Association of emergency department length of stay with safety-net status.

JAMA. 2012 Feb 1;307(5):476-82

Authors: Fee C, Burstin H, Maselli JH, Hsia RY

Abstract
CONTEXT: Performance measures, particularly pay for performance, may have unintended consequences for safety-net institutions caring for disproportionate shares of Medicaid or uninsured patients.
OBJECTIVE: To describe emergency department (ED) compliance with proposed length-of-stay measures for admissions (8 hours or 480 minutes) and discharges, transfers, and observations (4 hours or 240 minutes) by safety-net status.
DESIGN, SETTING, AND PARTICIPANTS: The 2008 National Hospital Ambulatory Medical Care Survey (NHAMCS) ED data were stratified by safety-net status (Centers for Disease Control and Prevention definition) and disposition (admission, discharge, observation, transfer). The 2008 NHAMCS is a national probability sample of 396 hospitals (90.2% unweighted response rate) and 34 134 patient records. Visits were excluded for patients younger than 18 years, missing length-of-stay data or dispositions of missing, other, left against medical advice, or dead on arrival. Median and 90th percentile ED lengths of stay were calculated for each disposition and admission/discharge subcategories (critical care, psychiatric, routine) stratified by safety-net status. Multivariable analyses determined associations with length-of-stay measure compliance.
MAIN OUTCOME MEASURES: Emergency Department length-of-stay measure compliance by disposition and safety-net status.
RESULTS: Of the 72.1% ED visits (N = 24 719) included in the analysis, 42.3% were to safety-net EDs and 57.7% were to non-safety-net EDs. The median length of stay for safety-net was 269 minutes (interquartile range [IQR], 178-397 minutes) for admission vs 281 minutes (IQR, 178-401 minutes) for non-safety-net EDs; 156 minutes (IQR, 95-239 minutes) for discharge vs 148 minutes (IQR, 88-238 minutes); 355 minutes (IQR, 221-675 minutes) for observations vs 298 minutes (IQR, 195-440 minutes); and 235 minutes (IQR, 155-378 minutes) for transfers vs 239 minutes (IQR, 142-368 minutes). Safety-net status was not independently associated with compliance with ED length-of-stay measures; the odds ratio was 0.83 for admissions (95% CI, 0.52-1.34); 1.03 for discharges (95% CI, 0.83-1.27); 1.05 for observations (95% CI, 0.57-1.95), 1.30 for transfers (95% CI, 0.70-2.45]); or subcategories except for psychiatric discharges (1.67, [95% CI, 1.02-2.74]).
CONCLUSION: Compliance with proposed ED length-of-stay measures for admissions, discharges, transfers, and observations did not differ significantly between safety-net and non-safety-net hospitals.

PMID: 22298679 [PubMed - in process]

Finding the cause of acute kidney injury: Which index of fractional excretion is better?

Cleve Clin J Med. 2012 Feb;79(2):121-6

Authors: Gotfried J, Wiesen J, Raina R, Nally JV

Abstract
The fractional excretion of urea (FEU) is a useful index for differentiating the main categories of causes of acute kidney injury, ie, prerenal causes and intrinsic causes. It may be used in preference to the more widely used fractional excretion of sodium (FENa) in situations in which the validity of the latter is limited, such as in patients taking a diuretic.

PMID: 22301562 [PubMed - in process]

New and future therapies for lupus nephritis.

Cleve Clin J Med. 2012 Feb;79(2):134-40

Authors: Appel GB

Abstract
Based on data from randomized controlled trials over the past decade, oral mycophenolate (CellCept) now rivals intravenous cyclophosphamide (Cytoxan) as a first-line therapy for lupus nephritis, offering similar efficacy but less toxicity. The roles of rituximab (Rituxan) and new immunomodulatory agents are being explored. Creativity in treating lupus nephritis is needed; one regimen does not fit all.

PMID: 22301564 [PubMed - in process]

The Editor's Roundtable: Medical Management of Atrial Fibrillation.

Am J Cardiol. 2012 Feb 15;109(4):563-9

Authors: Friedewald VE, Kowal RC, Olshansky B, Yancy CW, Roberts WC

PMID: 22293222 [PubMed - in process]

Screening and prevention of venous thromboembolism in critically ill patients: a decision analysis and economic evaluation.

