Pulmonary Thromboembolism Patients Research Articles

Resveratrol as an adjuvant prebiotic therapy in the management of pulmonary thromboembolism.

Pulmonary thromboembolism (PTE) presents a grave threat to patient lives, often marked by arterial occlusion in the pulmonary vasculature, frequently stemming from deep vein thrombosis (DVT). While current anticoagulant therapies offer temporary relief, they fall short of addressing the long-term management of PTE. Notably, PTE-associated mortality rates continue to rise annually, positioning it as a crucial concern within the cardiovascular landscape. An intriguing suspect underlying compromised prognoses is the intricate interplay between the gut microbiome and PTE outcomes. The gut-derived metabolite, trimethylamine N-oxide (TMAO), has emerged as a direct contributor to accelerated thrombogenesis, thereby heightening PTE susceptibility. In pursuit of remedies, research has delved into diverse prebiotic and probiotic interventions, with Resveratrol (RSV) emerging as a promising candidate. This paper explores the potential of RSV, a polyphenolic compound, as an adjuvant prebiotic therapy. The proposed therapeutic approach not only augments anticoagulant potency through strategic pharmacokinetic interactions but also introduces a novel avenue for attenuating future PTE incidents through deliberate gut microbiome modulation. RSV's multifaceted attributes extend beyond its role in PTE prevention. Recognized for its anti-inflammatory, antioxidant, and cardioprotective properties, RSV stands as a versatile therapeutic candidate. It exhibits the ability to curtail platelet aggregation, augment warfarin bioavailability, and mitigate pulmonary arterial wall thickening - an ensemble of effects that substantiate its potential as an adjunct prebiotic for PTE patients. This literature review weaves together the latest insights, culminating in a compelling proposition: RSV is an instrumental player in the trajectory of PTE management.

Prospective analysis of pre and postoperative laboratory parameters associated with thrombosis in patients with ovarian cancer.

Patients with ovarian cancer have a high risk of developing thrombosis. We aimed to investigate pre and post operative biomarkers associated with thrombosis including deep vein thrombosis and pulmonary thromboembolism in patients treated for ovarian cancer. We collected pre and post operative blood samples from 133 patients undergoing surgery for ovarian cancer between December 2021 and August 2022. The measured parameters were white blood cell count, hemoglobin, platelets, monocytes, serum glucose, CA125, D-dimer, fibrinogen, prothrombin time, activated partial thromboplastin time, fibrinogen degradation products, antithrombin III, protein C, protein S, plasminogen, plasminogen activator inhibitor 1, homocysteine, N-terminal pro-brain natriuretic peptide, interleukin 6, thrombopoietin, soluble P-selectin and granulocyte stimulating factor. Body mass index of patients were collected. Differences between patients who developed thrombosis and those without were compared with Wilcoxon rank-sum test and we analyzed the continuous variables using logistic regression. Twenty-one (15.8%) patients developed thrombosis ranging from 6 to 146 days (median 15 days) after surgery. Pre operative values of homocysteine (p = 0.033) and IL-6 (p = 0.043) were significantly increased and post operative aPTT (p = 0.022) was prolonged and plasminogen (p = 0.041) was decreased in patients with thrombosis. It is important to find novel biomarkers for thrombosis to carefully manage patients who are prone to develop thrombosis despite preventive measures were applied.

Evaluation of right ventricle functions in acute pulmonary thromboembolism using tissue doppler imaging

