Browsing by Author "Dzudovic, Boris (55443513300)"

This study aimed to assess the prognostic significance of total leukocyte count (TLC) and hemoglobin (Hb) levels upon admission for patients with acute pulmonary embolism (PE), considering the European Society of Cardiology (ESC) model for mortality risk. 1622 patients from a regional PE registry were included. Decision tree statistics were employed to evaluate the prognostic value of TLC and Hb, both independently and in conjunction with the ESC model. The results indicated all-cause and PE-related in-hospital mortality rates of 10.7% and 6.5%, respectively. Subgrouping patients based on TLC cut-off values (≤11.2, 11.2–16.84, >16.84 × 109/L) revealed increasing all-cause mortality risks (7.0%, 11.8%, 30.2%). Incorporating Hb levels (≤126 g/L or above) further stratified the lowest risk group into two strata with all-cause mortality rates of 10.1% and 4.7%. Similar trends were observed for PE-related mortality. Notably, TLC improved risk assessment for intermediate–high-risk patients within the ESC model, while Hb levels enhanced mortality risk stratification for lower-risk PE patients in the ESC model for all-cause mortality. In conclusion, TLC and Hb levels upon admission can refine the ESC model’s mortality risk classification for patients with acute PE, providing valuable insights for improved patient management. © 2023 by the authors.

Factors associated with provoked PE may influence a biomarker's predictive value for the primary outcome. The aim of this study was to investigate the value of BNP, cTnI, CRP and D-Dimer measurements taken soon after hospital admission for the prediction of 30-day PE-caused death in patients with spontaneous versus provoked PE.Data were extracted from a pool of 726 consecutive PE patients enrolled in the multicenter Serbian PE registry. Blood concentrations of BNP, cTnI, CRP and D-dimer were measured during the first 24 h of hospitalization. BNP blood level had strong predictive value for the primary outcome in spontaneous PE (c-statistics 0.943, 95% CI 0.882–1.000, p = .001) and a slightly lower predictive outcome in provoked PE (c-statistics 0.824, 95% CI 0.745–0.902, p < .001). NRI and IDI showed that none of the markers, when added to BNP, could improve Cox regression prediction models for 30-day PE-related mortality in either the spontaneous or provoked PE group. Blood levels of BNP measured during the first 24 h of hospital admission had an excellent predictive value for 30-day PE-related mortality in spontaneous PE and slightly lower predictive value in provoked PE, whereas CRP, cTnI and D-Dimer did not contribute significantly to the predictive value of BNP in either group. © 2019 Elsevier B.V.

Factors associated with provoked PE may influence a biomarker's predictive value for the primary outcome. The aim of this study was to investigate the value of BNP, cTnI, CRP and D-Dimer measurements taken soon after hospital admission for the prediction of 30-day PE-caused death in patients with spontaneous versus provoked PE.Data were extracted from a pool of 726 consecutive PE patients enrolled in the multicenter Serbian PE registry. Blood concentrations of BNP, cTnI, CRP and D-dimer were measured during the first 24 h of hospitalization. BNP blood level had strong predictive value for the primary outcome in spontaneous PE (c-statistics 0.943, 95% CI 0.882–1.000, p = .001) and a slightly lower predictive outcome in provoked PE (c-statistics 0.824, 95% CI 0.745–0.902, p < .001). NRI and IDI showed that none of the markers, when added to BNP, could improve Cox regression prediction models for 30-day PE-related mortality in either the spontaneous or provoked PE group. Blood levels of BNP measured during the first 24 h of hospital admission had an excellent predictive value for 30-day PE-related mortality in spontaneous PE and slightly lower predictive value in provoked PE, whereas CRP, cTnI and D-Dimer did not contribute significantly to the predictive value of BNP in either group. © 2019 Elsevier B.V.