Am J Respir Crit Care Med. 2011 Dec 1;184(11):1289-98

Authors: Sud S, Mittmann N, Cook DJ, Geerts W, Chan B, Dodek P, Gould MK, Guyatt G, Arabi Y, Fowler RA

Abstract
RATIONALE: Venous thromboembolism is difficult to diagnose in critically ill patients and may increase morbidity and mortality.
OBJECTIVES: To evaluate the cost-effectiveness of strategies to reduce morbidity from venous thromboembolism in critically ill patients.
METHODS: A Markov decision analytic model to compare weekly compression ultrasound screening (screening) plus investigation for clinically suspected deep vein thrombosis (DVT) (case finding) versus case finding alone; and a hypothetical program to increase adherence to DVT prevention. Probabilities were derived from a systematic review of venous thromboembolism in medical-surgical intensive care unit patients. Costs (in 2010 $US) were obtained from hospitals in Canada, Australia, and the United States, and the medical literature. Analyses were conducted from a societal perspective over a lifetime horizon. Outcomes included costs, quality-adjusted life-years (QALY), and incremental cost-effectiveness ratios.
MEASUREMENTS AND MAIN RESULTS: In the base case, the rate of proximal DVT was 85 per 1,000 patients. Screening resulted in three fewer pulmonary emboli than case-finding alone but also two additional bleeding episodes, and cost $223,801 per QALY gained. In sensitivity analyses, screening cost less than $50,000 per QALY only if the probability of proximal DVT increased from a baseline of 8.5-16%. By comparison, increasing adherence to appropriate pharmacologic thromboprophylaxis by 10% resulted in 16 fewer DVTs, one fewer pulmonary emboli, and one additional heparin-induced thrombocytopenia and bleeding event, and cost $27,953 per QALY gained. Programs achieving increased adherence to best-practice venous thromboembolism prevention were cost-effective over a wide range of program costs and were robust in probabilistic sensitivity analyses.
CONCLUSIONS: Appropriate prophylaxis provides better value in terms of costs and health gains than routine screening for DVT. Resources should be targeted at optimizing thromboprophylaxis.

PMID: 21868500 [PubMed - indexed for MEDLINE]

Proton Pump Inhibitor Use and Recurrent Clostridium difficile-associated Disease: A Case-control Analysis Matched by Propensity Score.

J Clin Gastroenterol. 2012 Jan 30;

Authors: Kim YG, Graham DY, Jang BI

Abstract
BACKGROUND AND AIM:: Clostridium difficile has been increasingly diagnosed in hospitalized patients. An association between proton pump inhibitors (PPIs) use and Clostridium difficile-associated disease (CDAD) and between recurrent CDAD has been suggested. The aim of this study is to investigate whether PPI use is associated with the development of recurrent CDAD. METHODS:: This was a retrospective case-control study of patients with CDAD at Yeungnam University Medical Center, seen from January 2004 to December 2008. C. difficile infection was diagnosed by the presence of C. difficile toxin in the stool. Those with recurrent disease were matched with nonrecurrent controls using multivariate matched sampling methods that incorporated the propensity score. RESULTS:: Recurrent CDAD developed in 28 (14.1%) of the 198 patients with diarrhea and positive C. difficile stool toxin assays. Multivariate analysis of the total population of recurrent versus nonrecurrent CDAD revealed that additional use of non-C. difficile antimicrobial therapy (concomitant with the treatment or after or both), poor response to therapy with metronidazole or vancomycin, and recent gastrointestinal surgery were risk factors for recurrent CDAD. We were able to match 21 recurrent CDAD subjects with 21 without recurrent CDAD. Among the matched patients only PPI use was associated with recurrent CDAD (ie, 47.6% vs. 4.8%, P=0.004 for recurrent vs. nonrecurrent CDAD, respectively). CONCLUSIONS:: Among the matched patient groups, only PPI therapy was associated with recurrent CDAD. Prospective studies are needed to clarify whether avoidance of PPIs or specific cotherapies will reduce the incidence of recurrent C. difficile-associated diarrhea.

PMID: 22298089 [PubMed - as supplied by publisher]

Medication reconciliation: identifying medication discrepancies in acutely ill hospitalized older adults.

