To identify predictors of in-hospital mortality in a group of patients with low and intermediate risk acute PE submitted to thrombolysis.
Retrospective analysis of a database containing 100 consecutive patients with low and intermediate risk PE according with the most recent ESC guidelines (patients without shock or hypotension but with right ventricular dysfunction, myocardial injury or both at hospital admission or patients without those markers but with extensive pulmonary thrombi on contrast enhanced chest computer tomography (CT)), submitted to thrombolysis and admitted in a single intensive care unit. Two groups were created, regarding in-hospital mortality: group A (n = 91), survivors, group B (n = 9), deceased.
In-hospital mortality rate was 9%. No difference was found among groups in prevalence of the most important predisposing factors and in results of routine laboratory tests (chest X-ray, electrocardiogram, arterial blood gases). Echocardiography and CT did not show significant differences between groups. In our population, higher age (76 vs. 59 years; p = 0.007), lower systolic (113 vs. 128 mmHg; p = 0.043) and mean (83 v.s 93 mmHg; p = 0.035) blood pressures, higher INR at admission (1.4 vs. 1.2; p = 0.032), prior history of heart failure (43 vs. 4%, p = 0.009) and rales at clinical presentation (57 vs. 13%, p = 0.017) were predictors of in-hospital mortality in univariate analysis. Regarding in-hospital bleeding, we observed a trend (44% vs. 18%, p = 0.091) towards more incidence of death. On multivariate analysis, age > 80 years (p = 0.034) and rales at admission (p = 0.049) were independent predictors of in-hospital mortality.
It is possible and feasible, with simple clinical data, to risk stratify non-high risk PE patients. Once identified, more aggressive management of these patients may be warranted to improve prognosis.
Pulmonary embolism (PE) is a major health problem and may present as a cardiovascular emergency. The need to risk stratify PE is widely accepted to better define the therapeutic strategy.
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