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    "textoCompleto" => "<p class="elsevierStylePara">Dear Editor&#44;</p><p class="elsevierStylePara">The clinical course of pulmonary arterial hypertension &#40;PAH&#41; is highly variable&#59; therefore&#44; reliable parameters are needed to characterize the severity of the disease and to detect the disease progression sensitively&#46; In recent years&#44; several parameters have been tested&#46;<a href="&#35;bib7" class="elsevierStyleCrossRefs"><span class="elsevierStyleSup">1</span></a> Anaemia and renal function are unspecific markers&#44;<a href="&#35;bib8" class="elsevierStyleCrossRefs"><span class="elsevierStyleSup">2</span></a> while Nt-ProBNP has been extensively studied<a href="&#35;bib9" class="elsevierStyleCrossRefs"><span class="elsevierStyleSup">3</span></a><span class="elsevierStyleSup">&#44; </span><a href="&#35;bib10" class="elsevierStyleCrossRefs"><span class="elsevierStyleSup">4</span></a><span class="elsevierStyleSup">&#44; </span><a href="&#35;bib11" class="elsevierStyleCrossRefs"><span class="elsevierStyleSup">5</span></a> and is recommended in current guidelines&#46;<a href="&#35;bib12" class="elsevierStyleCrossRefs"><span class="elsevierStyleSup">6</span></a> However&#44; renal function may interfere with its levels&#46; We sought to evaluate in patients with PAH&#44; already on specific therapy&#44; which would be the best parameter to predict the long-term hospitalization within the routine laboratory workup&#46;</p><p class="elsevierStylePara">Thirty consecutive adult patients &#40;73&#46;3&#37; women&#41; with PAH&#44; age of 63&#46;7&#160;&#177;&#160;12&#46;6 years&#44; Group I PAH&#44; on specific pulmonary vasodilator target therapy &#62;12 months &#40;sildenafil 83&#46;3&#37;&#44; bosentan 60&#37;&#59; both 43&#46;3&#37;&#41;&#44; stable outpatients &#40;last hospitalization and diuretic therapy changes &#62;3 months&#41; were included in this 2-year clinical follow-up&#46; Also&#44; at inclusion sPAP and mPAP should be &#62;35&#160;mmHg and &#62;25&#160;mmHg&#44; respectively&#46; Our Unit routine laboratorial workup includes the determination of the Nt-ProBNP&#44; complete blood count including haemoglobin&#44; haematocrit&#44; erythrocyte count&#44; red cell distribution width&#44; creatinine and estimated glomerular filtration rate &#40;MDRD equation&#41;&#44; hepatic enzymes and the ionogram&#46; Outcome&#58; cardiovascular hospitalization&#46;</p><p class="elsevierStylePara">Besides clinical stability&#44; no recent hospitalization and specific therapy &#62;12 months the sPAP &#40;73&#46;9&#160;&#177;&#160;24&#46;7&#160;mmHg&#41;&#44; pulmonary vascular resistance &#40;3&#46;2&#160;&#177;&#160;1&#46;2 wood&#41; and Nt-ProBNP &#40;1021&#160;&#177;&#160;1200&#160;pg&#47;ml&#41; were high&#46; The hospitalization and death rate were 46&#46;7 and 16&#46;7&#37;&#44; respectively&#46; The ROC curve for hospitalization was significant for haemoglobin &#40;AUC&#160;&#61;&#160;0&#46;75&#59; <span