Aims: Right ventricular (RV) systolic and diastolic functions are impaired in a significant proportion of patients with acute pulmonary thromboembolism (PTE). In these cases, knowledge of RV function is of great importance both in the diagnosis and in the choice of treatment. Our aim was to evaluate RV systolic and diastolic functions by standard pulse Doppler and tissue Doppler imaging (TDI) in normotensive patients with PTE without hemodynamic disturbances. Methods: A total of 48 subjects, including 28 acute PTE patients (14 M, 14 F) with a mean age of 41 ± 13 years and 20 healthy subjects (10 M, 10 F) with a mean age of 40 ± 9 years, were included in our study. At the level of the tricuspid and mitral valve cusps, pulse Doppler echocardiography evaluated diastolic filling parameters. With the TDI technique, the diastolic function of the RV lateral wall and septum were analyzed in segments in the apical four-cavity image. Diastolic early and late velocities (e', a'), e'/a' ratio, e'dt, isovolumetric relaxation time (IVRT), systolic velocity (s'), and systolic duration (s' duration) were evaluated by TDI. Results: Among the RV standard Doppler parameters, a significant decrease in E velocity and E/A ratio and a significant increase in A velocity were observed compared to the control group (p=0.042; p=0.002; p=0.001, respectively). A non-significant prolongation in E’dt was detected. RV ejection fraction was significantly lower in PTE patients compared to the control group (51.1% vs. 69.7%) (p=0.001). TDI was used to look at the RV systolic function, and it was found that all segments had higher systolic (Sa-m) velocities than the control group. However, systolic velocities in patients with DHB in the RV were found to be lower in the annular regions and RV-free wall. Increased s' velocities were observed in annular regions and RV-free walls. However, no statistical significance was found in s' velocity values. Conclusion: RV systolic and diastolic functions may be impaired in normotensive patients with PTE without hemodynamic disturbances.

Pulmonary Thromboembolism in Multidrug-Resistant Tuberculosis: A Case Series Highlighting the Importance of Early Diagnosis and Management

Background: Pulmonary tuberculosis (PTB) is an established cause of arterial and venous thrombosis. With the rising incidence of multidrug-resistant tuberculosis (MDR TB), which has a prolonged treatment course, pulmonary thromboembolism in such cases further complicates the treatment outcome in terms of mortality and morbidity. TB causes systemic hypercoagulability, which may lead to both arterial and venous thrombosis. Therefore, it is important for treating physicians to be aware of the entity and have a sharp watch for the development of Pulmonary thromboembolism in cases of MDR TB. The Case: We present the association of pulmonary thromboembolism (PTE) with MDR TB in three young males who developed pulmonary thromboembolism during the treatment of MDR TB, along with their management using anticoagulant agents. Conclusion: PTE in cases of TB is rare but fatal. High suspicion of PTE in patients with MDR TB will help in diagnosing the dreaded condition early and aid in reducing preventable mortality with PTE. Early recognition, prompt diagnosis, and management is the key to saving the lives of those with this fatal complication.

The relationship between echocardiographic parameters and albumin bilirubin score in patients with acute pulmonary thromboembolism.

The Albumin-Bilirubin (ALBI) score is useful and easy-to-use for objectively assessing liver function. We investigated whether the ALBI score, a parameter indicating liver stiffness, congestion and fibrosis, has any relationship with echocardiographic parameters in patients with acute pulmonary thromboembolism (PTE). A total of 140 patients diagnosed with acute PTE were retrospectively analyzed. These patients were divided into three groups according to the hemodynamic severity of acute PTE: Group I [Low risk]; Group II [Submassive or intermediate-risk]; and Group III [Massive or high-risk]. Biochemical data obtained from venous blood samples taken at admission were analyzed. In addition, data were also analyzed from transthoracic echocardiography and pulmonary computed tomographic angiography performed at admission. ALBI, Bova, and PESI scores were calculated. ALBI scores (-3.32 ± 0.21 vs -2.86 ± 0.15 vs -2.46 ± 0.2, p < .001) were statistically significantly higher in Group III than Groups I and II. There was a significant difference between the three groups in terms of echocardiographic parameters, and LVEF and TAPSE values tended to decrease from group I to group III. In multivariate linear regression analysis, sPAP, RV/RA diameter, and NT-pro-BNP were found to be significantly associated with the ALBI score. An ALBI score higher than -2.87 was associated with Bova stage II-III in patients with Group I and Group II PTE, with a sensitivity of 87% and a specificity of 62% (AUC = 0.804; 95% CI 0.713-0.895; p < .001). The ALBI score, which is a common, easy-to-use, and inexpensive method, may be beneficial to select intermediate and high-risk patients in patients with acute PTE. Additionally, it may have prognostic value in distinguishing low and intermediate-risk acute PTE patients.