Am J Geriatr Pharmacother. 2011 Oct;9(5):339-44

Authors: Villanyi D, Fok M, Wong RY

Abstract
BACKGROUND: Medication discrepancies may occur during transitions from community to acute care hospitals. The elderly are at risk for such discrepancies due to multiple comorbidities and complex medication regimens. Medication reconciliation involves verifying medication use and identifying and rectifying discrepancies.
OBJECTIVE: The aim of this study was to describe the prevalences and types of medication discrepancies in acutely ill older patients.
METHODS: Patients who were ? 70 years and were admitted to any of 3 acute care for elders (ACE) units over a period of 2 nonconsecutive months in 2008 were prospectively enrolled. Medication discrepancies were classified as intentional, undocumented intentional, and unintentional. Unintentional medication discrepancies were classified by a blinded rater for potential to harm. This study was primarily qualitative, and descriptive (univariate) statistics are presented.
RESULTS: Sixty-seven patients (42 women; mean [SD] age, 84.0 [6.5] years) were enrolled. There were 37 unintentional prescription-medication discrepancies in 27 patients (40.3%) and 43 unintentional over-the-counter (OTC) medication discrepancies in 19 patients (28.4%), which translates to Medication Reconciliation Success Index (MRSI) of 89% for prescription medications and 59% for OTC medications. The overall MRSI was 83%. More than half of the prescription-medication discrepancies (56.8%) were classified as potentially causing moderate/severe discomfort or clinical deterioration.
CONCLUSION: Despite a fairly high overall MRSI in these patients admitted to ACE units, a substantial proportion of the prescription-medication discrepancies were associated with potential harm.

PMID: 21890424 [PubMed - indexed for MEDLINE]

Impact of different discharge patterns on bed occupancy rate and bed waiting time: a simulation approach.

J Med Eng Technol. 2011 Aug-Oct;35(6-7):338-43

Authors: Zhu Z

Abstract
Beds are one of the most important resources in a healthcare system. How to manage beds efficiently is an important indicator of the efficiency of the healthcare system. Bed management is challenging to many healthcare service providers in many aspects. In recent years, population growth and aging society impose extra pressure on bed requirement. There are usually two key performance indicators of a bed management system: bed occupancy rate and bed waiting time. In this paper, different discharge patterns and their impacts on the bed occupancy rate and bed waiting time are studied. A discrete event simulation model is constructed to evaluate the existing discharge pattern in a Singapore regional hospital using actual hospital admission and discharge transaction data. Then different discharge patterns are tested in the same context. Simulation results show that a proper discharge pattern significantly smoothes the fluctuation of bed occupancy rate and reduce the bed waiting time.

PMID: 21916602 [PubMed - indexed for MEDLINE]

Where do hands go? An audit of sequential hand-touch events on a hospital ward.

J Hosp Infect. 2012 Jan 30;

Authors: Smith SJ, Young V, Robertson C, Dancer SJ

Abstract
BACKGROUND: Reservoirs of pathogens could establish themselves at forgotten sites on a ward, posing a continued risk for transmission to patients via unwashed hands. AIM: To track potential spread of organisms between surfaces and patients, and to gain a greater understanding into transmission pathways of pathogens during patient care. METHODS: Hand-touch activities were audited covertly for 40 × 30 min sessions during summer and winter, and included hand hygiene on entry; contact with near-patient sites; patient contact; contact with clinical equipment; hand hygiene on exit; and contact with sites outside the room. FINDINGS: There were 104 entries overall: 77 clinical staff (59 nurses; 18 doctors), 21 domestic staff, one pharmacist and five relatives. Hand-hygiene compliance among clinical staff before and after entry was 25% (38/154), with higher compliance during 20 summer periods [47%; 95% confidence interval (CI): 35.6-58.8] than during 20 winter periods (7%; 95% CI: 3.2-14.4; P < 0.0001). More than half of the staff (58%; 45/77) touched the patient. Staff were more likely to clean their hands prior to contact with a patient [odds ratio (OR): 3.44; 95% CI: 0.94-16.0); P = 0.059] and sites beside the patient (OR: 6.76; 95% CI: 1.40-65.77; P = 0.0067). Nearly half (48%; 37/77) handled patient notes and 25% touched the bed. Most frequently handled equipment inside the room were intravenous drip (30%) and blood pressure stand (13%), and computer (26%), notes trolley (23%) and telephone (21%) outside the room. CONCLUSION: Hand-hygiene compliance remains poor during covert observation; understanding the most frequent interactions between hands and surfaces could target sites for cleaning.