class="elsevierStyleItalic">p</span>&#160;&#61;&#160;0&#46;028&#41;&#44; Erythrocytes &#40;AUC&#160;&#61;&#160;0&#46;76&#59; <span class="elsevierStyleItalic">p</span>&#160;&#61;&#160;0&#46;023&#41;&#44; Haematocrit &#40;AUC&#160;&#61;&#160;0&#46;73&#59; <span class="elsevierStyleItalic">p</span>&#160;&#61;&#160;0&#46;043&#41;&#44; Creatinine &#40;AUC&#160;&#61;&#160;0&#46;74&#59; <span class="elsevierStyleItalic">p</span>&#160;&#61;&#160;0&#46;026&#41;&#44; GFR &#40;AUC&#160;&#61;&#160;0&#46;73&#59; <span class="elsevierStyleItalic">p</span>&#160;&#61;&#160;0&#46;034&#41; and Nt-ProBNP &#40;AUC&#160;&#61;&#160;0&#46;79&#59; <span class="elsevierStyleItalic">p</span>&#160;&#61;&#160;0&#46;007&#41;&#46; The significant cut-off points were calculated from the ROC curve&#46; All these parameters were associated to increased risk of hospitalization &#40;<a href="&#35;t0005" class="elsevierStyleCrossRefs">Table 1</a>&#41; and with the hospitalization curve&#46; The multivariate Cox regression &#40;&#8220;backward stepwise method&#41; model showed that the Haematocrit&#160;&#60;&#160;42&#46;4 &#40;HR&#160;&#61;&#160;11&#46;1&#59; <span class="elsevierStyleItalic">p</span>&#160;&#61;&#160;0&#46;036&#41;&#44; Creatinine&#160;&#60;&#160;1&#46;16 &#40;HR&#160;&#61;&#160;4&#46;93&#59; <span class="elsevierStyleItalic">p</span>&#160;&#61;&#160;0&#46;022&#41; and Nt-ProBNP&#62;895 &#40;HR&#160;&#61;&#160;14&#46;9&#59; <span class="elsevierStyleItalic">p</span>&#160;&#60;&#160;0&#46;001&#41; were the independent predictors of hospitalization&#46; Patients with at least one of these parameters above the cut-off had greater risk of hospitalization &#40;HR&#160;&#61;&#160;5&#46;6&#59; 95&#37; CI 0&#46;73&#8211;43&#46;0&#59; <span class="elsevierStyleItalic">p</span>&#160;&#61;&#160;0&#46;097&#41;&#46;</p><p class="elsevierStylePara">Table 1&#46; Risk estimate&#44; hospitalization curve&#59; and the univariate and multivariate predictors of hospitalization by Cox regression&#46;</p><a name="t0005" class="elsevierStyleCrossRefs"></a><p class="elsevierStylePara"></p><table><tr align="left"><td>&#160;</td><td colspan="3">Fisher exact test with risk estimate</td><td>Kaplan&#8211;Meier</td><td colspan="5">Cox regression</td></tr><tr align="left"><td>&#160;</td><td>OR</td><td>95&#37; CI</td><td><span class="elsevierStyleItalic">P</span> value</td><td>Log-Rank</td><td colspan="2">Univariate analysis</td><td colspan="3">Multivariate analysis<span class="elsevierStyleSup">&#42;</span></td></tr><tr align="left"><td>&#160;</td><td>&#160;</td><td>&#160;</td><td>&#160;</td><td>&#160;</td><td>HR</td><td><span class="elsevierStyleItalic">P</span> value</td><td>HR</td><td>95&#37; CI</td><td><span class="elsevierStyleItalic">P</span> value</td></tr><tr align="left"><td>Hb&#160;&#60;&#160;14&#46;5&#160;g&#47;dl</td><td>2&#46;3</td><td>1&#46;3&#8211;3&#46;9</td><td>0&#46;003</td><td>0&#46;006</td><td>48&#46;1</td><td>0&#46;128</td><td>&#8211;</td><td>&#160;</td><td>&#160;</td></tr><tr