.Department of internal medicine, St. Vincenz and Elisabeth Hospital Mainz (KKM), Mainz, Germany.Department of Radiology and Nuclear Medicine, Catholic Clinic Mainz (KKM), Mainz, Germany; Department of Diagnostic and Interventional Radiology, University Clinic, Johann Wolfgang Goethe-University Frankfurt/Main, Frankfurt, Germany.Department of internal medicine, St. Vincenz and Elisabeth Hospital Mainz (KKM), Mainz, Germany.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

29030164

Citation

Keller, Karsten, et al. "Renal Function as a Cofactor for Risk Stratification and Short-term Outcome in Acute Pulmonary Embolism." Experimental Gerontology, vol. 100, 2017, pp. 11-16.
Keller K, Beule J, Balzer JO, et al. Renal function as a cofactor for risk stratification and short-term outcome in acute pulmonary embolism. Exp Gerontol. 2017;100:11-16.
Keller, K., Beule, J., Balzer, J. O., & Dippold, W. (2017). Renal function as a cofactor for risk stratification and short-term outcome in acute pulmonary embolism. Experimental Gerontology, 100, 11-16. https://doi.org/10.1016/j.exger.2017.10.007
Keller K, et al. Renal Function as a Cofactor for Risk Stratification and Short-term Outcome in Acute Pulmonary Embolism. Exp Gerontol. 2017 12 15;100:11-16. PubMed PMID: 29030164.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Renal function as a cofactor for risk stratification and short-term outcome in acute pulmonary embolism. AU - Keller,Karsten, AU - Beule,Johannes, AU - Balzer,Jörn Oliver, AU - Dippold,Wolfgang, Y1 - 2017/10/13/ PY - 2017/05/07/received PY - 2017/10/03/revised PY - 2017/10/07/accepted PY - 2017/10/17/pubmed PY - 2018/7/24/medline PY - 2017/10/15/entrez KW - Myocardial necrosis KW - Pulmonary embolism KW - Right ventricular dysfunction KW - Risk stratification KW - Systolic pulmonary artery pressure SP - 11 EP - 16 JF - Experimental gerontology JO - Exp Gerontol VL - 100 N2 - BACKGROUND: In addition to right ventricular dysfunction (RVD) and myocardial injury, impaired renal function is connected with poorer prognosis in pulmonary embolism (PE). We aimed to investigate renal function as a cofactor for risk stratification in PE. METHODS: Data from 182 patients with PE, treated between May 2006 and June 2011, were analysed retrospectively. PE patients with elevated creatinine were compared with those with normal values. Logistic regression models were calculated to investigate associations between creatinine and myocardial necrosis, RVD and in-hospital death. Prognostic performance of creatinine for prediction of myocardial necrosis and RVD were computed. RESULTS: Overall, 182 patients (61.5% females,aged 68.5±15.3years) with confirmed PE were included in this study; 142 patients(78.0%) showed normal creatinine, and 40(22.0%) had an elevated creatinine. Patients with elevated creatinine were older (75.9±10.7 vs. 66.5±15.7years, P=0.0003), more frequently female (77.5% vs. 57.0%,P=0.019), and had higher cardiac troponin I (0.19±0.23 vs. 0.11±0.29ng/ml,P=0.0004), systolic pulmonary artery pressure (43.18±16.69 vs. 30.83±17.53mmHG,P=0.0006) and percentage of RVD (77.1% vs. 54.1%,P=0.040). Creatinine was significantly and independently associated with myocardial necrosis (OR 10.192, 95%CI 2.850-36.452, P=0.0004), shock-index≥1.0 (OR 3.265, 95%CI 1.067-9.992, P=0.0381) and RVD (OR 5.172, 95%CI 1.387-19.295, P=0.014). Creatinine>1.25mg/dl indicated for myocardial necrosis (AUC 0.680) and RVD (AUC 0.663). CONCLUSIONS: Additionally, to RVD and myocardial necrosis, impaired renal function could give further information for risk stratification in PE. Cardio-pulmonary-renal interactions in PE seem to be multi-factorial. SN - 1873-6815 UR - https://www.unboundmedicine.com/medline/citation/29030164/Renal_function_as_a_cofactor_for_risk_stratification_and_short_term_outcome_in_acute_pulmonary_embolism_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0531-5565(17)30362-5 DB - PRIME DP - Unbound Medicine ER -