scholarly journals Reply to Correspondence on “Glomerular Filtration Rate as a Prognostic Factor for Long-Term Mortality after Acute Pulmonary Embolism”

2019 ◽  
Vol 28 (5) ◽  
pp. 498-498
Author(s):  
Valdis Ģībietis ◽  
Dana Kigitoviča ◽  
Barbara Vītola ◽  
Sintija Strautmane ◽  
Andris Skride
Keyword(s):  
Pulmonary Embolism ◽  
Glomerular Filtration Rate ◽  
Prognostic Factor ◽  
Glomerular Filtration ◽  
Filtration Rate ◽  
Acute Pulmonary Embolism ◽  
Long Term Mortality

scholarly journals Glomerular Filtration Rate as a Prognostic Factor for Long-Term Mortality after Acute Pulmonary Embolism

2019 ◽  
Vol 28 (3) ◽  
pp. 264-272 ◽  
Author(s):  
Valdis Ģībietis ◽  
Dana Kigitoviča ◽  
Barbara Vītola ◽  
Sintija Strautmane ◽  
Andris Skride
Keyword(s):  
Pulmonary Embolism ◽  
Glomerular Filtration Rate ◽  
Filtration Rate ◽  
Acute Pulmonary Embolism ◽  
All Cause Mortality ◽  
Acute Pe ◽  
D Dimer ◽  
Active Cancer ◽  
Long Term Mortality

Background: In-hospital mortality for patients presenting with acute pulmonary embolism (PE) has been reported to be up to 7 times higher for patients with decreased estimated glomerular filtration rate (eGFR). However, few studies have assessed its effect on long-term mortality. Objective: To determine the impact of eGFR and creatinine clearance (CrCl) on long-term all-cause mortality following acute PE in association with other routine laboratory analyses and comorbidities. Patients/Methods: The prospective study enrolled 141 consecutive patients presenting with objectively confirmed acute PE. Demographic, clinical data, comorbidities, and laboratory values were recorded. CrCl and GFR were estimated using the Cockcroft-Gault, MDRD, and chronic kidney disease (CKD)-EPI equations. Patients were followed up at 90 days and 1 year after the event. Results: In univariate analyses, age, active cancer, PE severity index (PESI), CrCl and eGFR, D-dimer value, and high-density lipoprotein level were found to be significantly associated with mortality in 90 days and 1 year. Additionally, body mass index was significant in the 1-year follow-up. CrCl by Cockcroft-Gault (90-day: area under the curve [AUC] 0.763; 1-year: AUC 0.718) demonstrated higher discriminatory power for predicting mortality than eGFR by the MDRD (AUC 0.686; AUC 0.609) and CKD-EPI (AUC 0.697; AUC 0.630) equations. In multivariate analyses, active cancer, CrCl by Cockcroft-Gault (90-day: hazard ratio [HR] 0.948, 95% CI 0.919–0.979; 1-year: HR 0.967, 95% CI 0.943–0.991), eGFR by CKD-EPI (90-day: HR 0.948, 95% CI 0.915–0.983; 1-year: HR 0.971, 95% CI 0.945–0.998) were found to be independent predictors of mortality. eGFR by MDRD, D-dimer, and PESI value were significant prognostic factors for 90-day mortality. Conclusion: Decreased renal function is a prognostic factor for increased all-cause mortality 90 days and 1 year after acute PE.

scholarly journals Impact of Glomerular Filtration Rate on the Incidence and Prognosis of New-Onset Atrial Fibrillation in Acute Myocardial Infarction

2020 ◽  
Vol 9 (5) ◽  
pp. 1396 ◽  
Author(s):  
Nicola Cosentino ◽  
Marco Ballarotto ◽  
Jeness Campodonico ◽  
Valentina Milazzo ◽  
Alice Bonomi ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Atrial Fibrillation ◽  
Acute Myocardial Infarction ◽  
Glomerular Filtration Rate ◽  
Glomerular Filtration ◽  
Filtration Rate ◽  
Group 2 ◽  
Long Term Mortality ◽  
New Onset

