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Query: UMLS:C0034065 (pulmonary embolism)
 14,979 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Multivariate statistical methods, multiple regression (RA) and automatic interaction detector analysis (AID) were used to study the possibility of an early prediction of staphylococcal etiology in 249 of 851 patients with verified septicemia or endocarditis. The variables included pertinent symptoms and signs and laboratory data available soon after admission. 10 of the 70 variables initially studied showed simple, or in various combinations, a statistically significant partial correlation to staphylococcal etiology in the AID. The highest predictive value with a high probability for staphylococcal etiology was recorded for combinations of the variables: i.v. narcotic addiction and septic pulmonary embolism; non-addiction, wound infection, and hospitalization within 4 weeks; non-addiction, absence of skin infection, presence of foreign body, and age less than 60 yr. Staphylococcal etiology was contradicted by the absence of i.v. narcotic addiction, skin infection, foreign body, septic skin manifestation, surgical procedure within 4 weeks, joint symptom and a C-reactive protein less than or equal to 10 mm. Thus, a prediction of etiology may be valuable in choosing therapy before definite confirmation by positive blood cultures or when blood cultures remain sterile.
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PMID:Prediction of staphylococcal etiology among patients with septicemia with or without endocarditis by multivariate statistical methods. 399 4

The reliability of D-dimer (NycoCard D-dimer) and CRP (C-reactive protein) tests to exclude suspected deep venous thrombosis (DVT) and pulmonary embolism (PE) was investigated in 116 patients. Venography, ultrasonography or ventilation-perfusion lung scanning was used as the control method in 95, 5, and 14 patients, respectively, and pulmonary angiography in two patients, one of whom also underwent lung scanning, the other venography. Of the 116 patients, 52 had thromboembolism (46 DVT and 6 PE). The respective sensitivity, specificity, and negative and positive predictive values (NPV, PPV) were 94%, 27%, 85% and 51% for the D-dimer test, and 80%, 53% 76% and 60% for the CRP test. As venous thromboembolism is a life-threatening condition, the NPV of an exclusion test must lie very close to 100 per cent, and thus the study showed neither the D-dimer nor the CRP test to be a satisfactory exclusion test for use in cases of suspected DVT or PE.
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PMID:[Evaluation of analyses for exclusion of suspected thrombosis. Do not rely on the D-dimer test!]. 944 58

The reliability of D-dimer (NycoCard D-dimer) and CRP (C-reactive protein) tests to exclude suspected deep venous thrombosis (DVT) and pulmonary embolism (PE) was investigated in 116 patients. Venography, ultrasonography or ventilation-perfusion lung scanning was used as the control method in 95, 5, and 14 patients, respectively, and pulmonary angiography in two patients, one of whom also underwent lung scanning, the other venography. Of the 116 patients, 52 had thromboembolism (46 DVT and 6 PE). The respective sensitivity, specificity, and negative and positive predictive values (NPV, PPV) were 94%, 27%, 85% and 51% for the D-dimer test, and 80%, 53% 76% and 60% for the CRP test. As venous thromboembolism is a life-threatening condition, the NPV of an exclusion test must lie very close to 100 per cent, and thus the study showed neither the D-dimer nor the CRP test to be a satisfactory exclusion test for use in cases of suspected DVT or PE.
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PMID:[Evaluation of analyses to exclude suspected thrombosis. Don't rely on the D-dimer test!]. 953 50

Our goal was to evaluate the diagnostic utility of C-reactive protein (CRP) alone or combined with clinical probability assessment in patients with suspected pulmonary embolism (PE), and to compare its performance to a D-dimer assay. We conducted a prospective study in which we performed a common immuno-turbidimetric CRP test and a rapid enzyme-linked immunosorbent assay (ELISA) D-dimer test in 259 consecutive outpatients with suspected PE at the emergency department of a teaching hospital. We assessed clinical probability of PE by a validated prediction rule overridden by clinical judgment. Patients with D-dimer levels > or = 500 microg/l underwent a work-up consisting of lower-limb venous ultrasound, spiral computerized tomography, ventilation-perfusion scan, or pulmonary angiography. Patients were followed up for three months. Seventy-seven (30%) of the patients had PE. The CRP alone had a sensitivity of 84% (95% confidence interval [CI).: 74 to 92%) and a negative predictive value (NPV) of 87% (95% CI: 78 to 93%) at a cutpoint of 5 mg/l. Overall, 61 (24%) patients with a low clinical probability of PE had a CRP < 5 mg/l. Due to the low prevalence of PE (9%) in this subgroup, the NPV increased to 97% (95% CI: 89 to 100%). The D-dimer (cutpoint 500 micro g/l) showed a sensitivity of 100% (95% CI: 95 to 100%) and a NPV of 100% (95% CI: 94 to 100%) irrespective of clinical probability and accurately rule out PE in 56 (22%) patients. Standard CRP tests alone or combined with clinical probability assessment cannot safely exclude PE.
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PMID:Exclusion of pulmonary embolism using C-reactive protein and D-dimer. A prospective comparison. 1465 57

