David Jiménez

Instituto Ramón y Cajal de Investigación Sanitaria

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Manuel Monréal

Universidad Católica San Antonio de Murcia

Remedios Otero

Hospital Universitario Virgen del Rocío

Luis Jara‐Palomares

Instituto de Salud Carlos III

Laurent Bertoletti

Inserm

Fernando Uresandi

HM Hospitales

Peter Verhamme

KU Leuven

Inna Tzoran

Rambam Health Care Campus

Carme Font

Hospital Clínic de Barcelona

C. Falgá

Hospital de Mataró

A. Rivas

Hospital Universitario Infanta Leonor

Cooperative Institutions

Universidad Católica San Antonio de Murcia

143

Hospital Universitari Germans Trias i Pujol

129

Universitat Autònoma de Barcelona

Harvard University

Centro de Investigación Biomédica en Red de Enfermedades Respiratorias

Inserm

Bayer (United States)

Brigham and Women's Hospital

Sanofi (Mexico)

Instituto de Salud Carlos III

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Short-term clinical outcome after acute symptomatic pulmonary embolism

Thrombosis and Haemostasis (2008)

Francisco Conget Remedios Otero David Martí Sánchez Carlos Escobar Consolación Rodríguez

Though studies have identified clinical variables that predict adverse events in patients with acute pulmonary embolism (PE), they have typically not differentiated short-term from long-term predictors. This multicenter prospective cohort study included consecutive outpatients with objectively confirmed symptomatic acute PE. We analyzed the incidence and time course of death, venous thromboembolism (VTE) recurrence, and major bleeding, and we compared event rates during short-term (first week) and long-term (3 months) follow-up after the diagnosis of PE. We also assessed risk factors for short-term mortality. During the first three months after diagnosis of PE, 142 of 1,338 (10.6%) patients died. Thirty-six deaths (2.7%) occurred during the first week after diagnosis of PE, and 61.1% of these were due to PE. Thirty-eight patients (2.8%) had recurrent VTE during the three-month follow-up, though none of the recurrences occurred during the first week after diagnosis of PE. During the three-month follow-up, major bleeding occurred in 48 patients (3.6%). Twenty-one (1.6%) major bleeds occurred during the first week of follow-up, and nine of these were fatal. Short-term mortality was significantly increased in patients who initially presented with systolic arterial hypotension (odds ratio [OR] 3.35; 95% CI, 1.51-5.41) or immobilization due to a medical illness (OR 2.89; 95% confidence interval [CI], 1.31-6.39). In conclusion, during the first week after the diagnosis of PE, death and major bleeding occur more frequently than recurrent VTE. Patients with systolic arterial hypotension and immobilization at the time of PE diagnosis had an increased risk of short-term mortality.

Major bleeding

10.1160/th08-02-0065

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Citations (60)

Prognostic value of plasma lactate in acute pulmonary embolism: the multicentre Thrombo-Embolism Lactate Outcome study

European Heart Journal (2013)

Simone Vanni David Jiménez Peiman Nazerian Chiara Gigli M. Parisi

Purpose: To investigate the prognostic value of plasma lactate in patients with acute pulmonary embolism (PE). In particular, we tested if high plasma lactate at presentation (≥ 2 mmol/L) was associated with high incidence (>10%) of death or hemodynamic collapse duo to PE in the short-term.

10.1093/eurheartj/eht308.758

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Abstract 4144053: Age- and Sex- Differences in the Accuracy of Rule-based Natural Language Processing Models for Identification of Pulmonary Embolism

Circulation (2024)

Darsiya Krishnathasan Sina Rashedi Candrika D. Khairani Antoine Bejjani Ying-Chih Lo

