The relation between international normalized ratio and mortality in acute pulmonary embolism: A retrospective study

Kırış, Tuncay; Yazıcı, Selçuk; Durmuş, Gündüz; Çanga, Yiğit; Karaca, Mustafa; Nazlı, Cem; Doğan, Abdullah

doi:10.1002/jcla.22164

Cited by 9 publications

(5 citation statements)

References 37 publications

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“…This finding was further confirmed in retrospective calculation of sPESI, that predicts 30-day mortality of PE patients 1 . Therefore, this study is consistent with previous that confirmed INR as parameter helpful in reclassification of PE patients into more appropriate risk groups 13,18,19 , that should translate into more careful inhospital as well as long-term outpatient care, that might result in an improvement of post-PE patients survival.…”

Section: Discussionsupporting

confidence: 91%

“…Moreover, not all patients had information about previous anticoagulation, therefore the impact of this treatment on INR value can not be investigated. The increase of INR in our investigated population may be a result of overlaping organ impairment including heart failure, liver dysfunction and secondary to neoplasm abnormalities rather than the effect of anticoagulant treatment 13,14,18,19 . The mechanism of INR increase is not fully understood and in our population the data regarding anticoagulation are lacking, therefore this issue requires further research.…”

Section: Discussionmentioning

confidence: 85%

“…In PE patients acute RV failure results in systemic congestions and multiorgan failure encompassing an acute liver insufficiency which can lead to the impairment of coagulation factors synthesis 16,17 . Data concerning a prognostic value of an increased INR in patients with PE are scarce but available results seem to confirm its value in predicting poor short-term outcome 13,18,19 . Futhermore, there is lack of data on relation of INR with long-term mortality after acute PE.…”

Section: Introductionmentioning

confidence: 99%

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Can Inr on Admission Be a New Prognostic Parameter in Patients with Acute Pulmonary Embolism?

Ptaszyńska‐Kopczyńska¹,

Sawicka²,

Ciurzyński³

et al. 2021

Preprint

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Pulmonary embolism (PE) is one of the leading causes of cardiovascular mortality, therefore new parameters regarding risk stratification are sought after. In patients admitted for acute PE we investigated associations between the initial coagulation impairment, expressed by prothrombin time international normalised ratio (INR), and parameters reflecting PE severity. Furthermore, in-hospital, 30-day and long-term mortality were also evaluated. The analysis included 848 patients who were divided into two groups: with normal INR≤1.2, and elevated INR>1.2 (252 patients, 29.7%). The group with elevated INR presented higher incidence of tachycardia and lower systolic blood pressure, higher CRP, d-dimer, and NT-proBNP. This group presented higher estimated systolic pulmonary artery pressure (49 IQR39-62mmHg vs 43 IQR32-53mmHg, p<0.001) and shorter pulmonary artery acceleration time (65 IQR55-85ms vs 81 IQR63-102ms; p<0.001). Patients with elevated INR had more often a sPESI of 1 or higher (78%vs60%, p=0.003). Cox regression model revealed that age, leukocyte level, SBP, neoplasm, and INR are associated with higher risk of death (p<0.001). Finally, elevated INR was associated with higher in-hospital (13%vs3%; p<0.001), 30-day (19%vs6%; p<0.001), and long-term mortality (p<0.001). Summing up, elevated INR on admission is frequent in patients with PE, reflects worse clinical condition and is related to PE severity and prognosis.

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Section: Discussionsupporting

confidence: 91%

Section: Discussionmentioning

confidence: 85%

Section: Introductionmentioning

confidence: 99%

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Can Inr on Admission Be a New Prognostic Parameter in Patients with Acute Pulmonary Embolism?

Ptaszyńska‐Kopczyńska¹,

Sawicka²,

Ciurzyński³

et al. 2021

Preprint

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“…Recently, the association of INR on admission with the 90-day mortality of critically ill patients who underwent endarterectomy during hospitalization has been shown [6], and also that the prothrombin time-albumin ratio (PTAR) predicted 90-day mortality in critically ill patients with liver cirrhosis [7]. Another study reported that prolonged initial prothrombin time or higher INR in the absence of anticoagulant therapy was associated with all-cause mortality in patients with acute coronary syndrome who were undergoing percutaneous coronary intervention [8] and the INR has been shown to be associated with mortality in acute pulmonary embolism [9].…”

Section: Introductionmentioning

confidence: 99%

The association of high-normal international-normalized-ratio (INR) with mortality in patients referred for coronary angiography