align="left"><td>Eryth&#160;&#60;&#160;4&#44;710&#44;000</td><td>2&#46;2</td><td>1&#46;1&#8211;4&#46;4</td><td>0&#46;023</td><td>0&#46;036</td><td>4&#46;43</td><td>0&#46;055</td><td>&#160;</td><td>&#160;</td><td>NS</td></tr><tr align="left"><td>Ht&#160;&#60;&#160;42&#46;4&#37;</td><td>2&#46;1</td><td>1&#46;2&#8211;3&#46;8</td><td>0&#46;016</td><td>0&#46;021</td><td>7&#46;68</td><td>0&#46;051</td><td>11&#46;1</td><td>1&#46;16&#8211;106&#46;2</td><td>0&#46;036</td></tr><tr align="left"><td>Rdw&#160;&#62;&#160;13&#46;6</td><td>1&#46;6</td><td>1&#46;1&#8211;2&#46;3</td><td>0&#46;054</td><td>0&#46;047</td><td>32&#46;7</td><td>0&#46;23</td><td>&#8211;</td><td>&#160;</td><td>&#160;</td></tr><tr align="left"><td>Creat&#160;&#62;&#160;1&#46;16&#160;mg&#47;dl</td><td>8&#46;0</td><td>1&#46;1&#8211;57&#46;3</td><td>0&#46;012</td><td>0&#46;003</td><td>4&#46;43</td><td>0&#46;006</td><td>4&#46;9</td><td>1&#46;26&#8211;19&#46;3</td><td>0&#46;022</td></tr><tr align="left"><td>GFR&#160;&#60;&#160;77&#46;2&#160;cc&#47;min&#47;1&#46;73&#160;m<span class="elsevierStyleSup">2</span></td><td>2&#46;1</td><td>1&#46;1&#8211;4&#46;2</td><td>0&#46;033</td><td>0&#46;038</td><td>3&#46;59</td><td>0&#46;051</td><td>&#160;</td><td>&#160;</td><td>NS</td></tr><tr align="left"><td>Nt-ProBNP&#160;&#62;&#160;895&#160;pg&#47;mL</td><td>3&#46;43</td><td>1&#46;2&#8211;10&#46;2</td><td>0&#46;024</td><td>0&#46;003</td><td>4&#46;54</td><td>0&#46;007</td><td>14&#46;9</td><td>3&#46;33&#8211;67&#46;2</td><td>&#60;0&#46;001</td></tr></table><p class="elsevierStylePara"><span class="elsevierStyleItalic">Abbreviations</span>&#58; Hb&#44; haemoglobin&#59; Eryth&#44; erythrocyte count&#59; Ht&#44; haematocrit&#59; Rdw&#44; red cell distribution width&#59; Creat&#44; creatinine&#59; GRF&#44; glomerular filtration rate &#40;MDRD method&#41;&#46; <span class="elsevierStyleSup">&#42;</span> Multivariate analysis &#8220;backward stepwise method&#8221;&#46; NS&#44; non-significant&#59; OR&#44; odds ratio&#59; HR&#44; hazard ratio&#59; CI confidence interval&#46;<br></br></p><p class="elsevierStylePara">In conclusion&#44; the present data showed that the haematocrit&#44; creatinine and Nt-ProBNP&#44; which characterize the anaemia degree&#44; renal function and heart dysfunction&#59; and are included in the routine follow-up of our Unit&#44; are independent predictors of the 2 years hospitalization curve&#46; These data confirm and reinforce previous data on these prognostic markers&#46;</p><a name="sec0005" class="elsevierStyleCrossRefs"></a><span class="elsevierStyleSectionTitle">Conflicts of interest</span><p class="elsevierStylePara">The authors have no conflicts of interest to declare&#46;</p><p class="elsevierStylePara">Corresponding author&#46; luisjosesargento&#64;gmail&#46;com</p>"
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Nt-ProBNP, Anaemia and Renal function are independent predictors of hospitalization in outpatients with pulmonary artery hypertension
L.. Sargentoa,
Corresponding author
luisjosesargento@gmail.com

Corresponding author. luisjosesargento@gmail.com
