Evaluation of soluble P-selectin as a predictive biomarker in acute symptomatic pulmonary embolism: Insights from a prospective observational study.

BACKGROUND: Soluble P-selectin (sP-selectin) has been proposed as a potential biomarker for venous thromboembolism (VTE) diagnosis with interesting results. However, its role in predicting early mortality in pulmonary embolism (PE) remains unexplored. METHODS: This observational, prospective, single-center study enrolled consecutive patients aged 18 or older with confirmed acute symptomatic PE and no prior anticoagulation. The study aims to assess the prognostic capacity of sP-selectin measured at the time of PE diagnosis for short-term mortality and major bleeding. RESULTS: A total of 196 patients, with a mean age of 69.1 years (SD 17), were included, of whom 52.6% were male. Within 30 days, 9.7% of patients (n = 19) died, and 5.1% (n = 10) suffered major bleeding. PE risk stratification revealed 4.6% (n = 9) with high-risk PE, 34.7% (n = 68) with intermediate-high-risk PE, 38.3% (n = 75) with intermediate-low-risk PE, and 22.5% (n = 44) with low-risk PE according to the European Society of Cardiology score. Mean plasma sP-selectin levels were comparable between survivors and non-survivors (489.7 ng/mL ±63 vs. 497.3 ng/mL ±51; p = .9). The ROC curve for 30-day all-cause mortality and major bleeding yielded an AUC of 0.49 (95% CI 0.36-0.63) and 0.46 (95% CI 0.24-0.68), respectively. Multivariate and survival analyses were precluded due to lack of significance. CONCLUSIONS: sP-selectin was not useful for predicting short-term mortality or major bleeding in patients with acute symptomatic pulmonary embolism. Further studies are required to clarify the role of sP-selectin in VTE, particularly in prognosticating PE outcomes.

Características clínicas y forma de presentación en pacientes con enfermedad tromboembólica venosa y dímero-D negativo o débilmente positivo / Clinical characteristics and presentation form in patients with venous thromboembolism and negative or weakly positive D-dimer

Introducción: El dímero-D presenta un elevado valor predictivo negativo (VPN) para el diagnóstico de enfermedad tromboembólica venosa (ETV). Sin embargo, se ha descrito ETV en presencia de valores normales de dímero-D.Pacientes y métodosEstudio observacional prospectivo en pacientes con ETV en el Hospital Gregorio Marañón entre 2001-2022 que compara las características de presentación clínica en función de los niveles de dímero-D (< 500 ng/mL vs. ≥ 500 ng/mL).ResultadosDel total de 2.582 pacientes, 333 pacientes (12,9%) presentaron dímero-D negativo o débilmente positivo. Estos eran significativamente más jóvenes (57,9 vs. 65,3 años), con menor prevalencia de comorbilidades (cardiopatía isquémica, demencia y enfermedad renal crónica), mayor historia familiar de ETV (8,4% vs. 5,2%) y trombofilia (11,7% vs. 7,8%). Presentaron significativamente menor disnea (57,6% vs. 75,4%), síncope (3% vs. 13,5%), menor carga trombótica, elevación de Nt-pro-BNP (22,0% vs. 48,2%) y dilatación del ventrículo derecho (8,1% vs. 30,0%).ConclusiónLos pacientes con ETV y niveles bajos de dímero-D al diagnóstico fueron más jóvenes, con presentación clínica más leve y menor carga trombótica; pero presentaron mayor prevalencia de trombofilia e historia familiar de ETV. (AU)

Introduction: D-dimer has a high negative predictive value for the diagnosis of venous thromboembolic disease (VTE). However, VTE has been reported in the presence of normal D-dimer values.MethodsThis is a prospective observational study in patients with VTE from Hospital Gregorio Marañón between 2001 and 2022, comparing the characteristics of clinical presentation based on D-dimer levels (<500 ng/mL vs. ≥500 ng/mL).ResultsA total of 2582 patients were found, 333 patients (12.9%) presented negative or weakly positive D-dimer levels. They were significantly younger (57.9 vs. 65.3 years), with a lower prevalence of comorbidities (ischemic heart disease, dementia, and chronic kidney disease), and a greater family history of VTE (8.4% vs. 5.2%) and thrombophilia (11.7% vs. 7.8%). They presented significantly less dyspnea (57.6% vs. 75.4%), syncope (3% vs. 13.5%), less thrombotic load, elevated NT-pro-BNP (22.0% vs. 48.2%), and right ventricle dilatation (8.1% vs. 30.0%).ConclusionPatients with VTE and low D-dimer levels at diagnosis were younger, with milder clinical presentation and lower thrombotic load; but they presented a higher prevalence of thrombophilia and a family history of VTE. (AU)

[Clinical characteristics and presentation form in patients with venous thromboembolism and negative or weakly positive D-dimer]. / Características clínicas y forma de presentación en pacientes con enfermedad tromboembólica venosa y dímero-D negativo o débilmente positivo.