Background: Newly or already diagnosed cancer might significantly influence the clinical presentation, outcome, and therapy of acute pulmonary embolism (PE). Methods: Out of 1745 patients with acute PE, 66 patients were diagnosed with cancer during an initial hospitalization due to acute PE (where PE was the first clinical manifestation of cancer), 165 patients had known cancer treated in the last 6 months, and 1514 patients had acute PE without known or suspected cancer. The primary end-point of the present study was all-cause hospital death. The secondary end-points were the proportion of patients treated with thrombolysis and who had severe disease, and the ocurrence of major or clinically relevant nonmajor bleeding. Results: Patients with PE as the first presentation of cancer had the highest hospital mortality rate compared to the other two groups (HR for the mortality rate in patients without cancer as a reference, adjusted to four-stratum mortality risk, and Charlson's comorbidity index was 3.440; 95% confidence interval (CI), 1.795–6.591; p < 0.001). Patients with known cancer before PE had a significantly lower chance of being treated with thrombolysis than patients without cancer (OR, 0.523; 95% CI, 0.339–0.807; p = 0.003); additionally, this difference was attenuated but remained when the OR was adjusted to age (OR, 0.542; 95% CI, 0.351–0.838; p = 0.006). Patients with known cancer had a higher frequency of high-risk PE compared with patients without cancer (18.2% vs. 12.8%; p < 0.001). Patients with PE as the first manifestation of cancer had a higher frequency of intermediate-high-risk PE than those without (36.4% vs. 30.9%; p < 0.001). There was no significant difference in bleeding during hospitalization between groups. Conclusion: Patients with cancer had a more severe presentation of acute PE than patients without. Furthermore, patients with PE as the first manifestation of cancer had the highest hospital mortality rate, and patients with known cancer were least likely to be treated with thrombolysis. © 2025 The Author(s). Cancer Medicine published by John Wiley & Sons Ltd.

Background: Newly or already diagnosed cancer might significantly influence the clinical presentation, outcome, and therapy of acute pulmonary embolism (PE). Methods: Out of 1745 patients with acute PE, 66 patients were diagnosed with cancer during an initial hospitalization due to acute PE (where PE was the first clinical manifestation of cancer), 165 patients had known cancer treated in the last 6 months, and 1514 patients had acute PE without known or suspected cancer. The primary end-point of the present study was all-cause hospital death. The secondary end-points were the proportion of patients treated with thrombolysis and who had severe disease, and the ocurrence of major or clinically relevant nonmajor bleeding. Results: Patients with PE as the first presentation of cancer had the highest hospital mortality rate compared to the other two groups (HR for the mortality rate in patients without cancer as a reference, adjusted to four-stratum mortality risk, and Charlson's comorbidity index was 3.440; 95% confidence interval (CI), 1.795–6.591; p < 0.001). Patients with known cancer before PE had a significantly lower chance of being treated with thrombolysis than patients without cancer (OR, 0.523; 95% CI, 0.339–0.807; p = 0.003); additionally, this difference was attenuated but remained when the OR was adjusted to age (OR, 0.542; 95% CI, 0.351–0.838; p = 0.006). Patients with known cancer had a higher frequency of high-risk PE compared with patients without cancer (18.2% vs. 12.8%; p < 0.001). Patients with PE as the first manifestation of cancer had a higher frequency of intermediate-high-risk PE than those without (36.4% vs. 30.9%; p < 0.001). There was no significant difference in bleeding during hospitalization between groups. Conclusion: Patients with cancer had a more severe presentation of acute PE than patients without. Furthermore, patients with PE as the first manifestation of cancer had the highest hospital mortality rate, and patients with known cancer were least likely to be treated with thrombolysis. © 2025 The Author(s). Cancer Medicine published by John Wiley & Sons Ltd.