Incidence of pulmonary thromboembolism in patients who underwent CT pulmonary angiography in the first quarter of 2023 at CHC Rijeka

Cilj: Plućna tromboembolija (PTE) je hitno medicinsko stanje kod kojeg dolazi do okluzije jedne ili više grana plućnih arterija tromboembolusom. CT plućna angiografija (CTPA) je brza, neinvazivna radiološka metoda kojom se postavlja dijagnoza PTE. Glavni cilj ovog rada je odrediti incidenciju pozitivnih PTE nalaza kod 524 pacijenta podvrgnutih CTPA te odrediti učestalost zahvaćenih grana plućnih arterija. Nadalje, jedan od ciljeva je i odrediti incidenciju usputnih nalaza (plućni nodusi, tumor pluća, pneumonija, infarkt pluća, pleuralni izljev). Ispitanici i metode: U ovom retrospektivnom istraživanju prikupljeni su podaci 524 bolesnika koji su zbog sumnje na PTE podvrgnuti CTPA pregledu na Kliničkom zavodu za dijagnostičku i intervencijsku radiologiju, na lokalitetu Sušak, u Kliničkom bolničkom centru (KBC) Rijeka, u razdoblju od siječnja do travnja 2023. godine. Svi potrebni podaci navedeni u nalazu radiologa prikupljeni su iz integriranog bolničkog informacijskog sustava (IBIS) i pripadajuće aplikacije (ISSA). Rezultati: Od ukupno 524 bolesnika podvrgnutih CTPA, PTE je dokazana kod 97 ili 18,51% pacijenata. U našem istraživanju bio je podjednak broj ispitanika muškog i ženskog spola (260 ili 49,62% naprema 264 ili 50,39%). Nešto je veća incidencija PTE bila kod muškaraca (52 ili 53,61%) nego kod žena (45 ili 46,39%). Najveći broj bolesnika (262 ili 50,00%) pripadao je dobnom razredu između 61. i 80. godine života. Usputni nalazi opisani na CTPA, prema redoslijedu učestalosti su bili: pneumonije (37,15%), pleuralni izljevi (34,86%), plućni nodusi (16,79%), tumori pluća (6,87%) i plućni infarkti (4,33%). Zaključak: CT plućna angiografija predstavlja zlatni standard za detekciju plućne tromboembolije. Pregledom dostupne literature, incidencija PTE je komparabilna s rezultatima našeg istraživanja. U našoj, kao i u većini recentnih studija, PTE je najčešće detektirana u segmentalnim i subsegmentalnim granama plućnih arterija, dok se incidencija usputnih nalaza detektiranih na CTPA ne podudara s rezultatima drugih istraživanja.

Correlation between the preoperative maximum soleal vein diameter and the postoperative bilateral deep venous thrombosis in THA: a case-control study.

Patients with bilateral lower limb deep venous thrombosis (DVT) have a higher risk of pulmonary thromboembolism (PTE) and mortality than patients with unilateral lower limb DVT. Preoperative dilatation of the soleal vein (SV) diameter is a predictor of postoperative DVT. The purpose of this study is to investigate the cutoff value for SV diameter as a risk factor for VTE development. The authors examined 274 patients with unilateral THA who met the inclusion criteria in a retrospective study. The mean age of the patients was 65.7±11.2 years, with 70 males and 204 females. Bilateral lower limb vein ultrasonography was performed preoperatively and ~1 week after THA. The frequency and localization of DVT were investigated in postoperative ultrasonography. The patients were divided into three groups: no DVT (non-DVT), unilateral lower limb DVT (Uni-DVT), and bilateral lower limb DVT (Bi-DVT). The three groups were compared in terms of preoperative venous vessel maximum diameter. There were 62 patients (22.6%) who had postoperative DVT. There are no symptomatic PTE patients. DVT was found in 44 patients (16.0%) of the Uni-DVT group and 18 patients (6.6%) of the Bi-DVT group. The SV maximum diameter was 6.41±1.79mm in the non-DVT group, 7.06±2.13mm in the Uni-DVT group, and 8.06±2.26mm in the Bi-DVT group, with a significant difference (P=0.001) between the non-DVT and Bi-DVT groups. In the Bi-DVT group, the cutoff value for preoperative SV maximum diameter was 6.75mm (95% CI: 0.625-0.831; P=0.001; sensitivity, 77.8%; specificity, 60.4%; area under the curve, 0.728). In THA, preoperative ultrasonography with a maximum SV diameter of 6.75mm or greater was the risk of bilateral DVT leading to fatal PTE is increased.

