Does Right Ventricular Dysfunction Predict Mortality in Hemodynamically Stable Patients With Acute Pulmonary Embolism?
Bibliographic record
Abstract
Background: Acute pulmonary embolism (APE) is directly responsible for 100,000 deaths annually. Right ventricular dysfunction (RVD) on admission is considered a poor prognostic factor in these patients, though existing evidence of its significance in predicting mortality in hemodynamically stable patients is still unclear. We attempted to clarify this association by doing a retrospective review. Methods: We retrospectively reviewed electronic medical records of hemodynamically stable patients older than 18 years of age with APE who were admitted to a tertiary care hospital in rural Upstate New York from July 2014 to July 2016. One hundred thirty-four patients were reviewed in two groups: patients who presented with computed tomography (CT) or echocardiographic evidence of RVD, and those without RVD. To identify differences in mortality between the two groups, the Chi-square/Fisher's exact test and t -tests were used. All variables with P < 0.2 in the initial analysis were included in a stepwise multivariable logistic regression model to predict RVD. Results: No statistically significant difference was found in 30-day mortality between the groups (7.8% in RVD and 5.3% in no RVD, P = 0.563). The overall prevalence of RVD was found to be 57% (77/134). Troponin elevation (53.2% in RVD group vs. 19.3 in the no RVD group with P < 0.01) and central location of thrombus (53.1% vs. 32.1% with P = 0.016) were more prevalent in RVD group. A marginally significant difference was found in length of hospital stay among those with RVD versus no RVD (7.13 days vs. 5.46 days; P = 0.061). The multivariable analysis shows that the odds of RVD were greater for patients with elevated troponin levels (odds ratio = 7.8). Conclusion: There was no difference in 30-day mortality in hemodynamically stable patients with APE having RVD compared to patients with no RVD. On the basis of this study, we do not suggest the routine use of systemic fibrinolysis in hemodynamically stable patients with radiographic evidence of RVD alone. Cardiol Res. 2017;8(4):143-146 doi: https://doi.org/10.14740/cr577w Â
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.001 | 0.004 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.001 | 0.001 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.000 | 0.001 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.000 |
| Insufficient payload (model declined to judge) | 0.001 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".