Aims: To examine the relationship between admission glucose (AG) level and short-term in-hospital mortality and to investigate the association between hyperglycemia and major bleeding in PE patients with and without DMT2. Methods: We evaluated 1165 patients with diagnosed acute PE with multi-detector computed tomography pulmonary angiography (MDCT-PA) enrolled in the Regional multicenter PE registry (REPER). The study population was classified to patients with diabetes mellitus type 2 (DMT2) and those without diabetes. According to quartiles of AG patients, both groups separately were categorized into four subgroups (DMT2 I: < 7.5 mmol/L; II: 7.5–10.0 mmol/L; III: 10.0–15.7 mmol/L; IV: > 15.7 mmol/L and (non-DMT2 I: < 5.5 mmol/L; II: 5.5–6.3 mmol/L; III: 6.3–7.9 mmol/L; IV: > 7.9 mmol/L). Results: All-cause mortality was higher in the DMT2 group (9.5% vs. 18.2%, p < 0.001), and PE-cause mortality was 6% for the patients without DMT2 and 12.4% for DMT2 patients (p = 0.02). The patients in the fourth AG quartiles in both groups, without DMT2 and with DMT2, had significantly higher all-cause and PE-cause in-hospital mortality compared with the first quartile. Rates of major bleeding were similar between the groups. On the multivariable analysis, after adjusting for age, gender and mortality risk, the adherence in the fourth AG quartile had an independent predictive value for all-cause death (HR 2.476, 95% CI 1.017–6.027) only in DM patients. Conclusion: In our cohort of patients with acute PE, diabetes was associated with increased rates for all-cause and PE-cause mortality. © 2021, Springer-Verlag Italia S.r.l., part of Springer Nature.

Aims: To examine the relationship between admission glucose (AG) level and short-term in-hospital mortality and to investigate the association between hyperglycemia and major bleeding in PE patients with and without DMT2. Methods: We evaluated 1165 patients with diagnosed acute PE with multi-detector computed tomography pulmonary angiography (MDCT-PA) enrolled in the Regional multicenter PE registry (REPER). The study population was classified to patients with diabetes mellitus type 2 (DMT2) and those without diabetes. According to quartiles of AG patients, both groups separately were categorized into four subgroups (DMT2 I: < 7.5 mmol/L; II: 7.5–10.0 mmol/L; III: 10.0–15.7 mmol/L; IV: > 15.7 mmol/L and (non-DMT2 I: < 5.5 mmol/L; II: 5.5–6.3 mmol/L; III: 6.3–7.9 mmol/L; IV: > 7.9 mmol/L). Results: All-cause mortality was higher in the DMT2 group (9.5% vs. 18.2%, p < 0.001), and PE-cause mortality was 6% for the patients without DMT2 and 12.4% for DMT2 patients (p = 0.02). The patients in the fourth AG quartiles in both groups, without DMT2 and with DMT2, had significantly higher all-cause and PE-cause in-hospital mortality compared with the first quartile. Rates of major bleeding were similar between the groups. On the multivariable analysis, after adjusting for age, gender and mortality risk, the adherence in the fourth AG quartile had an independent predictive value for all-cause death (HR 2.476, 95% CI 1.017–6.027) only in DM patients. Conclusion: In our cohort of patients with acute PE, diabetes was associated with increased rates for all-cause and PE-cause mortality. © 2021, Springer-Verlag Italia S.r.l., part of Springer Nature.

In patients with pulmonary embolism (PE), the D-dimer assay is commonly utilized as part of the diagnostic workup, but data on D-dimer for early risk stratification and short-term mortality prediction are limited. The purpose of this study was to determine D-dimer levels as a predictive biomarker of PE outcomes in younger (<50 years of age) compared to older patients. We conducted retrospective analysis for 930 patients diagnosed with PE between 2015 and 2019 as part of the Serbian University Multicenter Pulmonary Embolism Registry (SUPER).All patients had D-dimer levels measured within 24 hours of hospital admission. The primary outcome was mortality at 30 days or during hospitalization. Patients were categorized into two groups based on age (≤ 50 and >50 years of age). Younger patients constituted 20.5% of the study cohort. Regarding all-cause mortality, 5.2% (10/191)of patients died in group under the 50 years of age; the short-term all-causemortality was 12.4% (92/739) in older group.We have found that there was significant difference in plasma D-dimer level between patients ≤ 50 years of age and older group (>50), p= 0.006.D-dimer plasma level had good predictive value for the primary outcome in younger patients (c-statistics 0.710; 95% CI, 0.640-0.773; p<0.031). The optimal cutoff level for D-dimer to predict PE-cause death in patients aged > 50 years was found to be 8.8 mg/l FEU(c-statistics 0,580; 95% CI 0.544-0.616; p=0.049). In younger PE patients, D-dimer levels have good prognostic performance for 30-day all-cause mortalityand concentrations above 6.3 mg/l FEU are associated with increased risk of death. D-dimer in patients aged over 50 years does not have predictive ability for all-caused short-term mortality. The relationship between D-dimer and age in patients with PE may need further evaluation. © 2023 Ljiljana Jovanovic et al., published by Sciendo.

