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J. Clin. Med. 2019, 8(2), 160; https://doi.org/10.3390/jcm8020160

Assessment of Renal Dysfunction Improves the Simplified Pulmonary Embolism Severity Index (sPESI) for Risk Stratification in Patients with Acute Pulmonary Embolism

1
Pôle d’Activité Médico-Chirurgicale Cardio-Vasculaire, Nouvel Hôpital Civil, Centre Hospitalier Universitaire, Université de Strasbourg, 67091 Strasbourg, France
2
Pôle NUDE, Nouvel Hôpital Civil, Centre Hospitalier Universitaire, Université de Strasbourg, 67091 Strasbourg, France
3
Department of Cardiology, Austin and Northern Health, Melbourne 3084, Australia
4
Laboratory of Regenerative Nanomedicine, UMR 1260, INSERM (French National Institute of Health and Medical Research), FMTS (Fédération de Médecine Translationnelle de l’Université de Strasbourg), Faculté de Médecine, Université de Strasbourg, 11 rue Humann, 67085 Strasbourg, France
*
Author to whom correspondence should be addressed.
Received: 7 January 2019 / Revised: 22 January 2019 / Accepted: 24 January 2019 / Published: 1 February 2019
(This article belongs to the Section Nephrology & Urology)
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Abstract

Background: Whereas the major strength of the simplified pulmonary embolism severity index (sPESI) lies in ruling out an adverse outcome in patients with sPESI of 0, the accuracy of sPESI ≥ 1 in risk assessment remains questionable. In acute pulmonary embolism (APE), the estimated glomerular filtration rate (eGFR) can be viewed as an integrate marker reflecting not only previous chronic kidney disease (CKD) damage but also comorbid conditions and hemodynamic disturbances associated with APE. We sought to determine whether renal dysfunction assessment by eGFR improves the sPESI score risk stratification in patients with APE. Methods: 678 consecutive patients with APE were prospectively enrolled. Renal dysfunction (RD) at diagnosis of APE was defined by eGFR < 60 mL/min/1.73 m2 and acute kidney injury (AKI) by elevation of creatinine level >25% during in-hospital stay. Results: RD was observed in 26.9% of the cohort. AKI occurred in 18.8%. A stepwise increase in 30-day mortality, cardiovascular mortality and overall mortality was evident with declining renal function. Multivariate analysis identified RD and CRP (C-reactive protein) level but not sPESI score as independent predictors of 30-day mortality. AKI, 30-day mortality, overall mortality, and cardiovascular mortality were at their highest level in patients with eGFR < 60 mL/min/1.73 m2 and sPESI ≥1. Conclusion: in patients with APE, the addition of RD to the sPESI score identifies a specific subset of patients at very high mortality. View Full-Text
Keywords: chronic kidney disease; cardio-renal syndrome; contrast-induced nephropathy; venous thromboembolism chronic kidney disease; cardio-renal syndrome; contrast-induced nephropathy; venous thromboembolism
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Trimaille, A.; Marchandot, B.; Girardey, M.; Muller, C.; Lim, H.S.; Trinh, A.; Ohlmann, P.; Moulin, B.; Jesel, L.; Morel, O. Assessment of Renal Dysfunction Improves the Simplified Pulmonary Embolism Severity Index (sPESI) for Risk Stratification in Patients with Acute Pulmonary Embolism. J. Clin. Med. 2019, 8, 160.

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