Submited on: 25 May 2016 09:11:43 PM GMT
Published on: 27 May 2016 05:52:02 AM GMT
Review of CTEPH-mortality predictors
Posted by Dr. Wilbur C Rutter on 21 Nov 2016 05:29:31 AM GMT Reviewed by Interested Peers

  • What are the main claims of the paper and how important are they?

    Performance on the 6 minute walking test, NT-proBNP, and D-Dimer are all clinical factors associated with increased mortality among patients with CTEPH. While these give some indication of what to monitor in these patients, there does not seem to be any actionable items to address as a result of this paper. The authors also state that there is no association between renal function and anemia with mortality, which were shown in previous literature that they cite.

  • Are these claims novel? If not, please specify papers that weaken the claims to the originality of this one.

    It is unclear from the paper if these are novel findings. However, they do state that there finding of no associations between mortality and renal failure or anemia is contrary to previous literature.

  • Are the claims properly placed in the context of the previous literature?


  • Do the results support the claims? If not, what other evidence is required?

    The authors make appropriate claims based on the results presented.

  • If a protocol is provided, for example for a randomized controlled trial, are there any important deviations from it? If so, have the authors explained adequately why the deviations occurred?


  • Is the methodology valid? Does the paper offer enough details of its methodology that its experiments or its analyses could be reproduced?

    This study was a prospective cohort study of survivors of pulmonary embolism with a focus on patients experiencing CTEPH. The authors give a brief summary of how the study was performed. Statistical analyses were standard procedures.

  • Would any other experiments or additional information improve the paper? How much better would the paper be if this extra work was done, and how difficult would such work be to do, or to provide?

    Including time to mortality would be of great value in this study. The endpoint of death is not defined and could be expanded upon (for example, 30-day all cause mortality or 2-year all cause mortality). Inclusion of more patients would improve the statistical power in the primary endpoint. Would it be possible to perform a retrospective claims study to further elucidate treatment factors associated with mortality? The downside of claims data would be the loss of laboratory information. Would it be possible to expand the cohort by partnering with another similar institution?


  • Is this paper outstanding in its discipline? (For example, would you like to see this work presented in a seminar at your hospital or university? Do you feel these results need to be incorporated in your next general lecture on the subject?) If yes, what makes it outstanding? If not, why not?

    No. Although the authors found significant differences in mortality, the sample size is a serious limiting factor in determining what other factors are predictive of death in CTEPH patients. Also, more definintions of the outcome could be applied that would strengthen this study.

  • Other Comments:

    Overall, this was a fairly well written and conducted study. More data would be beneficial to the impact of this paper.

  • Competing interests:
  • Invited by the author to review this article? :
  • Have you previously published on this or a similar topic?:
  • References:


  • Experience and credentials in the specific area of science:

    I have significant experience conducting retrospective cohort studies during my graduate training. Additionally, I have a clinical background from pharmacy practice residency training.

  • How to cite:  Rutter W C.Review of CTEPH-mortality predictors[Review of the article 'Clinical and Biochemical Predictive Factors of Mortality in Patients with Chronic with thromboembolic pulmonary Hypertension ' by Tase M].WebmedCentral 2016;7(11):WMCRW003336
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