In patients with pulmonary embolism (PE), the D-dimer assay is commonly utilized as part of the diagnostic workup, but data on D-dimer for early risk stratification and short-term mortality prediction are limited. The purpose of this study was to determine D-dimer levels as a predictive biomarker of PE outcomes in younger (<50 years of age) compared to older patients. We conducted retrospective analysis for 930 patients diagnosed with PE between 2015 and 2019 as part of the Serbian University Multicenter Pulmonary Embolism Registry (SUPER).All patients had D-dimer levels measured within 24 hours of hospital admission. The primary outcome was mortality at 30 days or during hospitalization. Patients were categorized into two groups based on age (≤ 50 and >50 years of age). Younger patients constituted 20.5% of the study cohort. Regarding all-cause mortality, 5.2% (10/191)of patients died in group under the 50 years of age; the short-term all-causemortality was 12.4% (92/739) in older group.We have found that there was significant difference in plasma D-dimer level between patients ≤ 50 years of age and older group (>50), p= 0.006.D-dimer plasma level had good predictive value for the primary outcome in younger patients (c-statistics 0.710; 95% CI, 0.640-0.773; p<0.031). The optimal cutoff level for D-dimer to predict PE-cause death in patients aged > 50 years was found to be 8.8 mg/l FEU(c-statistics 0,580; 95% CI 0.544-0.616; p=0.049). In younger PE patients, D-dimer levels have good prognostic performance for 30-day all-cause mortalityand concentrations above 6.3 mg/l FEU are associated with increased risk of death. D-dimer in patients aged over 50 years does not have predictive ability for all-caused short-term mortality. The relationship between D-dimer and age in patients with PE may need further evaluation. © 2023 Ljiljana Jovanovic et al., published by Sciendo.

Background: Estimation of bleeding risk is an unmet need for individualized therapy in acute pulmonary embolism (PE) patients with increased mortality risk. Methods: We analyzed the association between various patients' characteristics and occurrence of major bleeding (MB) according to the modified International Society of Thrombosis and Hemostasis (ISTH) criteria (“overt” bleeding is the only modification from the original criteria) at 7 days from admission to the hospital and thrombolytic therapy with a tissue-plasminogen activator (tPA). Pulmonary embolism bleeding score index (PEBSI) was created using multivariate regression analyses, and finely, dichotomous index was used for the discrimination of patients with low risk for MB from those with high risk. Results: During the 6-year period (2015–2021) 367 PE patients were treated with tPA and included in the Regional PE registry. Among them, 29 (7.9%) fulfilled the criteria for MB. Five factors were identified as significantly associated with MB and were used to build the PEBSI score: previous bleeding, recent surgery, diabetes, the use of drugs that could be associated with bleeding, and anemia. PEBSI score showed c-index for 7-day MB 0.794 (95CI% 0.698–0.889). Patients with PEBSI scores of 0 or 1 had a low risk for MB (2.8%) and those with scores>1 had a high risk for MB (18.6%) (p < 0.001). Internal validation of PEBSI score using a randomly, equally split method confirmed the discriminative value of the PEBSI score. Conclusion: Novel PEBSI score has significant power to discriminate patients with low risk for MB on thrombolytic therapy from those with high risk. © 2022 Elsevier Ltd

