Publications (128) View all
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Article: The prognostic value of pro-B-Type natriuretic peptide in acute pulmonary embolism.
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ABSTRACT: AIMS: To assess the clinical performance of pro-B-type natriuretic peptide 1-108 (proBNP) for the prognosis of acute pulmonary embolism. METHODS: This study was ancillary to a recently published multicentre study including 570 patients with acute pulmonary embolism. ProBNP values were analysed using a new sandwich immunoassay proBNP1-108, Bioplex2200™ (Bio-Rade Laboratories). Data was compared with BNP and N-terminal (NT) proBNP values. Adverse outcomes at 30days were defined as death, secondary cardiogenic shock, or recurrent venous thromboembolism. RéSULTS: ProBNP values were analysed in 549 patients, with 39 (7.1%) presenting adverse outcomes. All three natriuretic peptides were significantly elevated in these 39 patients compared with the group without adverse outcomes (BNP: p <0.001; NT-proBNP: p <0.001; proBNP: 0.044), with median proBNP values being 605pg/ml (113-1437) and 109pg/ml (30-444), respectively. Multivariate analyses revealed that proBNP significantly depended on patient age (p <0.001) and renal failure (p=0.001), with proBNP values increasing with both factors. The areas under the receiver operating curve were 0.74 (95% CI 0.69-0.79) for BNP, 0.76 (95% CI 0.72-0.80) for NT-proBNP, and 0.70 (95% CI 0.65-0.75) for proBNP, meaning that the performance of proBNP was significantly lower than that of the two other peptides (p=0.017). CONCLUSION: ProBNP, BNP, and NT-proBNP values were significantly increased in patients with adverse outcomes after acute pulmonary embolism. However, the prognostic performance of proBNP for predicting adverse versus favourable outcomes was lower than that of the other natriuretic peptides, thus limiting the clinical relevance of proBNP as a prognostic marker in pulmonary embolism.Thrombosis Research 04/2013; · 2.44 Impact Factor -
Article: The Swiss cohort of elderly patients with venous thromboembolism (SWITCO65+): rationale and methodology.
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ABSTRACT: Venous thromboembolism (VTE) is common and has a high impact on morbidity, mortality, and costs of care. Although most of the patients with VTE are aged ≥65 years, there is little data about the medical outcomes in the elderly with VTE. The Swiss Cohort of Elderly Patients with VTE (SWITCO65+) is a prospective multicenter cohort study of in- and outpatients aged ≥65 years with acute VTE from all five Swiss university and four high-volume non-university hospitals. The goal is to examine which clinical and biological factors and processes of care drive short- and long-term medical outcomes, health-related quality of life, and medical resource utilization in elderly patients with acute VTE. The cohort also includes a large biobank with biological material from each participant. From September 2009 to March 2012, 1,863 elderly patients with VTE were screened and 1003 (53.8 %) were enrolled in the cohort. Overall, 51.7 % of patients were aged ≥75 years and 52.7 % were men. By October 16, 2012, after an average follow-up time of 512 days, 799 (79.7 %) patients were still actively participating. SWITCO65+ is a unique opportunity to study short- and long-term outcomes in elderly patients with VTE. The Steering Committee encourages national and international collaborative research projects related to SWITCO65+, including sharing anonymized data and biological samples.Journal of Thrombosis and Thrombolysis 01/2013; · 1.48 Impact Factor -
Article: Prospective, multicenter validation of prediction scores for major bleeding in elderly patients with venous thromboembolism.