Incidence and risk factors of deep vein thrombosis and pulmonary thromboembolism after spinal cord disease at a rehabilitation unit: a retrospective study.

Deep vein thrombosis (DVT) and pulmonary thromboembolism (PTE) are major complications of spinal cord disease. However, studies of their incidence in Korean patients are limited. Thus, this study investigated the incidence and risk factors of DVT and PTE in Korean patients with spinal cord disease. We retrospectively analyzed the medical records of 271 patients with spinal cord disease who were admitted to a rehabilitation unit within 3 months of disease onset at a tertiary hospital. The presence of DVT and PTE was mainly determined using Doppler ultrasonography and chest embolism computed tomography. Risk factor analysis included variables such as sex, age, obesity, completeness of motor paralysis, neurological level of injury, cause of injury, lower extremity fracture, active cancer, and functional ambulation category (FAC) score. The incidences of DVT and PTE in the patients with spinal cord disease were both 6.3%. Risk factor analysis revealed that age of ≥65 years (p=0.031) and FAC score of ≤1 (p=0.023) were significantly associated with DVT development. Traumatic cause of injury (p=0.028) and DVT (p<0.001) were significant risk factors of PTE. Patients with spinal cord disease developed DVT and PTE within 3 months of disease onset with incidence rates of 6.3% and 6.3%, respectively. Age of ≥65 years and an FAC of score ≤1 were risk factors for DVT. Traumatic cause of injury and DVT were risk factors for PTE. However, given the inconsistent results of previous studies, the risk factors for DVT and PTE remain inconclusive. Therefore, early screening for DVT and PTE should be performed in patients with acute-to-subacute spinal cord disease regardless of the presence or absence of these risk factors.

Pulmonary Thromboembolism in Covid-19 Pneumonia: A Case Series and Update

BACKGROUND: COVID-19 is associated with lots of complications. Pulmonary thromboembolism is a rare complication of pneumonia that is showing a rising trend in the context of COVID-19. CASE PRESENTATION: We present the CTPA findings in 3 patients of pulmonary thromboembolism in patients with COVID-19 pneumonia. The patients had varying involvement of pulmonary arteries. We also provide and update on the published literature on covid pulmonary embolism in 2023. CONCLUSIONS: Pulmonary embolism can complicate Covid-19 pneumonia and lead to poorer prognosis. Hence, the correct diagnosis is imperative as prompt antithrombotic therapy can significantly reduce mortality and morbidity. There have been updates on pulmonary embolism in Covid-19 patients especially in late 2022 to early 2023 and they have been presented in this study.

Multiple sclerosis and the incidence of venous thromboembolism: a systematic review and meta-analysis.

A number of studies have suggested that multiple sclerosis (MS) can be associated with serious vascular complications, for which pulmonary thromboembolism (PTE) is a potentially lethal complication. The purpose of this study is to establish a current literature-based estimate of the incidence of venous thromboembolism (VTE), deep vein thrombosis (DVT), and PTE in patients with MS (pwMS) due to the lack of systematic reviews and meta-analyses on this topic. In this systematic review and meta-analysis, studies were assessed regarding the association between MS and the incidence of VTE. The studies were identified through a systematic search of major electronic databases spanning the period from 1950 to February 2022. A random-effects analysis was conducted to calculate the pooled effect size (ES) and 95% confidence intervals (CI) using STATA software. Nine out of 4605 studies were included in the meta-analysis, with an overall sample size of 158,546 individuals. Meta-analysis revealed that the pooled incidence of VTE was 1.8% (95% CI 1.4-2.3) among pwMS. Also, there was an incidence of 0.9% (95% CI 0.4-1.4) and 1.5% (95% CI 1-2.2) for PTE and DVT, respectively in pwMS. Analysis showed MS would be significantly associated with a twofold increased risk of VTE [risk ratios (RR) = 2.12 (95% CI 1.53-2.93)]. Although MS is not typically considered a major risk factor for VTE, the meta-analysis of cohort studies shows that MS has a relative association with an increased incidence of VTE. Future research should focus on the investigation of the effects of MS and its treatments on VTE risk, and also a full range of confounding adjustments will be needed.

A Scoring System to Determine the Risk Factors Causing Recurrent Pulmonary Thromboembolism.

