4 articles
Pulmonary thromboembolism (PTE) is a major cardiovascular emergency associated with significant mortality. Systemic inflammation contributes to the pathogenesis of thrombosis and to disease severity, and hematological indices derived from the complete blood count, such as the neutrophil-to-lymphocyte ratio (NLR) and the platelet-to-lymphocyte ratio (PLR), have been proposed as prognostic predictors.
A prospective observational study was conducted on a cohort of 182 consecutively investigated patients at Holy Trinity Municipal Clinical Hospital and the Institute of Cardiology. The diagnosis of PTE was confirmed by CT pulmonary angiography. Clinical data, inflammatory hematological indices, echocardiographic parameters, and severity scores were analyzed during the course of inpatient care. The prognostic value of NLR and PLR was assessed using ROC curve analysis.
Pulmonary thromboembolism was confirmed in 153 patients (84.1%, 95% CI [78.7, 89.4]). Elevated NLR was identified in 82 patients (45.1%; 95% CI [37.8, 52.3]), and elevated PLR in 89 patients (48.9%; 95% CI [41.6, 56.2]). Overall mortality was 17.0% (95% CI [11.6, 22.5]) (31 patients). Elevated NLR was present in 26 (14.3; 95% CI [9.2, 19.4]) of deceased patients (p<0.00001), while elevated PLR was present in 22 (12.1%; 95% CI [7.4, 16.8]) of deceased patients (p = 0.012). ROC analysis demonstrated that NLR has a very good predictive ability for mortality (AUC = 0.799), whereas PLR has good predictive ability (AUC = 0.715). Additionally, NLR was significantly correlated with severity according to the PESI score (AUC = 0.614; p = 0.0048). Echocardiography revealed right ventricular dysfunction in 80.2% (95% CI [74.4, 86.0]) of patients and reduced TAPSE in 57.7% (95% CI [50.5, 64.9]) of patients.
The neutrophil-to-lymphocyte ratio is an important prognostic marker of severity and mortality in pulmonary thromboembolism, with a predictive value superior to that of the platelet-to-lymphocyte ratio. Integrating inflammatory hematological indices with clinical scores and imaging assessment may improve risk stratification and the management of patients with pulmonary thromboembolism.
Pulmonary embolism is a life-threatening condition requiring prompt diagnosis. While contrast-enhanced computed tomography is the gold standard, its limited availability and associated risks necessitate complementary diagnostic tools. Recent studies suggest that combining multiple electrocardiographic abnormalities into a composite score may enhance diagnostic performance.
We conducted a prospective, cross-sectional study involving 200 patients with suspected pulmonary embolism admitted to two hospitals in the Republic of Moldova between 2022 and 2025. Among them, 168 had confirmed pulmonary embolism based on computed tomography pulmonary angiography, while 32 patients with similar symptoms but negative imaging served as the control group. All participants underwent a standard 12-lead electrocardiogram upon admission. A composite electrocardiographic score was applied, incorporating 10 criteria (e.g., sinus tachycardia, S1Q3T3 pattern, negative T waves in V1-V4, right bundle branch block, and right axis deviation), with a total score ranging from 0 to 12. Diagnostic thresholds were defined as follows: 0-3 low risk, 4-6 intermediate risk, and ≥7 high risk.
Electrocardiographic abnormalities such as negative T waves in V1–V4 (42.9% vs. 6.2%), atrial fibrillation (28.0% vs. 6.2%), and S1Q3T3 pattern (21.4% vs. 3.1%) were significantly more frequent in pulmonary embolism patients. A composite electrocardiographic score of ≥5 demonstrated excellent diagnostic performance: sensitivity 89.9%, specificity 93.8%, positive predictive value 98.7%, and overall accuracy 90.5%. The area under the ROC curve was 0.92, indicating strong discriminative ability. Among combinations of electrocardiographic findings, the pairing of S1Q3T3 with negative T waves in V1-V4 showed a statistically significant association with confirmed pulmonary embolism.
Our study confirms that a composite electrocardiographic score ≥5 is a highly effective, rapid, and noninvasive tool for identifying pulmonary embolism, improving early triage, particularly in emergency settings where imaging may be delayed. The model significantly outperforms isolated electrocardiographic findings and should be interpreted within a broader clinical context, including symptomatology and imaging when available.
