Value of Cardiac Troponin and sPESI in Treatment of Pulmonary Thromboembolism at Outpatient Setting.

BACKGROUND: Currently, guidelines do not recommend any standard approach for treatment of pulmonary thromboembolism (PTE) at outpatient setting. We investigated the efficacy and safety of a 90-day anticoagulant treatment of outpatients diagnosed with PTE who had negative troponin levels and low-risk simplified pulmonary embolism severity index (sPESI) at presentation. METHODS: This prospective cohort study included a total of 206 patients with objectively confirmed acute symptomatic PTE. Any troponin negative (cTn-) and low sPESI patients (as classified Group-1) were treated in outpatient setting. The primary endpoint was all-cause mortality during the first 90 days, and the secondary endpoint included non-fatal symptomatic recurrent PTE or non-fatal major bleeding. Presence of cancer was excluded from sPESI score. RESULTS: Fifty-two of 206 patients were eligible for had Group-1, and 31 were treated at outpatients settings. The 90-day all-cause mortality rate was 3.2 % among patients who received outpatient treatment. Otherwise cTn+ and high-risk sPESI 90-day mortality rate was 43.7 %. No difference was found in terms of secondary endpoints between the patients who received outpatient treatment and those who received inpatient treatment in Group-1 (p = NS). In our study, cancer was present in 16 (51.6 %) of the 31 outpatients. CONCLUSION: We observed that patients with acute PTE, low-risk sPESI, and negative troponin levels can be safely treated in the outpatient settings. Also the presence of cancer alone does not necessitate hospitalization.

Pentraxin-3: A novel biomarker for discriminating parapneumonic from other exudative effusions.

BACKGROUND AND OBJECTIVE: Pentraxin-3 (PTX-3) is a relatively new marker of inflammation that has not been previously tested in pleural effusions. We aimed to assess whether PTX-3 is an accurate biomarker of parapneumonic effusions (PPE) and whether it discriminates complicated (CPPE)from non-complicated PPE. METHODS: The concentrations of pleural fluid PTX-3 were measured by a commercial enzyme-linked immunosorbent assay in a prospective cohort of 84 patients with pleural effusions, including 24 PPE, 40 malignant, and 20 miscellaneous exudative effusions. The area under the curve quantified the overall diagnostic accuracy of the test. A multivariate logistic regression analysis selected pleural fluid biochemistries predictive of PPE. RESULTS: Median pleural fluid PTX-3 levels were higher in PPE than in both malignant effusions and other exudates (32.4 ng/mL vs 6.7 ng/mL, and 8.5 ng/mL, respectively, P < 0.001). PTX-3 > 12 ng/mL yielded 88% sensitivity, 73% specificity, likelihood ratio positive 3.3 and likelihood ratio negative 0.17 for diagnosing PPE, with an area under the curve of 0.855 (95% CI: 0.769-0.941). In the multivariate analysis, pleural PTX-3 levels remained associated with increased diagnostic odds for PPE (odds ratio 17.7, 95% confidence interval: 3.7-85.1, P < 0.001). There was a non-significant trend towards higher pleural PTX-3 levels in CPPE as compared with non-complicated. CONCLUSIONS: High concentrations of PTX-3 in pleural effusions are very sensitive to differentiate PPE from non-PPE. However, they do not seem to differentiate uncomplicated-complicated from CPPE differentiation.

A Rare Cause of Chylothorax: Hennekam Syndrome.

Hennekam syndrome was defined as a syndrome characterized by a new autosomal recessive, severe lymphedema in legs, face and genitalia with intestinal lymphangiectasia, various face anomalies and severe mental retardation. A 21 years old male patient was examined due to bilateral pleural effusion. There were edema in both legs and eyelids, swelling in the scrotum and operation scar, broad forehead and face, depressed nasal bridge, epicanthal folds and micrognathia in the physical examination. Chylothorax was diagnosed due to level of pleural triglyceride (650 mg/dL). Lymphatic flow delayed in both lower extremities in lymphoscintigraphy. The patient was diagnosed as Hennekam syndrome due to face anomalies, lymphedema, epilepsy, chylothorax and mild mental retardation.

Carbonic anhydrase IX in the prediction of right ventricular dysfunction in patients with hemodynamically stable acute pulmonary embolism.

Right ventricular dysfunction (RVD) defined by echocardiography and/or by natriuretic peptides is a well-known predictor of prognosis in patients with pulmonary embolism (PE). This study investigated carbonic anhydrase IX (CA IX) levels for predicting echocardiographic RVD in patients with PE. A total of 150 normotensive patients with PE were included. The levels of CA IX, N-terminal pro-brain-type natriuretic peptide (NT-proBNP), and high-sensitive cardiac troponin T were significantly elevated in patients with PE with RVD on echocardiography. A receiver-operating characteristic curve analysis showed a value of 0.751 for CA IX, 0.714 for NT-proBNP, and 0.650 for high-sensitive troponin-T to predict RVD on echocardiography. The cutoff value to predict RVD was 32.45 pg/mL for CA IX (sensitivity: 89.3% and specificity: 51.1%). There was a significant positive correlation between the CA IX level and the systolic pulmonary arterial pressure on echocardiography (ρ = .21; P = .035). The CA IX is a significant serologic predictor of RVD in acute PE and correlates with systolic pulmonary arterial pressure.