, S.. Longoa, N.. Lousadaa, R.P.. dos Reisb
a Heart Failure Unit, Cardiology Department, Pulido Valente Hospital, Lisbon North Hospital Centre, Lisbon, Portugal
b Cardiology Department, Pulido Valente Hospital, Lisbon North Hospital Centre, Lisbon, Portugal
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    "textoCompleto" => "<p class="elsevierStylePara">Dear Editor&#44;</p><p class="elsevierStylePara">The clinical course of pulmonary arterial hypertension &#40;PAH&#41; is highly variable&#59; therefore&#44; reliable parameters are needed to characterize the severity of the disease and to detect the disease progression sensitively&#46; In recent years&#44; several parameters have been tested&#46;<a href="&#35;bib7" class="elsevierStyleCrossRefs"><span class="elsevierStyleSup">1</span></a> Anaemia and renal function are unspecific markers&#44;<a href="&#35;bib8" class="elsevierStyleCrossRefs"><span class="elsevierStyleSup">2</span></a> while Nt-ProBNP has been extensively studied<a href="&#35;bib9" class="elsevierStyleCrossRefs"><span class="elsevierStyleSup">3</span></a><span class="elsevierStyleSup">&#44; </span><a href="&#35;bib10" class="elsevierStyleCrossRefs"><span class="elsevierStyleSup">4</span></a><span class="elsevierStyleSup">&#44; </span><a href="&#35;bib11" class="elsevierStyleCrossRefs"><span class="elsevierStyleSup">5</span></a> and is recommended in current guidelines&#46;<a href="&#35;bib12" class="elsevierStyleCrossRefs"><span class="elsevierStyleSup">6</span></a> However&#44; renal function may interfere with its levels&#46; We sought to evaluate in patients with PAH&#44; already on specific therapy&#44; which would be the best parameter to predict the long-term hospitalization within the routine laboratory workup&#46;</p><p class="elsevierStylePara">Thirty consecutive adult patients &#40;73&#46;3&#37; women&#41; with PAH&#44; age of 63&#46;7&#160;&#177;&#160;12&#46;6 years&#44; Group I PAH&#44; on specific pulmonary vasodilator target therapy &#62;12 months &#40;sildenafil 83&#46;3&#37;&#44; bosentan 60&#37;&#59; both 43&#46;3&#37;&#41;&#44; stable outpatients &#40;last hospitalization and diuretic therapy changes &#62;3 months&#41; were included in this 2-year clinical follow-up&#46; Also&#44; at inclusion sPAP and mPAP should be &#62;35&#160;mmHg and &#62;25&#160;mmHg&#44; respectively&#46; Our Unit routine laboratorial workup includes the determination of the Nt-ProBNP&#44; complete blood count including haemoglobin&#44; haematocrit&#44; erythrocyte count&#44; red cell distribution width&#44; creatinine and estimated glomerular filtration rate &#40;MDRD equation&#41;&#44; hepatic enzymes and the ionogram&#46; Outcome&#58; cardiovascular hospitalization&#46;</p><p class="elsevierStylePara">Besides clinical stability&#44; no recent hospitalization and specific therapy &#62;12 months the sPAP &#40;73&#46;9&#160;&#177;&#160;24&#46;7&#160;mmHg&#41;&#44; pulmonary vascular resistance &#40;3&#46;2&#160;&#177;&#160;1&#46;2 wood&#41; and Nt-ProBNP &#40;1021&#160;&#177;&#160;1200&#160;pg&#47;ml&#41; were high&#46; The hospitalization and death rate were 46&#46;7 and 16&#46;7&#37;&#44; respectively&#46; The ROC curve for hospitalization was significant for haemoglobin &#40;AUC&#160;&#61;&#160;0&#46;75&#59; <span class="elsevierStyleItalic">p</span>&#160;&#61;&#160;0&#46;028&#41;&#44; Erythrocytes &#40;AUC&#160;&#61;&#160;0&#46;76&#59; <span class="elsevierStyleItalic">p</span>&#160;&#61;&#160;0&#46;023&#41;&#44; Haematocrit &#40;AUC&#160;&#61;&#160;0&#46;73&#59; <span class="elsevierStyleItalic">p</span>&#160;&#61;&#160;0&#46;043&#41;&#44; Creatinine &#40;AUC&#160;&#61;&#160;0&#46;74&#59; <span class="elsevierStyleItalic">p</span>&#160;&#61;&#160;0&#46;026&#41;&#44; GFR &#40;AUC&#160;&#61;&#160;0&#46;73&#59; <span class="elsevierStyleItalic">p</span>&#160;&#61;&#160;0&#46;034&#41; and Nt-ProBNP &#40;AUC&#160;&#61;&#160;0&#46;79&#59; <span class="elsevierStyleItalic">p</span>&#160;&#61;&#160;0&#46;007&#41;&#46; The significant cut-off points were calculated from the ROC curve&#46; All these parameters were associated to increased risk of hospitalization &#40;<a href="&#35;t0005" class="elsevierStyleCrossRefs">Table 1</a>&#41; and with the hospitalization curve&#46; The multivariate Cox regression &#40;&#8220;backward stepwise method&#41; model showed that the Haematocrit&#160;&#60;&#160;42&#46;4 &#40;HR&#160;&#61;&#160;11&#46;1&#59; <span class="elsevierStyleItalic">p</span>&#160;&#61;&#160;0&#46;036&#41;&#44; Creatinine&#160;&#60;&#160;1&#46;16 &#40;HR&#160;&#61;&#160;4&#46;93&#59; <span class="elsevierStyleItalic">p</span>&#160;&#61;&#160;0&#46;022&#41; and Nt-ProBNP&#62;895 &#40;HR&#160;&#61;&#160;14&#46;9&#59; <span class="elsevierStyleItalic">p</span>&#160;&#60;&#160;0&#46;001&#41; were the independent predictors of hospitalization&#46; Patients with at least one of these parameters above the cut-off had greater risk of hospitalization &#40;HR&#160;&#61;&#160;5&#46;6&#59; 95&#37; CI 0&#46;73&#8211;43&#46;0&#59; <span class="elsevierStyleItalic">p</span>&#160;&#61;&#160;0&#46;097&#41;&#46;</p><p class="elsevierStylePara">Table 1&#46; Risk estimate&#44; hospitalization curve&#59; and the univariate and multivariate predictors of hospitalization by Cox regression&#46;</p><a name="t0005" class="elsevierStyleCrossRefs"></a><p class="elsevierStylePara"></p><table><tr align="left"><td>&#160;</td><td colspan="3">Fisher exact test with risk estimate</td><td>Kaplan&#8211;Meier</td><td colspan="5">Cox regression</td></tr><tr align="left"><td>&#160;</td><td>OR</td><td>95&#37; CI</td><td><span class="elsevierStyleItalic">P</span> value</td><td>Log-Rank</td><td colspan="2">Univariate analysis</td><td colspan="3">Multivariate analysis<span class="elsevierStyleSup">&#42;</span></td></tr><tr align="left"><td>&#160;</td><td>&#160;</td><td>&#160;</td><td>&#160;</td><td>&#160;</td><td>HR</td><td><span class="elsevierStyleItalic">P</span> value</td><td>HR</td><td>95&#37; CI</td><td><span class="elsevierStyleItalic">P</span> value</td></tr><tr