PMID: 22297169 [PubMed - as supplied by publisher]

Risk factors associated with carotid artery puncture following landmark-guided internal jugular vein cannulation attempts.

Med Princ Pract. 2011;20(6):562-6

Authors: Jankovic RJ, Pavlovic MS, Stojanovic MM, Stosic BS, Milic DJ, Ignjatovic NS, Bogicevic AN, Djordjevic DR, Savic NN

Abstract
OBJECTIVE: The relationship between certain risk factors and carotid artery puncture (CAP) as an early mechanical complication following internal jugular vein cannulation attempts (IJVCAs) was evaluated.
METHODS: In a retrospective 1-year observational single-center study, 86 IJVCAs conducted in the operating room by 4 competent anesthesiologists were evaluated. Age, gender, puncture side, number of cannulation attempts, circumstances of the procedure and incidence of CAP were obtained from medical records.
RESULTS: Of the 86 IJVCAs performed in patients aged 18-75 years, CAP occurred in 8 (9.3%): 5 (5.8%) in patients >65 years and 3 (3.5%) in patients <65 years of age. CAP was not associated with patient's age (p = 0.11) and gender (p = 0.76). Multiple cannulation attempts (OR = 26.25; 95% CI = 4.52-152.51; p < 0.001) and placement of CVC under emergency conditions (OR = 14.84; 95% CI = 1.73-127.22; p = 0.014) increased the risk for CAP significantly. Also, the risk for CAP was higher when IJVCAs were performed before induction of general anesthesia (OR = 15.75; 95% CI = 1.83-135.1; p = 0.019). CAP was more likely to happen during left-sided than right-sided IJVCA (OR = 5.98; 95% CI = 1.29-27.59; p = 0.022). In addition, left-sided attempts considerably increased the risk for multiple cannulation attempts (OR = 2.782; 95% CI = 1.342-3.965; p < 0.01). Also, manifold cannulation attempts were more frequent if the IJVCA was performed before induction of anesthesia (OR = 4.219; CI = 1.579-11.271; p = 0.004).
CONCLUSIONS: Our results strongly suggest that left-sided, multiple IJVCAs, performed under emergency conditions in conscious patients in the operating room, represent considerable risks for possible CAP.

PMID: 21986016 [PubMed - indexed for MEDLINE]

Prevalence and predictors of warfarin use in patients with atrial fibrillation at low or intermediate risk and relation to thromboembolic events.

Clin Cardiol. 2011 Oct;34(10):640-4

Authors: Chae SH, Froehlich J, Morady F, Oral H

Abstract
BACKGROUND: According to the American College of Cardiology/American Heart Association/European Society of Cardiology guidelines, the choice of aspirin or warfarin to prevent thromboembolic events (TEs) in patients with nonrheumatic atrial fibrillation (AF) should be based on the CHADS(2) score. The purpose of this study was to determine the predictors of warfarin use in patients with AF at low (CHADS(2) =0) or intermediate (CHADS(2) =1) risk for TEs.
HYPOTHESIS: Warfarin use is low in intermediate- and low-risk patients.
METHODS: Clinical characteristics of 3086 consecutive patients (mean age, 70 ± 13 years) with nonrheumatic AF from an academic multispecialty practice were determined between 2006 and 2008 through individual chart review. Patients were identified based on an inpatient or outpatient encounter, in which a billing diagnosis code of AF or atrial flutter (AFl) was recorded. The decision for anticoagulation was at the discretion of the primary care physician or cardiologist. No intervention to guide anticoagulant therapy was made.
RESULTS: Warfarin was prescribed in 180/497 low-risk patients (36%), and in 646/938 intermediate-risk patients (69%). Among high-risk patients (CHADS(2) ?2), warfarin was used in 792/968 patients (82%) with a CHADS(2) = 2, in 343/410 patients (84%) with a CHADS(2) =3, and in 225/273 patients (82%) with a CHADS(2) ?4. On multivariate analysis, independent predictors of warfarin use in low-risk patients were nonparoxysmal AF (odds ratio [OR]: 5.02, P<0.0001) and age between 65 and 74 years (OR: 2.21, P<0.0001). Among intermediate-risk patients, congestive heart failure (OR: 7.34, P<0.0001), nonparoxysmal AF (OR: 4.04, P<0.0001), coronary artery disease (OR: 2.53, P<0.0001), age between 65 and 74 years (OR: 1.68, P = 0.002), and female gender (OR: 1.69, P = 0.002) were independent predictors of warfarin use. Lack of warfarin use (OR: 4.9, P<0.001) and female gender (OR: 2.0, P = 0.03) were associated with a higher risk of TEs in intermediate-risk patients. None of the CHADS(2) parameters was predictive of TEs. Warfarin was not associated with reduction in TEs in low-risk patients. Warfarin use did not have a significant effect on bleeding.
CONCLUSIONS: Although either aspirin or warfarin is recommended to prevent TEs in patients with AF at intermediate risk for TEs, warfarin is preferred in the majority of patients in general practice. Lack of warfarin use is associated with a higher risk of TEs in intermediate-risk patients with AF. The adoption of new oral anticoagulants that have lower risk of major hemorrhage than warfarin for low- or intermediate-risk AF patients remains to be determined.