Background: Presentation, treatment and outcomes of pulmonary embolism (PE) in adults varies by age and sex. Recently, some rule-based natural language processing (NLP) tools have been developed to detect PE from radiology reports. It is unknown whether variations in age and sex influence the accuracy of the NLP models to detect PE in radiology reports. Methods: We used patient data from the Mass General Brigham (MGB) Health System between 2016 and 2021. The NLP models developed by Verma et al. and Johnson et al. were applied to radiology reports to determine PE among a randomly selected sample of 1,712 patients (52.3% female and 45.3% ≥65 years old). Two independent physicians conducted a manual chart review of patient records with predefined criteria, serving as the reference standard. Accuracy metrics were ascertained across age (≥65 vs. <65 years) and sex (female vs. male) subgroups. Weighted estimates were established based on the total number of hospitalizations at MGB (n=381,642, 54.0% female and 47.2% ≥65 years old). Results: In the weighted sample, the prevalence of PE was 2.0% (7,708/ 381,642). The weighted estimates of the NLP models resulted in high sensitivity (range 71.0% to 89.3%) and specificity (range 96.8% to 98.6) for patients ≥65 and <65 years of age (Table, Part A). Similarly, both models resulted in high sensitivity (range 76.9% to 88.2%) and specificity (range 96.6% to 98.7%) for females and males (Table, Part B). However, positive predictive values were low for both models in the two age categories (range 36.8% to 51.0%) and sex groups (range 35.1% to 54.7%) (Table, Parts A and B). Conclusions: Despite some variations in the accuracy of the rule-based NLP models, positive predictive values across age and sex groups were low. Further improvements are necessary before rule-based NLP tools can be reliably utilized for PE identification from imaging reports.

Identification

10.1161/circ.150.suppl_1.4144053

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Analysis of noncatheter-associated upper extremity deep venous thrombosis from the RIETE registry

Journal of Vascular Surgery Venous and Lymphatic Disorders (2016)

Daniel H. Newton Manuel Monreal Bosch Michael Amendola Luke G. Wolfe Cristina Pérez Ductor

10.1016/j.jvsv.2016.08.002

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A RIETE registry analysis of recurrent thromboembolism and hemorrhage in patients with catheter-related thrombosis

Journal of Vascular Surgery Venous and Lymphatic Disorders (2015)

Lisa Baumann Kreuziger Lauren Cote Peter Verhamme Steven B. Greenberg Joseph A. Caprini

Concomitant

10.1016/j.jvsv.2015.03.002

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Clinical outcomes after discontinuing anticoagulant therapy in patients with first unprovoked venous thromboembolism.

Journal of Thrombosis and Haemostasis (2024)

Cristina Gabara Jesús Aibar Yuji Nishimoto Yugo Yamashita Paolo Prandoni

Anticoagulant Therapy

Major bleeding

10.1016/j.jtha.2024.05.007

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Validation of N-terminal pro-brain natriuretic peptide cut-off values for risk stratification of pulmonary embolism

European Respiratory Journal (2014)

Mareike Lankeit David Jiménez Maciej Kostrubiec Claudia Dellas Katherina Kuhnert

The optimal N-terminal pro-brain natriuretic peptide (NT-proBNP) cut-off value for risk stratification of pulmonary embolism remains controversial. In this study we validated and compared different proposed NT-proBNP cut-off values in 688 normotensive patients with pulmonary embolism. During the first 30 days, 28 (4.1%) patients reached the primary outcome (pulmonary embolism-related death or complications) and 29 (4.2%) patients died. Receiver operating characteristic analysis yielded an area under the curve of 0.70 (0.60–0.80) for NT-proBNP. A cut-off value of 600 pg·mL −1 was associated with the best prognostic performance (sensitivity 86% and specificity 50%) and the highest odds ratio (6.04 (95% CI 2.07–17.59), p=0.001) compared to the cut-off values of 1000, 500 or 300 pg·mL −1 . Using multivariable logistic regression analysis, NT-proBNP ≥600 pg·mL −1 had a prognostic impact on top of that of the simplified Pulmonary Embolism Severity Index and right ventricular dysfunction on echocardiography (OR 4.27 (95% CI 1.22–15.01); p=0.024, c-index 0.741). The use of a stepwise approach based on the simplified Pulmonary Embolism Severity Index, NT-proBNP ≥600 pg·mL −1 and echocardiography helped optimise risk assessment. Our findings confirm the prognostic value of NT-proBNP and suggest that a cut-off value of 600 pg·mL −1 is most appropriate for risk stratification of normotensive patients with pulmonary embolism. NT-proBNP should be used in combination with a clinical score and an imaging procedure for detecting right ventricular dysfunction.