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ABSTRACT: BACKGROUND: The Outpatient Bleeding Risk Index (OBRI) and the Kuijer, RIETE, and Kearon scores are clinical prognostic scores for bleeding in patients receiving oral anticoagulants for venous thromboembolism (VTE). We prospectively compared the performance of these scores in elderly patients with VTE. METHODS: In a prospective multicenter Swiss cohort study, we studied 663 patients aged ≥65 years with acute VTE. The outcome was a first major bleeding at 90 days. We classified patients into three categories of bleeding risk (low, intermediate, and high) according to each score and dichotomized patients as high vs. low or intermediate risk. We calculated the area under the receiver operating characteristic (ROC) curve, positive predictive values and likelihood ratios for each score. RESULTS: Overall, 28 out of 663 patients (4.2%, 95% confidence interval 2.8-6.0%) had a first major bleeding within 90 days. According to different scores, the rate of major bleeding varied from 1.9% to 2.1% in low-risk, from 4.2% to 5.0% in intermediate-risk, and from 3.1% to 6.6% in high-risk patients. The discriminative power of the scores was poor to moderate, with areas under the ROC curve ranging from 0.49 to 0.60 (P=0.21). The positive predictive values and positive likelihood ratios were low and varied from 3.1% to 6.6% and from 0.72 to 1.59, respectively. CONCLUSION: In elderly patients with VTE, existing bleeding risk scores do not have sufficient accuracy and power to discriminate between patients with VTE who are at high-risk of short-term major bleeding and those who are not. © 2012 International Society on Thrombosis and Haemostasis.Journal of Thrombosis and Haemostasis 12/2012; · 5.73 Impact Factor -
Article: Echocardiography and PESI have independent prognostic role in pulmonary embolism.
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ABSTRACT: We analysed a cohort of patients with normotensive pulmonary embolism (PE) in order to assess whether combining echocardiography and biomarkers with the pulmonary embolism severity index (PESI) improves the risk-stratification in comparison to the PESI alone.The PESI was calculated in normotensive patients with PE who also underwent echocardiography and assays of troponin and brain natriuretic peptide. Thirty-day adverse outcome was defined as death, recurrent PE or shock.529 patients were included, 25 (4.7%; 95% confidence interval (CI), 3.2% to 6.9%) had at least one outcome event. The proportion of patients with adverse events increased from 2.1% in PESI class I-II to 8.4% in PESI class III-IV, and to 14.3% in PESI class V (P<0.001). In PESI class I-II, the rate of outcome events was significantly higher in patients with abnormal values of biomarkers or right ventricular (RV) dilatation. In multivariate analysis, the PESI (Odds Ratio (OR) III-IV versus I-II: 3.1; 95%CI, 1.2-8.3; OR V versus I-II: 5.5; 95%CI, 1.5-25.5) and echocardiography (RV/left ventricular ratio, OR for an increase of 0.1: 1.3; 95%CI, 1.1-1.5) were independent predictors of an adverse outcome.In patients with normotensive PE, biomarkers and echocardiography provided additional prognostic information to the PESI.European Respiratory Journal 12/2012; · 5.89 Impact Factor -
Article: Predicting deep venous thrombosis in pregnancy: externalvalidation of the "left" clinical prediction rule.
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ABSTRACT: Background. The assessment of clinical probability represents an important step in the diagnostic strategy of patients with suspected deep vein thrombosis. The recently derived "LEFt" clinical prediction rule for pregnant women combines three variables: symptoms in the left leg ("L"), calf circumference difference ≥ 2 centimeters ("E" for edema) and first trimester presentation ("Ft"), but is lacking an external validation. Design and Methods. The LEFt rule was computed among pregnant women with suspected deep vein thrombosis who were included in a multicentre prospective diagnostic management outcome study. We calculated the proportion of women and the prevalence of deep vein thrombosis in each probability group, along with the diagnostic performances of the LEFt rule. Results. All variables needed to compute the rule could be retrieved in 157 out of the 167 pregnant women with suspected deep vein thrombosis. The prevalence of confirmed deep vein thrombosis was 13/157 (8.3%). The "LEFt" rule was negative in 46 (29%) women. A deep vein thrombosis was diagnosed in 13/111 (11.7%, 95% CI: 8.3 to 20.9%) of women with at least one of the "LEFt" criteria, as compared with 0/46 (0.0%, 95% CI:0.0 to 7.9%) of women with none of the "LEFt" criteria. Conclusions. These results suggest that a negative "LEFt" rule accurately identifies pregnant women in whom the proportion of confirmed deep vein thrombosis appears to be very low. The rule should not be used as stand-alone test for excluding DVT during pregnancy but might rather be implemented in a diagnostic strategy in association with Ddimer measurement and compression ultrasonography.Haematologica 10/2012; · 6.42 Impact Factor