Background: Acute pulmonary embolism (PE), due to hemodynamic disturbances, may lead to multi-organ damage, including acute renal dysfunction. The aim of our study was to investigate the predictive role of renal dysfunction at admission regarding the short-term mortality and bleeding risk in hospitalized PE patients. Methods: The retrospective cohort study included 1330 consecutive patients with PE. The glomerular filtration rate (GFR) was calculated using the serum creatinine value and Cocroft-Gault formula, at hospital admission. Primary outcomes were all-cause mortality and PE-related mortality in the 30 days following admission, as well as major bleeding events. Results: Based on the estimated GFR, patients were divided into three groups: the first with GFR < 30 mL/min, the second with GFR 30–60 mL/min, and the third group with GFR > 60 mL/min. A multivariable analysis showed that GFR at admission was strongly associated with all-cause death, as well as with death due to PE. Patients in the first and second group had a significantly higher risk of 30-day all-cause mortality (HR 7.109, 95% CI 4.243–11.911, p < 0.001; HR 2.554, 95% CI 1.598–4.081, p < 0.001). Fatal bleeding was recorded in 1.6%, 0.5% and 0.8% of patients in the first, second and in the third group (p < 0.05). There were no significant differences regarding major bleeding rates among the groups. Conclusion: Renal dysfunction at admission in patients with acute pulmonary embolism is strongly associated with overall PE mortality. © 2019 Elsevier B.V.

[No abstract available]

Introduction: Recent studies report that syncope is not a significant predictor of 30-day mortality in pulmonary embolism (PE) patients, yet some data suggest sex-related differences may be relevant. Objectives: To evaluate sex-specific prediction significance of syncope for 30-day mortality in PE patients. Methods: A multicentric, retrospective, observational, registry-based study on consecutive PE patients was undertaken. Patients were allocated into either a men or a women group before comparisons were made between patients with syncope and those without syncope. A sex-related prediction of the significance of syncope for 30-day mortality was evaluated. Results: Overall 588 patients [294 (50%) men and 294 (50%) women] were included within the study. Among men, patients with syncope were older and had significantly higher parameters of increased 30-day mortality then patients without syncope. Within the same group, however, difference in the 30-day mortality rate was not significant (log rank P =.942). In contrast to the men, fewer differences in admission characteristics were noticed among women, but those with syncope had significantly increased signs of the right ventricular dysfunction and increased 30-day mortality rate, as compared with those without syncope (log rank P =.025). After adjustment for age in a Cox regression analysis, syncope was a significant predictor of 30-day mortality in women (HR = 2.01, 95%CI 1.02-3.95). Conclusion: Although syncope is associated with other predictors of higher early mortality in both male and female PE patients, only in women it is a significant predictor of 30-day mortality. © 2020 John Wiley & Sons Ltd

Background The incidence of the signs and symptoms of acute pulmonary embolism (PE) according to mortality risk, age and sex has been partly explored. Patients and methods A total of 1242 patients diagnosed with acute PE and included in the Regional Pulmonary Embolism Registry were enrolled in the study. Patients were classified as low risk, intermediate risk or high risk according to the European Society of Cardiology mortality risk model. The incidence of the signs and symptoms of acute PE at presentation with respect to sex, age, and PE severity was investigated. Results The incidence of haemoptysis was higher in younger men with intermediate-risk (11.7% vs 7.5% vs 5.9% vs 2.3%; p=0.01) and high-risk PE (13.8% vs 2.5% vs 0.0% vs 3.1%; p=0.031) than in older men and women. The frequency of symptomatic deep vein thrombosis was not significantly different between subgroups. Older women with low-risk PE presented with chest pain less commonly (35.8% vs 55.8% vs 48.8% vs 51.9%, respectively; p=0.023) than men and younger women. However, younger women had a higher incidence of chest pain in the lower-risk PE group than in the intermediate-risk and high-risk PE subgroups (51.9%, 31.4% and 27.8%, respectively; p=0.001). The incidence of dyspnoea (except in older men), syncope and tachycardia increased with the risk of PE in all subgroups (p<0.01). In the low-risk PE group, syncope was present more often in older men and women than in younger patients (15.5% vs 11.3% vs 4.5% vs 4.5%; p=0.009). The incidence of pneumonia was higher in younger men with low-risk PE (31.8% vs<16% in the other subgroups, p<0.001). Conclusion Haemoptysis and pneumonia are prominent features of acute PE in younger men, whereas older patients more frequently have syncope with low-risk PE. Dyspnoea, syncope and tachycardia are symptoms of high-risk PE irrespective of sex and age. © Author(s) (or their employer(s)) 2023. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.