Risk Stratification

Stratification (seeds)

Brain natriuretic peptide

10.1183/09031936.00211613

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Citations (148)

Pulmonary embolism work-up in chronic obstructive pulmonary disease exacerbations: what is the best strategy for clinicians?

Current Opinion in Pulmonary Medicine (2024)

David Jiménez Laurent Bertoletti Behnood Bikdeli

Purpose of review Acute exacerbations of chronic obstructive pulmonary disease (COPD) are important events in the natural course of COPD, as they increase morbidity and mortality. Acute pulmonary embolism may mimic the symptoms of COPD exacerbations. However, the exact prevalence of pulmonary embolism in unexplained exacerbations of COPD is unclear based on the current data. This review provides a practical approach to patients with COPD complaining of worsening respiratory symptoms. Recent findings A randomized clinical trial has shown that a routine pulmonary embolism diagnostic work-up does not improve care of patients with acute exacerbations of COPD. However, review of the recent literature suggests that a nonnegligible proportion of otherwise unexplained exacerbations of COPD may be caused by pulmonary embolism. To date, nevertheless, there are limited studies developing and validating clinical models that might aid in the identification of patients requiring additional tests for the diagnosis of pulmonary embolism. Summary Until new evidence becomes available, we believe that a routine diagnostic strategy for pulmonary embolism is not appropriate for patients with acute exacerbations of COPD. Recommendations for routine pulmonary embolism diagnostic work-up necessitate further development of prognostic models and conduct of clinical trials that assess important health outcomes.

10.1097/mcp.0000000000001130

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Development of a Risk Prediction Score for Occult Cancer in Patients With VTE

CHEST Journal (2016)

Luis Jara‐Palomares Remedios Otero David Jiménez Marc Carrier Inna Tzoran

Occult

10.1016/j.chest.2016.10.025

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Citations (63)

Validation of a prognostic score for hidden cancer in unprovoked venous thromboembolism

PLoS ONE (2018)

Luis Jara‐Palomares Remedios Otero David Jiménez Juan Manuel Praena‐Fernández Carme Font

The usefulness of a diagnostic workup for occult cancer in patients with venous thromboembolism (VTE) is controversial. We used the RIETE (Registro Informatizado Enfermedad Trombo Embólica) database to perform a nested case-control study to validate a prognostic score that identifies patients with unprovoked VTE at increased risk for cancer. We dichotomized patients as having low- (≤2 points) or high (≥3 points) risk for cancer, and tried to validate the score at 12 and 24 months. From January 2014 to October 2016, 11,695 VTE patients were recruited. Of these, 1,360 with unprovoked VTE (11.6%) were eligible for the study. At 12 months, 52 patients (3.8%; 95%CI: 2.9–5%) were diagnosed with cancer. Among 905 patients (67%) scoring ≤2 points, 22 (2.4%) had cancer. Among 455 scoring ≥3 points, 30 (6.6%) had cancer (hazard ratio 2.8; 95%CI 1.6–5; p<0.01). C-statistic was 0.63 (95%CI 0.55–0.71). At 24 months, 58 patients (4.3%; 95%CI: 3.3–5.5%) were diagnosed with cancer. Among 905 patients scoring ≤2 points, 26 (2.9%) had cancer. Among 455 patients scoring ≥3 points, 32 (7%) had cancer (hazard ratio 2.6; 95%CI 1.5–4.3; p<0.01). C-statistic was 0.61 (95%CI, 0.54–0.69). We validated our prognostic score at 12 and 24 months, although prospective cohort validation is needed. This may help to identify patients for whom more extensive screening workup may be required.

10.1371/journal.pone.0194673

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Citations (19)