C-reactive protein level predicts 30-day mortality and bleeding in patients with venous thromboembolism: A prospective single-center study / Proteína C reactiva como predictor de mortalidad y hemorragia a 30 días en pacientes con enfermedad tromboembólica venosa: estudio prospectivo, monocéntrico

AIMS: The association of on-admission CRP and early adverse outcomes in acute venous thromboembolism (VTE) has not been investigated. We hypothesized that increased on-admission CRP levels would correlate with adverse outcomes in patients with acute VTE. METHOD: In this prospective observational study, consecutive patients with acute VTE were enrolled and CRP levels were measured within the first 24h after diagnosis. Mortality, bleeding and recurrence were recorded during a 30-day follow-up. RESULTS: 586 patients were included. Higher CRP levels were found in patients with mortality (7.5 vs 4.0mg/dL; p = 0.01) and bleeding (7.8 vs 3.9mg/dL; p = 0.03). Multivariable logistic regression showed that CRP levels >5mg/dL were associated with higher mortality (OR 6.25; 95% CI, 2.1-18.6) and bleeding (OR 2.7; CI 95% 1.3-5.7). These results were independent to ESC risk score and simplified PESI score for mortality prediction. The predictive capacity of CRP showed an area under the ROC curve - AUC - of .7 (CI 95% .56-.85) for mortality and .65 (CI 95% .54-.75) for bleeding. The prognostic capacity of the ESC risk score and simplified PESI score was improved after adding the CRP cutoff of 5mg/dL (AUC of .87 CI 95% .79-.95). CONCLUSION: Our findings suggest that on-admission CRP level may be a simple, widely available and valuable biomarker to identify high-risk VTE patients for early mortality and bleeding. CRP ≥5mg/dL was independently associated with 30-day VTE related death and bleeding

OBJETIVOS: La asociación de la medición de PCR al ingreso y las complicaciones precoces en la enfermedad tromboembólica venosa (ETV) aguda no ha sido evaluado. Nuestra hipótesis es que los niveles elevados de PCR al ingreso podrían estar correlacionados con complicaciones precoces en pacientes con ETV aguda. MÉTODOS: Estudio observacional prospectivo, en el que se incluyeron pacientes consecutivos con ETV aguda en los que se midió la PCR en las primeras 24h del diagnóstico. La mortalidad, el sangrado y la recurrencia fueron registrados durante el seguimiento a 30 días. RESULTADOS: Se incluyeron 586 pacientes. Se encontraron niveles más elevados de PCR en pacientes que fallecieron (7,5 vs. 4mg/dl; p = 0,01) y que sangraron (7,8 vs. 3,9mg/dl; p = 0,03). Una regresión logística multivariante mostró que niveles de PCR>5mg/dl se asociaron significativamente con mayor mortalidad (OR: 6,25; IC 95%: 2,1-18,6) y sangrado (OR: 2,7; IC 95%: 1,3-5,7). Estos resultados fueron independientes de las escalas pronósticas de mortalidad ESC y PESI simplificada. La capacidad predictiva de la PCR mostró un área bajo la curva (ABC) ROC de 0,7 (IC 95%: 0,56-0,85) para mortalidad y 0,65 (IC 95%: 0,54-0,75) para sangrado. La capacidad pronóstica de las escalas pronósticas ESC y PESI simplificada mejoró de forma significativa al añadir el punto de corte de PCR>5mg/dl (ABC de 0,87; IC 95%: 0,79-0,95). CONCLUSIÓN: La medición de PCR al ingreso puede ser un marcador sencillo y ampliamente disponible para identificar a pacientes con ETV aguda y alto riesgo de mortalidad y sangrado precoces. Niveles de PCR≥5mg/dl se asociaron de forma independiente con mayor mortalidad y sangrado a 30 días en pacientes con ETV aguda

C-reactive protein level predicts 30-day mortality and bleeding in patients with venous thromboembolism: A prospective single-center study.

AIMS: The association of on-admission CRP and early adverse outcomes in acute venous thromboembolism (VTE) has not been investigated. We hypothesized that increased on-admission CRP levels would correlate with adverse outcomes in patients with acute VTE. METHOD: In this prospective observational study, consecutive patients with acute VTE were enrolled and CRP levels were measured within the first 24h after diagnosis. Mortality, bleeding and recurrence were recorded during a 30-day follow-up. RESULTS: 586 patients were included. Higher CRP levels were found in patients with mortality (7.5 vs 4.0mg/dL; p=0.01) and bleeding (7.8 vs 3.9mg/dL; p=0.03). Multivariable logistic regression showed that CRP levels >5mg/dL were associated with higher mortality (OR 6.25; 95% CI, 2.1-18.6) and bleeding (OR 2.7; CI 95% 1.3-5.7). These results were independent to ESC risk score and simplified PESI score for mortality prediction. The predictive capacity of CRP showed an area under the ROC curve - AUC - of .7 (CI 95% .56-.85) for mortality and .65 (CI 95% .54-.75) for bleeding. The prognostic capacity of the ESC risk score and simplified PESI score was improved after adding the CRP cutoff of 5mg/dL (AUC of .87 CI 95% .79-.95). CONCLUSION: Our findings suggest that on-admission CRP level may be a simple, widely available and valuable biomarker to identify high-risk VTE patients for early mortality and bleeding. CRP ≥5mg/dL was independently associated with 30-day VTE related death and bleeding.

Retroperitoneal fibrosis associated with orbital pseudotumor without evidence of IgG4: A case report with review of literature.

Retroperitoneal fibrosis (RPF) is a rare disease characterized by chronic inflammation and periaortic fibrosis that affects retroperitoneal structures and often entraps the ureters. The idiopathic form has an incidence of 0.1-1.3/100,000 person-years. A substantial percentage of patients with idiopathic retroperitoneal fibrosis (IRF), as well as patients with orbital pseudotumor, is associated with IgG4-related disease (IgG4-RD). It is not clear what percentage of IRF is related to the spectrum of the IgG4-RD or if both represent different stages of the same disease (especially in those cases with extra-retroperitoneal involvement). Histopathological features such as storiform fibrosis, obliterative phlebitis and tissue infiltration of IgG4-positive plasma cells (ratio IgG4+/IgG higher than 0.4) are essential to identify this association. Extra-retroperitoneal manifestations are often presented among patients with IgG4-related RPF. About 90% of cases of IRF have a good prognosis, with adequate response to treatment. We report a case of a 59-year-old woman with history of past occupational asbestos exposure and smoking habit. She was diagnosed with RPF, periaortitis and orbital pseudotumor, without histopathologic or serologic features of IgG4- related disease. This could be related to the fact that the biopsy was done in a place with scarce inflammatory activity but high fibrosis. We want to emphasize the usual need to perform several biopsies or to be guided by positron emission tomography (PET-CT) in order to achieve a histopathological confirmation. Our case differs from the main IgG4 international cohorts in the involvement of the retroperitoneum, aorta and eye, whereas the usual involvement includes liver, pancreas, lymph nodes and salivary glands. Our patient had lower IgG4 serum levels than those described in the international cohorts. However, they were similar to those of the Spanish population.