The risk of recurrence in pulmonary embolism is the highest in the first week after the acute event. Although it decreases over time, it may remain high for months depending on compliance with treatment and the nature of the underlying risk factor. Our study aimed to identify risk factors that lead to recurrence in pulmonary thromboembolism (PTE) patients and establish an easy-to-use scoring system that determines the risk of recurrence after the first embolism. We retrospectively evaluated 1452 patients who were diagnosed with acute PTE between 7/1/2014 and 7/1/2019. Demographic data, comorbidities and clinical data of the patients, and risk factors were recorded. The relationship of the examined parameters with recurrent PTE was evaluated. Diabetes mellitus (DM), hypertension, obesity, and the presence of at least one hereditary risk factor were found to be associated with recurrence. The sensitivity of our score was 66.9%, the specificity was 63.2%, the positive predictive value was 19%, and the negative predictive value was 93.7%. The risk of recurrence in the patients identified as high-risk in the scoring system was 3.47 times higher than those identified as low-risk. In terms of risk of recurrence, special attention should be paid to patients with diabetes, HT, obesity and any of the hereditary risk factors. Using scoring systems to determine the risk of recurrence will be valuable and interesting as it is easy-to-use, gives quick results and provides quantitative results.

BHMT polymorphism and susceptibility to PTE in Chinese patients.

Pulmonary thromboembolism (PTE) is as a common form of venous thrombosis and a potentially fatal cardiovascular disorder, which has become a severe clinical problem with high incidence and mortality. The PTE has a strong genetic basis, which contributes up to half of the variance in PTE incidence and susceptibility single-nucleotide polymorphisms (SNPs) is associated with PTE. Betaine homocysteine methyltransferase (BHMT) is an essential enzyme that catalyzes the remethylating reaction from homocysteine to methionine and participates in conserving methionine and detoxifying homocysteine. In this work, we aimed to explore BHMT polymorphism and susceptibility to PTE in Chinese patients. Variant loci of the BHMT gene were screened in serum samples of PTE patients, followed by verification using Sanger sequencing. These polymorphic loci were validated in 16 PTE patients and 16 matched normal patients. The frequency differences between the allele and genotypes were compared using the Hardy-Weinberg equilibrium test and Chi-square test. A SNP was identified in PTE patients and a heterozygous transition of G>A (Arg239Gln) in rs3733890 was found. The variance difference at rs3733890 between normal patients (2/16, 0.125) and PTE patients (9/16, 0.5625) was significant (p<0.01). Therefore, we concluded that the BHMT polymorphism, rs3733890 may be a susceptibility SNP for PTE.

Prediction of in-hospital adverse clinical outcomes in patients with pulmonary thromboembolism, machine learning based models.

Pulmonary thromboembolism (PE) is the third leading cause of cardiovascular events. The conventional modeling methods and severity risk scores lack multiple laboratories, paraclinical and imaging data. Data science and machine learning (ML) based prediction models may help better predict outcomes. In this retrospective registry-based design, all consecutive hospitalized patients diagnosed with pulmonary thromboembolism (based on pulmonary CT angiography) from 2011 to 2019 were recruited. ML based algorithms [Gradient Boosting (GB) and Deep Learning (DL)] were applied and compared with logistic regression (LR) to predict hemodynamic instability and/or all-cause mortality. A total number of 1,017 patients were finally enrolled in the study, including 465 women and 552 men. Overall incidence of study main endpoint was 9.6%, (7.2% in men and 12.4% in women; p-value = 0.05). The overall performance of the GB model is better than the other two models (AUC: 0.94 for GB vs. 0.88 and 0.90 for DL and LR models respectively). Based on GB model, lower O2 saturation and right ventricle dilation and dysfunction were among the strongest adverse event predictors. ML-based models have notable prediction ability in PE patients. These algorithms may help physicians to detect high-risk patients earlier and take appropriate preventive measures.

Comment on: Silent Pulmonary Thromboembolism in Patients Undergoing Craniotomy for Brain Tumor.

Comment on: Silent Pulmonary Thromboembolism in Patients Undergoing Craniotomy for Brain Tumor.

The Clinical Importance of C-Reactive Protein to Albumin Ratio (CAR) in Patients with Pulmonary Thromboembolism.