INTRODUCTION: D-dimer has a high negative predictive value for the diagnosis of venous thromboembolic disease (VTE). However, VTE has been reported in the presence of normal D-dimer values. METHODS: This is a prospective observational study in patients with VTE from Hospital Gregorio Marañón between 2001 and 2022, comparing the characteristics of clinical presentation based on D-dimer levels (<500 ng/mL vs. ≥500 ng/mL). RESULTS: A total of 2582 patients were found, 333 patients (12.9%) presented negative or weakly positive D-dimer levels. They were significantly younger (57.9 vs. 65.3 years), with a lower prevalence of comorbidities (ischemic heart disease, dementia, and chronic kidney disease), and a greater family history of VTE (8.4% vs. 5.2%) and thrombophilia (11.7% vs. 7.8%). They presented significantly less dyspnea (57.6% vs. 75.4%), syncope (3% vs. 13.5%), less thrombotic load, elevated NT-pro-BNP (22.0% vs. 48.2%), and right ventricle dilatation (8.1% vs. 30.0%). CONCLUSION: Patients with VTE and low D-dimer levels at diagnosis were younger, with milder clinical presentation and lower thrombotic load; but they presented a higher prevalence of thrombophilia and a family history of VTE.

Trombosis venosas portales / Venous portal thrombosis

This manuscript reviews the epidemiology, symptoms, diagnosticmethods and management of benign venous portal thrombosis in bothcirrhotic and non-cirrhotic patients.Annual incidence of portal thrombosis ranges from barely 0.7 per100.000 inhabitants/year in non-cirrhotic patients to 10-15% in patients with advanced liver cirrhosis. Up to 60% of all non-cirrhoticpatients with portal thrombosis show systemic etiologic factors. Clinical manifestations depend on the thrombus’ development processand its extension, with most symptoms occurring in acute thrombosis.Anticoagulation is the chosen treatment in most cases, although individualization is paramount. Broadening available evidence is essential to improve managementfor these patients, especially given the wide heterogeneity of the population with venous portal thrombosis. (AU)

En este manuscrito se revisan la epidemiología, clínica, los métodosdiagnósticos y el tratamiento de la trombosis venosa portal benigna enpacientes cirróticos y no cirróticos.Se estima que la incidencia anual de trombosis portal en pacientescon cirrosis avanzada es del 10-15%, mientras que en pacientes nocirróticos se sitúa en apenas 0.7 por 100.000 habitantes/año, presentando hasta un 60% factores etiológicos sistémicos. Las manifestaciones clínicas dependen del momento evolutivo en el que seencuentre la trombosis (aguda frente a crónica) y de la extensión deltrombo. La anticoagulación es el tratamiento de elección en la mayoríade casos, si bien es necesario individualizar en cada paciente.Es necesario ampliar la evidencia disponible para optimizar el manejode estos pacientes, especialmente dada la heterogeneidad de la población con trombosis venosa portal. (AU)

Pneumocystis jirovecii and methicillin-resistant Staphylococcus aureus superinfection, a challenge in a post-COVID-19 scenario / Sobreinfección por Pneumocystis jirovecii y Staphylococcus aureus resistente a meticilina tras infección por SARS-CoV2

We present a case of an 87-year-old nonsmoker female who recovered after infection by SARS-CoV-2 and was readmitted two weeks laterdue to respiratory sepsis. Radiological imaging showed a significant radiological worsening with extensive areas of bronchopneumonia andground-glass opacities suggestive of organizing pneumonia. Empirical treatment with meropenem 1g/8h was started; however, clinical worseningpersisted with tachypnea and desaturation requiring heated high-flow nasal cannula oxygen therapy, with poor response. Methicillin-resistantStaphylococcus aureus was isolated both in nasal screening swab and sputum, and RNA polymerase chain reaction in induced sputum waspositive for P. jirovecii. Serum (1-3)-beta-D-glucan was normal, and blood cultures were sterile. Antibiotic therapy was adjusted with intravenouslinezolid 600mg/12h and trimethoprim-sulfamethoxazole 320/1600mg/6h, plus methylprednisolone 40mg/day. Unfortunately, the patient hadno response to optimized treatment and finally died. Clinicians should be aware of opportunistic and resistant microorganisms superinfections inrelation to SARS-CoV-2 infection, even more, when corticosteroids are widely used. (AU)