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Serum Alkaline Phosphatase as a Risk-Stratification Tool in Pulmonary Embolism
Session:
Sessão de Posters 02 - Embolia Pulmonar
Speaker:
Tiago Filipe Aguiar
Congress:
CPC 2024
Topic:
F. Valvular, Myocardial, Pericardial, Pulmonary, Congenital Heart Disease
Theme:
21. Pulmonary Circulation, Pulmonary Embolism, Right Heart Failure
Subtheme:
21.4 Pulmonary Circulation, Pulmonary Embolism, Right Heart Failure - Treatment
Session Type:
Cartazes
FP Number:
---
Authors:
Tiago Filipe Aguiar; Carlos Costa; Simão Carvalho; Adriana Pacheco; Diana Carvalho; Lisa Ferraz; Joana Ribeiro; Ana Briosa Neves
Abstract
<p style="text-align:justify"><strong><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif">INTRODUCTION:</span></span></strong></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif">Through its combined potential as a biomarker for systemic inflammation, acute hepatic overload injury, and diffuse vascular calcification, serum alkaline phosphatase (ALP) could act as an important biomarker for risk-stratification in acute pulmonary embolism (APE).</span></span></p> <p style="text-align:justify"><strong><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif">OBJECTIVE:</span></span></strong></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif">To evaluate the prognostic value of serum ALP in patients presenting at the emergency department with APE.</span></span></p> <p style="text-align:justify"><strong><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif">METHODS:</span></span></strong></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif">Cohort analysis of 201 sequential patients presenting in the Internal Medicine ward due to APE diagnosed by computed tomography pulmonary angiogram (CTPA). The study endpoints were in-hospital mortality, and a composite endpoint (CE) of in-hospital mortality and need for fibrinolysis.</span></span></p> <p style="text-align:justify"><strong><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif">RESULTS:</span></span></strong></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif">The population consisted of 237 patients, with a mean age of 69±17 years, of which 40% were male. According to the PESI score, 34% of the patients were classified as high or intermediate-high risk.</span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif">ALP levels were positively associated with a higher in-hospital mortality (120 [IQR 66-164] vs 78 [71-100], with vs without in-hospital mortality, respectively [P<0.05]), and with the CE (80 [IQR 62-139] vs 68 [62-100], P<0.05). In the multivariate analysis, ALP remained and independent predictor of the CE (OR 1.003 per unit increase in ALP, 95%CI 1.000-1.007, P<0.05); a non-significant trend was observed for the prediction of in-hospital mortality after adjustment for confounding variables (OR 1.004 per unit increase, 95%CI 1.000-1.009, P=0.057).</span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif">To assess whether gamma-glutamyl transferase (GGT), also a marker of cholestasis, would be an equivalent predictor of prognosis, similar analyses were performed for GGT. GGT was associated with both in-hospital mortality and the CE in univariate but not multivariate analysis, suggesting it is inferior to ALP as a prognostic indicator in this setting.</span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif">Limitations: Our study was retrospective in nature. The fact that our cohort was small and that there were some missing cases for the TTE data and PESI score, precluded their inclusion in the multivariate analyses.</span></span></p> <p style="text-align:justify"><strong><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif">CONCLUSION:</span></span></strong></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif">Our results suggest that serum ALP is an important prognostic indicator in the setting of APE, and may be used as an add-on to existing risk-scores to support treatment decisions.</span></span></p>
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