align="left"><td>Hb&#160;&#60;&#160;14&#46;5&#160;g&#47;dl</td><td>2&#46;3</td><td>1&#46;3&#8211;3&#46;9</td><td>0&#46;003</td><td>0&#46;006</td><td>48&#46;1</td><td>0&#46;128</td><td>&#8211;</td><td>&#160;</td><td>&#160;</td></tr><tr align="left"><td>Eryth&#160;&#60;&#160;4&#44;710&#44;000</td><td>2&#46;2</td><td>1&#46;1&#8211;4&#46;4</td><td>0&#46;023</td><td>0&#46;036</td><td>4&#46;43</td><td>0&#46;055</td><td>&#160;</td><td>&#160;</td><td>NS</td></tr><tr align="left"><td>Ht&#160;&#60;&#160;42&#46;4&#37;</td><td>2&#46;1</td><td>1&#46;2&#8211;3&#46;8</td><td>0&#46;016</td><td>0&#46;021</td><td>7&#46;68</td><td>0&#46;051</td><td>11&#46;1</td><td>1&#46;16&#8211;106&#46;2</td><td>0&#46;036</td></tr><tr align="left"><td>Rdw&#160;&#62;&#160;13&#46;6</td><td>1&#46;6</td><td>1&#46;1&#8211;2&#46;3</td><td>0&#46;054</td><td>0&#46;047</td><td>32&#46;7</td><td>0&#46;23</td><td>&#8211;</td><td>&#160;</td><td>&#160;</td></tr><tr align="left"><td>Creat&#160;&#62;&#160;1&#46;16&#160;mg&#47;dl</td><td>8&#46;0</td><td>1&#46;1&#8211;57&#46;3</td><td>0&#46;012</td><td>0&#46;003</td><td>4&#46;43</td><td>0&#46;006</td><td>4&#46;9</td><td>1&#46;26&#8211;19&#46;3</td><td>0&#46;022</td></tr><tr align="left"><td>GFR&#160;&#60;&#160;77&#46;2&#160;cc&#47;min&#47;1&#46;73&#160;m<span class="elsevierStyleSup">2</span></td><td>2&#46;1</td><td>1&#46;1&#8211;4&#46;2</td><td>0&#46;033</td><td>0&#46;038</td><td>3&#46;59</td><td>0&#46;051</td><td>&#160;</td><td>&#160;</td><td>NS</td></tr><tr align="left"><td>Nt-ProBNP&#160;&#62;&#160;895&#160;pg&#47;mL</td><td>3&#46;43</td><td>1&#46;2&#8211;10&#46;2</td><td>0&#46;024</td><td>0&#46;003</td><td>4&#46;54</td><td>0&#46;007</td><td>14&#46;9</td><td>3&#46;33&#8211;67&#46;2</td><td>&#60;0&#46;001</td></tr></table><p class="elsevierStylePara"><span class="elsevierStyleItalic">Abbreviations</span>&#58; Hb&#44; haemoglobin&#59; Eryth&#44; erythrocyte count&#59; Ht&#44; haematocrit&#59; Rdw&#44; red cell distribution width&#59; Creat&#44; creatinine&#59; GRF&#44; glomerular filtration rate &#40;MDRD method&#41;&#46; <span class="elsevierStyleSup">&#42;</span> Multivariate analysis &#8220;backward stepwise method&#8221;&#46; NS&#44; non-significant&#59; OR&#44; odds ratio&#59; HR&#44; hazard ratio&#59; CI confidence interval&#46;<br></br></p><p class="elsevierStylePara">In conclusion&#44; the present data showed that the haematocrit&#44; creatinine and Nt-ProBNP&#44; which characterize the anaemia degree&#44; renal function and heart dysfunction&#59; and are included in the routine follow-up of our Unit&#44; are independent predictors of the 2 years hospitalization curve&#46; These data confirm and reinforce previous data on these prognostic markers&#46;</p><a name="sec0005" class="elsevierStyleCrossRefs"></a><span class="elsevierStyleSectionTitle">Conflicts of interest</span><p class="elsevierStylePara">The authors have no conflicts of interest to declare&#46;</p><p class="elsevierStylePara">Corresponding author&#46; luisjosesargento&#64;gmail&#46;com</p>"
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