This study shows that the abrupt cessation of one-year clopidogrel treatment was not associated with thrombotic events in a prospective, multicentre study that enrolled 200 patients subjected to coronary stent implantation and treated with aspirin + clopidogrel 1 year after the stent placement. The aim of the study was to investigate the causes of a sustained increase of platelet aggregability, considering that the values of platelet aggregation stimulated with ADP + PGE1 (ADPHS values) significantly increased 10-90 days after the cessation of clopidogrel. Values of platelet aggregation induced by thrombin receptor activating peptide (TRAP values) and arachidonic acid (ASPI values) were divided into quartiles on the basis of ADPHS values 10 days after stopping clopidogrel (ADPHS10). There was a significant difference between TRAP values divided into quartiles according to ADPHS10, 10, 45 and 90 days after stopping clopidogrel (P < 0.001, all), and ASPI values across the same quartiles 10 and 45 days after the cessation of clopidogrel (P = 0.028 and 0.003). The results of the study indicate that patients with early pronounced rebound phenomena to clopidogrel termination have a long-term (at least 90 days) increased platelet aggregation to other agonists such as thrombin-related activated protein and arachidonic acid, suggesting the complex mutual relationship of various factors/agonists influencing the function of platelets. © 2016 John Wiley & Sons Australia, Ltd.

This study shows that the abrupt cessation of one-year clopidogrel treatment was not associated with thrombotic events in a prospective, multicentre study that enrolled 200 patients subjected to coronary stent implantation and treated with aspirin + clopidogrel 1 year after the stent placement. The aim of the study was to investigate the causes of a sustained increase of platelet aggregability, considering that the values of platelet aggregation stimulated with ADP + PGE1 (ADPHS values) significantly increased 10-90 days after the cessation of clopidogrel. Values of platelet aggregation induced by thrombin receptor activating peptide (TRAP values) and arachidonic acid (ASPI values) were divided into quartiles on the basis of ADPHS values 10 days after stopping clopidogrel (ADPHS10). There was a significant difference between TRAP values divided into quartiles according to ADPHS10, 10, 45 and 90 days after stopping clopidogrel (P < 0.001, all), and ASPI values across the same quartiles 10 and 45 days after the cessation of clopidogrel (P = 0.028 and 0.003). The results of the study indicate that patients with early pronounced rebound phenomena to clopidogrel termination have a long-term (at least 90 days) increased platelet aggregation to other agonists such as thrombin-related activated protein and arachidonic acid, suggesting the complex mutual relationship of various factors/agonists influencing the function of platelets. © 2016 John Wiley & Sons Australia, Ltd.

OBJECTIVES: The objective of this study was to investigate whether there are differences between brain natriuretic peptide (BNP) levels and computed tomography pulmonary angiography (CTPA) parameters, in patients with acute PE, with respect of sex. BACKGROUND: Acute pulmonary embolism (PE) may provoke sudden right ventricle overload and stretching of their thin walls, causing significant raise of BNP blood levels, which correlates to acute PE severity. The properties of RV are different between sexes. METHODS: This retrospective analysis was gained from the data of 1612 PE patients from the regional PE register. The patients have had CTPA verification of PE, with described localization of thrombus masses, as well as the ratio between RV and left ventricle (RV/LV), and BNP as biomarker, measured during the first 24 hours upon admission. RESULTS: Out of 96 male patients with detected central thrombus, 75.0% patients had an increase in BNP level compared to 25.0% patients with normal BNP value (p<0.001). Of the 94 female patients with central thrombus, 85.1% patients had an elevated BNP level, compared to 14.9% patients, with BNP normal values (p<0.001). Of the 135 male patients with RV/LV>1, 79.3% of them, had elevated BNP, compared to 20.7% patients whose BNP level was normal (p<0.001). Out of 123 female patients with RV/LV>1, 91.1% patients had elevated BNP compared to 8.9%, whose BNP was normal (p<0.001). CONCLUSION: Elevated BNP blood level correlates with CTPA parameters, such as the presence of central thrombus and the ratio between right and left ventricles greater than 1, in patients with acute PE, regardless of sex (Tab. 2, Fig. 2, Ref. 23). Text in PDF www.elis.sk © (2024), (Comenius University in Bratislava). All rights reserved.