A 56-year-old woman was admitted to our hospital with fever, cough, and sputum production. Her chest radiograph and chest computed tomography showed multiple nodules. Laboratory findings revealed leukocytosis and an increased C-reactive protein concentration. Physical examination revealed a systolic murmur. Transesophageal echocardiography demonstrated a 1.5-cm area of vegetation on the tricuspid valve. Blood cultures grew Staphylococcus aureus. Tricuspid valve endocarditis and septic pulmonary embolism were diagnosed. She was treated successfully with intravenous ampicillin/sulbactam. This was a rare case of tricuspid valve infective endocarditis in an adult patient without known predisposing factors.
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PMID:[A case of tricuspid valve infective endocarditis presenting with multiple nodular shadows in both lungs without known predisposing factors]. 1500 19

The role of C-reactive protein (CRP) in venous thromboembolism (VTE) is still under discussion because of controversial results in the literature. Conflicting data may have partly been due to bias by exogenous factors altering CRP levels. We investigated CRP concentrations in patients with spontaneous VTE applying a study design that allowed the measurement of basal high sensitivity (hs)-CRP levels. Patients with a history of deep vein thrombosis (DVT, n=117) and pulmonary embolism (PE, n=97) were compared to healthy individuals (n=104). Hs-CRP levels (mg/dl) were significantly higher in patients (n=214, median/interquartile range: 0.171/0.082-0.366) than in controls (0.099/0.053-0.245, p=0.001). The unadjusted odds ratio (OR) for VTE per 1 mg/dl increase of CRP was 2.8 [95% confidence interval (CI): 1.1-6.8, p=0.03]. This association remained significant after adjustment for factor V Leiden, prothrombin G20210A and factor VIII activity above 230% (OR = 2.9, 95% CI [1.1-7.5]), but became remarkably attenuated and lost its statistical significance after adjustment for BMI alone (OR = 1.7 [0.7-4.0]). CRP was also not independently associated with VTE in subgroups of patients (those with DVT without symptomatic PE, those with PE and patients without established risk factor) in multiple regression analysis. In summary, we observed significantly higher basal hs-CRP levels in patients with spontaneous VTE compared to healthy controls. This association was independent of hereditary and laboratory risk factors for VTE, but lost its significance after adjustment for BMI. Increased basal CRP levels do not appear to represent an independent risk factor for VTE.
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PMID:Basal high-sensitivity-C-reactive protein levels in patients with spontaneous venous thromboembolism. 1573 99

Measurement of cardiac troponin I or T in serum (highly specific for the myocardium) have replaced classical markers, such as creatine kinase MB. Cardiac troponins are preferred markers because of their high specificity and sensitivity. This had led to modifications of the original World Health Organization criteria for acute myocardial infarction. Furthermore, the place of the troponins as superior markers of subsequent cardiac risk in acute coronary syndrome has now become firmly established, for both diagnostic and risk stratification purposes. The use of C-reactive protein and/or other inflammatory biomarkers may add independent information in this context. After non cardiac surgery, the total cardiospecificity of cardiac troponins explains why other biomarkers of necrosis should no longer be used. Recent studies suggest that any elevation of troponin in the postoperative period is indicative of increased risk of long-term cardiac complications. This prognostic value has been previously demonstrated in other clinical settings such as invasive coronary intervention (surgical myocardial revascularization and percutaneous coronary intervention) and after heart valve surgery. Increases of troponin indicate cardiac damage, whatever the mechanism (ischemic or not). Other causes of cardiac injury include: pulmonary embolism, myocarditis, pericarditis, congestive heart failure, septic shock, myocardial contusion. In most cases, elevation of troponins has been shown to be associated with a bad outcome.
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PMID:[The use of cardiac troponins (T or I) measurement in cardiology and various clinical settings]. 1601 83