PMID: 21994084 [PubMed - indexed for MEDLINE]

Decreasing hospitalization and in-hospital mortality related to cholangitis in the United States.

J Clin Gastroenterol. 2011 Nov-Dec;45(10):e92-6

Authors: Jamal MM, Yamini D, Singson Z, Samarasena J, Hashemzadeh M, Vega KJ

Abstract
OBJECTIVES: The aim of this study was to determine trends in hospitalization rates and in-hospital mortality of cholangitis and also determine predictive factors of in-hospital mortality.
METHODS: The Nationwide Inpatient Sample database was utilized for inpatient data analysis from 1988 to 2006. Patients with primary cholangitis International Classification of Diseases, ninth revision, Clinical Modification (ICD-9-CM) discharge diagnosis were included. Age-adjusted procedure rates for endoscopic retrograde cholangiopancreatography (ERCP) with biliary stent placement and sphincterotomy were also analyzed. Analysis of variance was used to evaluate trends, and linear Poisson multivariate regression model was used to control for variations in age, sex, time of diagnosis, and ethnicity. Logistic regression analysis was performed to determine predictive factors of in-hospital mortality.
RESULTS: The age-adjusted hospitalization rate of cholangitis decreased 24.8% from 2.34 per 100,000 in 1988 to 1.76 per 100,000 in 2006 (P < 0.01). The age-adjusted in-hospital mortality of cholangitis increased 9.2% from 165.0 to 181.6 per 100,000 from 1988 to 1998 (P < 0.01), and then declined 73% to 48.9 per 100,000 in 2006 (P < 0.01). The age-adjusted procedure rates for ERCP with biliary stenting increased from 0.55 to 15.23 per 100,000 from 1988 to 2006 (P < 0.01), as did the age-adjusted rates for ERCP with sphincterotomy from 1.06 to 35.64 per 100,000 (P < 0.01).
CONCLUSIONS: The hospitalization rate of cholangitis has been declining over the past 2 decades. The overall trend in mortality peaked in 1998 and has shown a subsequent decline that may in part be related to increased utilization of endoscopic biliary decompression.

PMID: 21989279 [PubMed - indexed for MEDLINE]

Hepatorenal syndrome.

Contrib Nephrol. 2011;174:46-55

Authors: Angeli P, Morando F, Cavallin M, Piano S

Abstract
Hepatorenal syndrome (HRS) is a functional renal failure that often occurs in patients with cirrhosis and ascites. Two different types of HRS have been described. Type 1 HRS develops as a consequence of a severe reduction of effective circulating volume due to both an extreme splanchnic arterial vasodilatation and a reduction of cardiac output. Type 2 HRS is characterized by a stable or slowly progressive renal failure so that its main clinical consequence is not acute renal failure, but refractory ascites, and its impact on prognosis is less negative. Liver transplantation (LT) represents the best therapeutic option in cirrhotic patients with HRS. Nevertheless, other therapeutic options were investigated as 'bridge treatments' towards orthotopic LT or for patients who cannot be candidates for LT. Several pilot studies and two randomized control studies have shown that terlipressin plus albumin improves renal function in patients with type 1 HRS. Terlipressin plus albumin can also improve short-term survival in these patients. Terlipressin was most commonly used by intravenous boluses moving from an initial dose of 0.5-1 mg every 4 h to 3 mg every 4h in cases of nonresponse. Nevertheless, there are some preliminary data showing that terlipressin given by continuous intravenous infusion is better tolerated than when it is given by intravenous boluses. The available data are sufficient to state that the use of terlipressin plus albumin has really changed the management of type 1 HRS. Nevertheless, it should be noted that recovery of renal function can only be achieved in less than 50% of patients with type 1 HRS and that the recovery of renal function may also be partial inpatients who are defined as full responders. Thus, while the optimization of this treatment should be investigated, other therapeutic options should be developed and tested as well.