Pulmonary thromboembolism (PTE) commonly arises from lower extremity thrombus and can be fatal if left untreated. To date, many laboratory biomarkers have been used for predicting the prognosis in patients with PTE. C-reactive protein (CRP) to albumin ratio (CAR) is a new biomarker of systemic inflammation. In this study, we aimed to evaluate the clinical importance of CAR in PTE patients. One hundred thirty-three eligible patients who were followed up with the diagnosis of PTE in our hospital between July 2016 and May 2020 were retrospectively evaluated in this study. The patients were divided into three groups as non-massive, sub-massive, and massive PTE. The results of complete blood counts (CBC) and biochemical analysis were evaluated among three groups. Neutrophil, neutrophil to lymphocyte ratio (NLR), D-dimer, troponin, CRP, albumin, and CAR were significantly different among groups. According to multivariate logistic regression analysis, CAR and troponin were determined as the independent predictors of massive PTE. Also, CAR was determined as the only independent predictor of in-hospital mortality in patients with PTE. CAR may be a reliable and easily accessible parameter to determine the severity and prognosis in PTE patients.

Investigation of the factors affecting the mortality of patients over 80 years of age diagnosed with acute pulmonary thromboembolism

Introduction: To investigate the factors affecting the 30-day mortality of patients over 80 years of age diagnosed with acute pulmonary thromboembolism. Materials and method: This descriptive, retrospective, and single-center study reviewed the medical records of patients over 80 years of age who were admitted to the hospital with a diagnosis of acute pulmonary thromboembolism between January 1, 2008, and April 30, 2023. The factors associated with mortality in patients who had died were examined. The recorded values of factors considered to be the determinants of 30-day mortality were also determined. Results: This study included 113 patients, with a mean age of 83.7 ± 2.7 years, and comprised of 68 (60.2%) females. During the one-month follow-up period, 30 patients (26.5%) died of acute pulmonary thromboembolism or related complications. No statistically significant difference in age and gender was observed between the exitus and non-exitus groups (p &gt; 0.05). Moreover, no significant difference was observed between the two groups in terms of hypertension and diabetes (p &gt; 0.05), whereas other comorbidities were statistically significantly higher in the exitus group (p &lt; 0.05). In the linear regression analysis, heart failure (p &lt; 0.001), D-dimer level (p = 0.019), partial arterial oxygen pressure (p &lt; 0.001), systolic pulmonary artery pressure (p &lt; 0.001), and recent history of major surgery (p = 0.021) were found to be factors that affected the mortality. Conclusion: The presence of comorbidities, poor hemodynamic findings, poor oxygenation, high pulmonary artery pressure, and high D-dimer levels may be mortality indicators in acute pulmonary thromboembolism patients over 80 years of age. Keywords: Pulmonary Embolism; Mortality; Ages.

Pulmonary thromboembolism in patients with stroke: the results of the clinical-anatomic analysis

Pulmonary embolism is a major cause of mortality in stroke patients and up to 50% of premature deaths in hospitalized patients. The non-specific clinical picture causes diagnostic errors and severely limits the initiation of treatment in atimely manner.The aim of the study was to analyze missed cases of pulmonary embolism in stroke patients treated within the institutional cohort by analyzing the results of morpho pathological examinations. Materials and methods: Retrospective study. Pulmonary thromboembolism was studied as a major cause of death in patients with stroke, hospitalized in the Diomid Gherman Institute of Neurology and Neurosurgery during 2017-2020. 13 patients with a morpho pathologically confirmed diagnosis were included in the study. Results: The study included 5 men (38.5%) and 8 women (61.5%) with an average age of 65±5.2 years. In all patients the diagnosis of stroke was confirmed by CT: ischemic stroke was established in 6 patients (46.8%), hemorrhagic stroke in 4 patients (30.1%), of which 1 patient underwent surgery (7.7%), stroke with hemorrhagic transformation in 3 patients (23.1%). For 11 patients (84.6%) the stroke was primary, and for 2 patients (15.4%) it was repeated. The risk factors were hypertension - 12 patients (92.3%), in 8 patients (61.5%) obesity, diabetes mellitus -5 patients (38.5%), atrial fibrillation in 5 patients (38.5%), 1 patient (7.7%) with thrombosis in other areas. The morpho pathological diagnosis established that pulmonary embolism was the cause of death in all cases, but only 2 (15.4%) patients presented specific symptoms. Conclusion. Stroke patients are at increased risk of pulmonary embolism due to bed rest, limb paralysis and predisposing risk factors, but only a small number of patients are diagnosed in a timely manner, therefore it is important for the clinician to be aware of the severity of the problem and establishing strict prophylaxis and treatment protocols.