This study evaluated the diagnostic value of C-reactive protein (CRP) combined with a clinical decision rule in the exclusion of pulmonary embolism (PE) and compared this with D-dimer. In 363 consecutive outpatients CRP and D-dimer test were performed and clinical probability of PE was assessed. Patients with D-dimer levels<500 microg/l and clinical probability indicating 'PE unlikely' were followed for 3 months. Ventilation-perfusion scan or spiral computerized tomography was performed in patients with D-dimer levels>or=500 microg/l or clinical probability indicating 'PE likely'. The CRP had a sensitivity of 95.7% [95% confidence interval (CI): 90-100] and negative predictive value (NPV) of 98.4% (96-100). CRP<5 mg/l with clinical probability score indicating 'PE unlikely' (n=108, 30%), had a sensitivity of 96.7% (90-100), a specificity of 43.0% (37-49) and NPV of 99.1% (97-100). D-dimer<500 microg/l with clinical probability score indicating 'PE unlikely' (n=170, 51%), had a sensitivity of 96.7% (90-100), a specificity of 67.9% (62-74) and NPV of 99.4% (98-100). Based on retrospective data it was concluded that a standard CRP test can potentially be used to safely exclude PE, either as a sole test or combined with clinical probability assessment. Prospective studies are needed to confirm these findings.
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PMID:C-reactive protein and D-dimer with clinical probability score in the exclusion of pulmonary embolism. 1609 77

Patients with severe gastrointestinal motility disorders are often found to have intravenous access clots or deep venous thrombosis. It has previously been reported that many patients who have intravenous access thrombosis have concomitant thrombotic risk factors. In this study, the goal was to determine the underlying prevalence of hypercoagulable risk in a series of patients with documented gastroparesis. Investigators studied 62 consecutive patients (52 female; mean age, 42 y) who had symptoms of gastroparesis. All patients were evaluated for placement of a gastric neural stimulation device, or they had had one placed previously. Patients underwent a hematologic interview and standardized coagulation measures of thrombotic risk. Laboratory studies measured acquired elevations of Factor VII, Factor VIII, fibrinogen, lupus anticoagulant panel, antiphospholipid antibody panel, homocysteine (in the setting of kidney disease), and activated protein resistance. Investigators also measured congenital factors: Factor VIII (with C-reactive protein levels), antithrombin III, protein C, protein S (total and free), Factor II mutation, Factor V Leiden, methylenetetrahydrofolate reductase, and homocysteine. Fifty-five patients (89%) were found to have detectable hypercoagulable risk factors. Twenty-five of the 62 patients (40%) had a documented history of abnormal clotting, including deep venous thrombosis, intravenous access thrombosis, and pulmonary embolism. All patients with a previous history of thrombosis had detectable clotting abnormalities. Of 56 patients, 40 (71%) had hypercoagulability and did not have diabetes (P=.036), and 20 (36%) had hypercoagulability and no known history of infection. However, this value was not statistically significant when infection and hypercoagulability were compared (P=.408). A high prevalence of acquired and congenital hypercoagulable defects has been observed in patients with gastroparesis, which may predispose them to arterial and venous clots. This unique finding warrants consideration of coagulation evaluation in patients with severe gastroparesis, especially when these patients are placed in high-risk thrombophilic situations, such as hospitalization, prolonged intravenous access, and surgery.
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PMID:Assessing thrombosis risk in patients with idiopathic, diabetic, and postsurgical gastroparesis. 1714 10

Early diagnosis and treatment are pivotal for patients with acute aortic dissection (AAD). D-dimer is a rule-out diagnostic test for pulmonary embolism but there is evidence that it may also be applicable to AAD. We evaluated plasma D-dimer, white cell blood count (WBC), C-reactive protein (CRP) and N-terminal pro-B-type natriuretic peptide (BNP) in 18 consecutive patients with established AAD, 21 consecutive patients with dilated ascending aortas scheduled for elective surgery and 8 normal subjects. Patients with AAD had significantly higher elevated D-dimer, compared to chronic aneurysms and normal controls (p<0.0001). D-dimer level higher than 700 ng/ml had a sensitivity of 94% and specificity of 59% for diagnosis of AAD. The WBC count was also significantly increased compared to the other groups (p<0.01). CRP and BNP values were significantly higher compared to normal controls but these parameters did not distinguish between AAD and chronic aneurysms. D-dimer can be used as a 'rule-out' test in patients with suspected AAD and seems useful in the discrimination between AAD and chronic uncomplicated aneurysms, unlike CRP and BNP plasma levels.
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PMID:D-dimer and BNP levels in acute aortic dissection. 1723 84


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