Delgado

Zirlik

Gruber³

et al. 2019

PLoS ONE

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Aims The international-normalized-ratio (INR) is typically used to monitor patients on warfarin or related oral anticoagulant therapy. The aim of our study was to investigate the association of the INR with mortality in coronary artery disease (CAD) patients not on oral anticoagulant therapy. Methods and results Between 1997 to 2000 the LUdwigshafen RIsk and Cardiovascular Health (LURIC) study enrolled 3316 patients of German ancestry that had been referred for coronary angiography. We excluded patients on coumarin therapy (n = 222) and patients with an INR more than 5 standard deviations (SD) away from the mean (n = 30). During a median follow-up of 9.9 years, 884 patients died, 547 patients from cardiovascular causes. After adjustment for cardiovascular risk factors the INR was associated with all-cause mortality in all patients and the CAD positive group with HRs (95% CI) of 1.14(1.07–1.21) and 1.16(1.09–1.23) per 1-SD increase, respectively. Adjustment for NT-proBNP rendered the association insignificant. Conclusion In LURIC, the INR was positively associated with mortality in patients with prevalent CAD not on oral anticoagulant therapy as well as in patients without CAD. Adjustment for NT-proBNP abolished the association suggesting clinical or subclinical heart failure strongly contributing to increased INR and higher mortality.

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“…Pulmonary embolism (PE) is the only preventable cause of death in hospitalized patients with 15% mortality rate, which increases to 25% among hemodynamically instable cases (1)(2)(3). It kills 200 to 300 thousands a year worldwide.…”

Section: Introductionmentioning

confidence: 99%

The Role of Euro SCORE and STS Prediction Systems in Prognosis of Candidates for Surgical Pulmonary Embolectomy at a Referral Hospital

et al. 2017

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Background: Pulmonary embolism (PE) is the only preventable cause of death in hospitalized patients with 15% mortality rate, which is increased to 25% among hemodynamically instable cases. The current study, regarding new concepts and techniques of risk assessment in pulmonary embolism, aimed at evaluating the role of STS score and EuroSCORE in prognosis forecast among cases of surgical embolectomy in patients with pulmonary embolism in order to suggest an acceptable way to reduce mortality rate in addition to optimum case selection for embolectomy.Methods: Through a prospective cross-sectional study, 50 patients were recruited out of the total candidates for embolectomy at Massih Daneshvari hospital, during years 2016 and 2017. The participants were followed up for complications, morbidities, hospital stay, intensive care unit (ICU) admission and also mortality. Two scoring systems, as named before, were used and the results were compared considering the consequences of surgical embolectomy, such as hospital stay, morbidity and mortality, to finally suggest an association between the scores in each system and the outcomes.Results: Fifty patients with pulmonary embolism, who were candidates for surgical embolectomy, entered the study. The mean age ± SD was 65.8 ± 14.1 and males made up 54.2% of the participants. The mean scores were significantly higher in patients, who died, compared with alive participants. The mean STS score was doubled in people who died while the EuroSCORE showed almost three-folded values in that group compared to survived individuals (P value < 0.001 and 0.003, respectively). The APACHE II score was significantly higher in dead participants (P value = 0.04) and they spent most of their hospitalization time at the ICU (78.2% versus 15.6% of the survived group) (P value = 0.01). The survived participants had lower rate of kidney injury as well (17% versus 29%; P value = 0.009), while the overall rate of the problem was 24% in 50 participants. There was a reverse correlation between STS and EuroSCORE obtained score and the length of stay that is not too far from the fact that individuals with worse conditions usually obtain higher scores and die faster than others. Conclusions:To sum up, with a global acceptance in addition to ease of utilization, euroSCORE is approved by the clinicians disregarding the overall controversy between the two predicting systems that were studied in terms of calibration and discrimination.

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The relation between international normalized ratio and mortality in acute pulmonary embolism: A retrospective study

Abstract: Elevated INR may have prognostic value for 30-day mortality in acute PE patients not on anticoagulation. Combining INR with sPESI score improved the predictive value for all-cause mortality. However, further large-scale studies are needed to confirm it's prognostic role.

Cited by 9 publications

References 37 publications

Can Inr on Admission Be a New Prognostic Parameter in Patients with Acute Pulmonary Embolism?

Can Inr on Admission Be a New Prognostic Parameter in Patients with Acute Pulmonary Embolism?

The association of high-normal international-normalized-ratio (INR) with mortality in patients referred for coronary angiography

The Role of Euro SCORE and STS Prediction Systems in Prognosis of Candidates for Surgical Pulmonary Embolectomy at a Referral Hospital

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