Risk stratification and clinical outcomes in patients with acute pulmonary embolism

ObjectivesPulmonary embolism is a common disease associated with a high mortality rate. The risk assessment and appropriate treatment selection of patients with acute pulmonary embolism remains a challenge.Design and methodsThis single center cohort study included a total of 150 patients (96 male, age = 71 ± 15 years) with acute pulmonary embolism confirmed by spiral-computed tomography or magnetic resonance image. The prognostic performance of the clinical characteristics and laboratory values were investigated to predict the in-hospital hemodynamically instable events and 30-day all-cause mortality.ResultsThe rate of in-hospital hemodynamic instability and 30-day all-cause mortality was 21% and 12%, respectively. A multivariate Cox regression analysis demonstrated that a heart rate ≥ 110 bpm (odd ratio 4.26 [95% CI 1.42–12.77]), chronic pulmonary disease (6.47 [1.99–21.04]), WBC ≥ 11,000 mm3 (3.78 [1.32–10.82]), and D-dimer level ≥ 4.0 μg/mL (3.68 [1.01–13.43]) independently predicted the 30-day fatal outcome. A Kaplan–Meier survival analysis showed that the categorization based on the number of risk factors was significantly associated with the likelihood of 30-day all-cause mortality (P < 0.0001).ConclusionsThe initial presentation of tachycardia, presence of chronic pulmonary disease, elevated WBC and D-dimer on admission can be used to identify the risk for a short-term fatal outcome within 30 days in patients with acute pulmonary embolism.