Background: Atrial fibrillation (AF) is a frequent complication of acute myocardial infarction (AMI) and is associated with a worse prognosis. Patients with chronic kidney disease are more likely to develop AF. Whether the association between AF and glomerular filtration rate (GFR) is also true in AMI has never been investigated. Methods: We prospectively enrolled 2445 AMI patients. New-onset AF was recorded during hospitalization. Estimated GFR was estimated at admission, and patients were grouped according to their GFR (group 1 (n = 1887): GFR >60; group 2 (n = 492): GFR 60–30; group 3 (n = 66): GFR <30 mL/min/1.73 m2). The primary endpoint was AF incidence. In-hospital and long-term (median 5 years) mortality were secondary endpoints. Results: The AF incidence in the population was 10%, and it was 8%, 16%, 24% in groups 1, 2, 3, respectively (p < 0.0001). In the overall population, AF was associated with a higher in-hospital (5% vs. 1%; p < 0.0001) and long-term (34% vs. 13%; p < 0.0001) mortality. In each study group, in-hospital mortality was higher in AF patients (3.5% vs. 0.5%, 6.5% vs. 3.0%, 19% vs. 8%, respectively; p < 0.0001). A similar trend was observed for long-term mortality in three groups (20% vs. 9%, 51% vs. 24%, 81% vs. 50%; p < 0.0001). The higher risk of in-hospital and long-term mortality associated with AF in each group was confirmed after adjustment for major confounders. Conclusions: This study demonstrates that new-onset AF incidence during AMI, as well as the associated in-hospital and long-term mortality, increases in parallel with GFR reduction assessed at admission.

scholarly journals Glomerular Filtration Rate as a Prognostic Marker in Acute Pulmonary Embolism

2019 ◽  
Vol 28 (5) ◽  
pp. 497-497
Author(s):  
Anca Ouatu ◽  
Mariana Floria ◽  
Smaranda Radu ◽  
Daniela Maria Tănase
Keyword(s):  
Pulmonary Embolism ◽  
Glomerular Filtration Rate ◽  
Glomerular Filtration ◽  
Prognostic Marker ◽  
Filtration Rate ◽  
Acute Pulmonary Embolism

scholarly journals Relative value of cystatin C and creatinine-based estimates of glomerular filtration rate in predicting long-term mortality after cardiac surgery: a cohort study

BMJ Open ◽  
2019 ◽  
Vol 9 (9) ◽  
pp. e029379 ◽  
Author(s):  
John F Mooney ◽  
Bernard L Croal ◽  
Sean Cassidy ◽  
Vincent W Lee ◽  
Clara K Chow ◽  
...  
Keyword(s):  
Cardiac Surgery ◽  
Cohort Study ◽  
Glomerular Filtration Rate ◽  
Glomerular Filtration ◽  
Cystatin C ◽  
Filtration Rate ◽  
Term Survival ◽  
Increased Risk ◽  
Long Term Mortality

ObjectiveRenal dysfunction predicts an increased risk of both early and long-term mortality after cardiac surgery. Cystatin C enables glomerular filtration rate (GFR) to be estimated accurately and may be superior in this regard to creatinine-based estimates. We hypothesised, therefore, that cystatin C and derived estimates of GFR would independently predict long-term survival after cardiac surgery and would be superior in this respect to traditional estimates of GFR. The current study tests this hypothesis in a large and well-characterised cohort of patients.DesignA prospective cohort study.SettingRegional cardiothoracic centre in Northeast Scotland.Participants1010 patients undergoing non-emergent cardiac surgery between 2004 and 2007. Serum creatinine and cystatin C levels were measured preoperatively and demographic and clinical variables were recorded.Primary outcome measureAll-cause mortality, established from the National Records of Scotland.ResultsThe median duration of follow-up after surgery was 9.7 years (IQR 8.9–10.6 years), during which 297 participants died. Preoperative creatinine and cystatin C levels and estimates of GFR derived from these were all strong predictors of death using Cox regression and remained independently predictive after adjustment for the logistic European System for Cardiac Operative Risk Evaluation, a well-validated clinical risk score and a range of other clinical predictors. Cystatin C-based measures were superior to creatinine-based estimates of GFR.ConclusionsCystatin C and creatinine derived eGFR are powerful and independent predictors of long-term mortality following cardiac surgery. Estimates of GFR derived from cystatin C convey superior prognostic information to conventional creatinine-based estimates, but the observed differences are modest.

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