Rapid improvement of renal function in patients with acute pulmonary embolism indicates favorable short term prognosis

ObjectiveVarious clinical and biochemical parameters predict the prognosis of patients with acute pulmonary embolism(APE). Treatment of APE can improve a patient's hemodynamic status, restoring adequate peripheral organ perfusion. Therefore, we hypothesized that improvement of renal function can predict short term prognosis of APE patients.Material & MethodWe evaluated 232 consecutive patients (94men,aged 67 ± 18 years) with APE proven by spiral computer tomography. Blood samples were collected for creatinine assays on admission and 72hours later, the glomerular filtration rate(eGFR) was estimated using the MDRD formula.ResultsDuring the first 72hours, 6 subjects died, while during the first 30 days 24(10%) subjects died (APE mortality 8%). On admission eGFR < 60 ml/min was present in 113 patients(49%) and after 72hours in 85 patients(38%). In 26 patients(11%) eGFR on admission was < 60 ml/min and renal function did not improve during subsequent 72hours. In this group the 30-day all-cause and APE-related mortality rates were 27% and 23%, respectively, while serious adverse events occurred in 38% of them. 206 patients with eGFR > 60 ml/min showed a more favorable prognosis (8% 30-day all-cause mortality) than subjects with eGFR < 60 ml/min and a stable eGFR during the first 72hours (27% mortality rate, p < 0.003). Persistent renal dysfunction predicted all-cause and PE-related 30-day mortality (hazard risk 2.53(CI95%:0.96-6.68),p = 0.06 and 3.04(CI95%:1.28-7.26),p = 0.01, respectively).ConclusionApproximately 50% of patients with APE have at least a moderately impaired renal function on admission. Renal function improves within 72 hours in patients with a good prognosis, while “persistent” renal dysfunction indicates an increased mortality.