Serum Lactate, an Independent Prognostic Marker in Normotensive Patients With Acute Pulmonary Thromboembolism

Abstract Objective Serum lactate, a marker of tissue hypoxia, is an important prognostic factor in sepsis, trauma, and cardiogenic shock. Data on the direct correlation of serum lactate and in-hospital mortality in normotensive acute pulmonary thromboembolism (APE) patients, however, remains scarce. Material and methods We analyzed normotensive APE patients admitted to our clinic from January 1, 2014, to December 31, 2021. Serum lactate was collected from arterial blood at admission. Results The study sample included 161 patients with an average age of 68.61 ± 11.54 years. 54.94% were female. In-hospital mortality was 19.88%. In ROC analysis, serum lactate was a predictor of in-hospital mortality with an AUC of 0.662 (95%CI 0.584 – 0.735, p = 0.005). The cut-off level identified by the Youden index-associated criterion was &gt; 38 mg/dL (34.38% sensitivity, 94.57% specificity). In multivariable analysis for in-hospital mortality alongside the biomarkers proposed by the 2019 ESC guidelines for severity assessment, lactate &gt; 38 mg/dL was an independent predictor of mortality (OR 10.92, 95%CI 3.04 – 39.29, p &lt; 0.001). The prediction model including PESI score, right ventricular dysfunction, troponin I, and lactate &gt; 38 mg/dL had the best predictive performance for in-hospital mortality (AUC 0.807, p &lt; 0.001). Conclusions Elevated serum lactate is an independent predictor of all-cause in-hospital mortality of normotensive APE patients, with the optimal cut-off &gt; 38 mg/dL. Adding the lactate level for mortality prediction outperformed the 2019 ESC guidelines algorithm for severity assessment of normotensive APE patients.

Clinical Profile, Immediate- and Short-term Outcome of Patients with Intermediate-risk Acute Pulmonary Thromboembolism.

Long-term outcomes of acute pulmonary thromboembolism (PTE) have been reported. However, the immediate- and short-term outcomes have not been reported adequately. Primary objective was to determine the patient characteristics, and immediate- and short-term outcomes of intermediate-risk PTE, and the secondary objective was to evaluate the benefit of thrombolysis in normotensive PTE patients. This study included patients diagnosed with acute intermediate PTE. Patient's electrocardiography (ECG) parameters along with echocardiography (echo), etc., conducted at the time of admission, during their stay in hospital, at the time of discharge, and during follow-up were recorded. The patients were treated using thrombolysis or anticoagulants depending on hemodynamic decompensation. During follow-up, they were reassessed for echo parameters-right ventricular (RV) function and pulmonary arterial hypertension (PAH). Among 55 patients, 29 (52.73%) were diagnosed with intermediate high-risk PTE and 26 (47.27%) with intermediate low-risk PTE. They were normotensive and most of them had a simplified pulmonary embolism severity index (sPESI) score <2. Typical ECG pattern S1Q3T3 along with echo patterns and elevated cardiac troponin levels were observed in most of the patients. Patients treated with thrombolytic agents showed a reduction in hemodynamic decompensation as opposed to patients treated with anticoagulants who had clinical signs of right heart failure (RHF) on follow-up after 3 months. This study contributes to the existing literature on outcomes of intermediate-risk PTE and the effect of thrombolysis on patients with hemodynamic stability. Thrombolysis reduced the incidence and progression of RHF in patients with hemodynamic instability. Mathiyalagan P, Rajangam T, Bhargavi K, Gnanaraj R, Sundaram S. Clinical Profile, Immediate- and Short-term Outcome of Patients with Intermediate-risk Acute Pulmonary Thromboembolism. Indian J Crit Care Med 2022;26(11):1192-1197.

Prevalence of acute pulmonary thromboembolism in patients with COVID-19 related pulmonary involvement: A study of 240 lung perfusion scans

Prevalence of acute pulmonary thromboembolism in patients with COVID-19 related pulmonary involvement: A study of 240 lung perfusion scans