Are biomarkers additive to pulmonary embolism severity index for severity assessment in normotensive patients with acute pulmonary embolism?

BACKGROUND: Biomarkers and clinical prediction rules have been proposed for severity assessment in acute pulmonary embolism (PE). AIM: The aim of this study was to compare biomarkers with the PE Severity Index (PESI), a validated scoring system for predicting 30-day mortality and to determine if addition of biomarkers to PESI would improve its predictive accuracy. STUDY DESIGN AND METHODS: We conducted a retrospective analysis of normotensive patients admitted with PE confirmed by CT pulmonary angiogram, to three teaching hospitals between January 2005 and July 2007. All patients had admission levels of D-dimer and Troponin I and calculation of PESI score on admission. The outcome of interest was 30-day mortality. RESULTS: There were 411 patients included in the study. Patients who died had higher levels of D-dimer (median 2947 ng/ml vs. 1464 ng/ml; P=0.02), Troponin (57.1% positive vs. 13.8%; P<0.0001) and higher PESI scores [median 109 vs. 83; P<0.0001], compared to survivors. PESI had superior accuracy for predicting 30-day mortality than a combination of Troponin and D-dimer (AUC 0.80 vs. 0.75). Addition of Troponin to PESI further improved the predictive value of the score (AUC 0.85 for vs. AUC 0.80 for PESI alone). CONCLUSION: Biomarkers and clinical prediction rules predict outcome in acute PE. Addition of troponin to the PESI scoring system improves the predictive value for 30-day mortality and may be useful for guiding initial management of patients presenting with PE.

Comparison between conventional interrupted high-resolution CT and volume multidetector CT acquisition in the assessment of bronchiectasis.

The aim of this study was to determine whether there is superior diagnostic accuracy for the detection and exclusion of bronchiectasis using 16-slice CT of the chest (1 mm) compared with conventional high-resolution CT (HRCT) of the chest (10 mm). A prospective study was carried out in patients who were referred for chest CT by a chest physician for the investigation of bronchiectasis over a 1-year period. All scans were performed using a 16-slice CT scanner. In addition to contiguous 1 mm slices, conventional HRCT images (1 mm slice every 10 mm) were prepared. Both datasets were dual read. There were 53 patients with a median age of 62 years (range, 51.5-71.5 years), comprising 14 males and 39 females. 10 of 53 scans had no bronchiectasis in either dataset. 36 patients had bronchiectasis diagnosed on both HRCT and 1 mm scans. Two patients had tubular bronchiectasis on the HRCT scans, which was not confirmed on the 1 mm scans. Five patients had confirmed tubular bronchiectasis on the 1 mm scans, which was not identified on HRCT scans. 40 extra lobes demonstrated bronchiectasis on the 1 mm vs the HRCT scans; of these, half were labelled as definite bronchiectasis on the 1 mm scan. There was a 32% increased confidence with the 1 mm scans compared with conventional HRCT of the chest in the diagnosis of bronchiectasis (p < 0.001). In conclusion, there is improved diagnostic accuracy and confidence for diagnosis and exclusion of bronchiectasis using 16-slice chest CT (1 mm cuts) compared with conventional HRCT of the chest.