PMID: 21921608 [PubMed - indexed for MEDLINE]

Chromium infusion in hospitalized patients with severe insulin resistance: a retrospective analysis.

Endocr Pract. 2012 Jan 31;:1-17

Authors: Drake TC, Rudser KD, Seaquist ER, Saeed A

Abstract
Objective: To investigate the effects of intravenous chromium on serum glucose and insulin infusion rates in hospitalized patients with severe insulin resistance.Methods: Hospital records from 01/01/08 - 12/01/10 were reviewed to identify patients for whom intravenous chromium was ordered at our academic medical center. To be included, patients were required to demonstrate profound insulin resistance and uncontrolled hyperglycemia (defined as the inability to achieve a blood glucose value <200 mg/dl during the 12 hours before chromium was given despite administration of continuous insulin infusion at a rate ?20 units/hr) and to have received a continuous infusion of chromium chloride at 20 mcg/hr for 10-15 hours for a total dose of 200-240 mcg.Results: Fourteen patients met our criteria. Over the hour preceding intravenous chromium, the mean ± SD rate of insulin infusion was 31 ± 15 units/hr and blood glucose was 326 ± 86 mg/dl. 12 hours after the initiation of chromium, these values were 16 ± 16 units/hr and 162 ± 76 mg/dl, respectively (p=0.011 difference in mean insulin rate from baseline, p<0.001 difference in mean blood glucose from baseline) and 24 hours after these values were 12 ± 15 units/hr and 144 ± 48 mg/dl, respectively (p<0.001 for both).Conclusions: Intravenous chromium decreased insulin needs and improved glucose control at 12 and 24 hrs compared to baseline values. Chromium appears to improve hyperglycemia and insulin resistance in acutely ill patients and represents a potential new therapy, with future prospective randomized controlled studies needed to confirm these results.

PMID: 22297054 [PubMed - as supplied by publisher]

Limited value of novel pulmonary embolism biomarkers in patients with coronary atherosclerosis.

Clin Physiol Funct Imaging. 2011 Nov;31(6):452-7

Authors: Gutte H, Mortensen J, Hag AM, Jensen CV, Kristoffersen US, Brinth L, Kjaer A

Abstract
BACKGROUND: Recent research supports the efficacy of various plasma biomarkers in diagnosing pulmonary embolism (PE) including E-selectin, MMP-9, MPO, sVCAM-1, sICAM-1, adiponectin, hs-CRP and tPAI-1.
OBJECTIVE: We hypothesized that these biomarkers, which are affected in both venous and arterial thromboembolic diseases, have a limited potential of diagnosing PE in patients with concomitant coronary atherosclerosis, as assessed from a low-dose CT scan of the thorax, compared to patients without atherosclerosis.
METHODS: Consecutive patients suspected of PE were referred. All patients had a ventilation/perfusion single photon emission tomography (V/Q-SPECT), low-dose pulmonary CT, pulmonary multidetector computer tomography angiography, blood samples and ECG-gated cardiac CT performed the same day.
RESULTS: A total of 69 patients were included, of which 28 (41%) had PE. In patients without coronary calcium, MMP-9 and tPAI-1 were significantly elevated (P<0·042 and P<0·049) in patients diagnosed with PE. From the receiver operating curves, we chose a cut-off value for MMP-9 at 164·4 ng l(-1) , which yielded sensitivity, specificity, positive and negative predictive values of 63%, 78%, 71% and 70%, respectively. With a chosen cut-off value for tPAI-1 at 56·3 ng l(-1) , the sensitivity, specificity, positive and negative predictive values were 88%, 89%, 88% and 89%, respectively. In patients with coronary calcium, none of the biomarkers could discriminate between PE and no PE.
CONCLUSION: Plasma levels of tPAI-1 and MMP-9 are potentially useful in patients suspected of PE, however, not in the presence of the coronary atherosclerosis.

PMID: 21981456 [PubMed - indexed for MEDLINE]