Diagnosing community-acquired pneumonia in patients with chronic heart failure can be challenging. Oxidative stress and inflammatory response play an important role in the development and diagnosis of community-acquired pneumonia and are also involved in many cardiovascular diseases, including chronic heart failure.
A total of 210 patients were enrolled and divided into two groups: group 1 (n = 105) – patients with community-acquired pneumonia associated with chronic heart failure, and group 2 (n = 105) – patients with community-acquired pneumonia without chronic heart failure. Several biomarkers were measured. For oxidative stress, we assessed prooxidant markers (ischemic modified albumin, advanced glycation end-products, advanced oxidation protein products, malonic dialdehyde) and antioxidant markers (total antioxidant activity with CUPRAC and ABTS methods, superoxide dismutase and catalase). Inflammatory status was assessed by determining leukocyte count, erythrocyte sedimentation rate, lactate dehydrogenase, fibrinogen and C-reactive protein. In all patients, N-terminal pro b-type natriuretic peptide values were determined.
The age of patients in the study group ranged from 50 to 92 years, with an overall mean of 70.6 ± 8.89 years (95% CI [68.8-72.3]), (F = 18.109; p = 0.205). Ischemic modified albumin values were higher in patients in Group 1 compared to Group 2: 236.60 ± 57.23 µM/L and 229.77 ± 64.35 µM/L, respectively (F = 0.660; p = 0.045). Serum lactate dehydrogenase had higher values in Group 1, compared to the control group: 232.65 ± 109.80 units/L and 192.40 ± 44.98 units/L, respectively (p = 0.001). The mean fibrinogen values were also higher in Group 1 (5.24 ± 1.60 g/L), compared to Group 2 (4.51 ± 1.78 g/L), p = 0.002. Total antioxidant activity by CUPRAC method, had higher values in Group 1 (6.70 ± 4.62) versus Group 2 (4.99 ± 2.29), p = 0.006.
The coexistence of community-acquired pneumonia and chronic heart failure resulted in a higher inflammatory response and greater accumulation of pro-oxidative reaction products. This condition was characterized by increased serum lactate dehydrogenase, erythrocyte sedimentation rate and fibrinogen levels. Furthermore, the state of heightened oxidative stress was marked by increased ischemic modified albumin and total antioxidant activity detected with CUPRAC method.
Obesity is a metabolic disease that presents a real challenge for the medical system due to the significant increase in the number of obese people in recent decades. Currently, 38% of the global population is overweight or obese. Obesity is an important risk factor for multiple chronic pathologies and lung infections, especially pneumonia. For obese subjects, chronic proinflammatory status due to an excess of fat cells is characteristic.
This prospective cohort study is based on clinical and laboratory examinations of patients hospitalized with community-acquired pneumonia in the Department of Internal Medicine at „Holy Trinity” Municipal Hospital, Chisinau, Republic of Moldova. The study included 210 patients with community-acquired pneumonia, divided into two groups: the base group (group 1) consisted of 105 patients with varying degrees of obesity, and the control group (group 2) consisted of 105 normal-weight patients. The research was conducted according to the principles of the Helsinki Declaration - WMA Declaration of Helsinki - Ethical Principles for Medical Research Involving Human Subjects. The study was approved by the Research Ethics Committee of the Nicolae Testemiţanu State University of Medicine and Pharmacy, with the issuance of favorable opinion no. 46 from March 27, 2018. All patients were examined clinically and paraclinically (radiological examination, pulse oximetry screening, complete blood count, erythrocyte sedimentation rate, fibrinogen, LDH, C-reactive protein, oxidative stress markers). The obtained data were statistically analyzed using Statistical Package for the Social Sciences (SPSS) version 20.
According to the obtained data, the most common comorbidities associated with obesity were cardiovascular and metabolic diseases. The main symptom that prevailed in the obese was dyspnea (97%). Obese subjects showed more frequent signs of acute respiratory failure (86.7%), required oxygen therapy with an average duration of 7.62±6.23 days, showed increased serum levels of LDH (286.31±94.66 U/L) and C-reactive protein (66.08±71.44 mg/l), data that influenced the clinical course of pneumonia.
Patients with obesity and community-acquired pneumonia presented with infectious symptoms and acute respiratory failure, increased values of inflammatory markers, and required oxygen therapy more frequently compared to those of normal weight.