The specific aim of this study is to determine predictors of adverse outcomes in hospitalized patients who present with hemodynamically stable pulmonary embolism (PE).
We retrospectively studied 218 hemodynamically stable patients diagnosed with PE at Washington Hospital Center from 2001 to 2004. Study variables included patient demographics, signs and symptoms, co-morbidities, treatments, and laboratory values. The primary endpoint was a composite of in-hospital mortality, use of mechanical or non-invasive positive pressure ventilation, cardio-pulmonary resuscitation, or hypotension. For all continuous variables we report means ±SD or medians and interquartile ranges. We use frequencies to describe categorical data. As a secondary analysis, we compared patients with and without adverse outcomes using the Chi-square or Mann-Whitney U statistic.
Patient demographics appear in Table 1. 81% of patients were dyspneic and 49% reported chest pain at presentation. Adverse outcomes were observed in 20 of 218 patients (9%) and death in 9 of 218 (4%) (Table 2). History of chronic obstructive pulmonary disease (COPD) (p=.01) and pulmonary hypertension (p=.01), use of an inferior vena cava (IVC) filter (p=0.004), and do not resuscitate code status (p=0.03) were associated with adverse outcomes.
History of COPD and pulmonary hypertension, use of an IVC filter, and code status are all associated with a higher rate of adverse outcomes in patients with hemodynamically stable PE.
Few studies have described risk factors for adverse outcomes in hemodynamically stable patients with PE. Despite hemodynamic stability at presentation, 9% of patients with PE experienced adverse outcomes during hospitalization. Early identification of these patients, more intensive monitoring and aggressive treatment may help reduce the incidence of these adverse outcomes. Our study identified several significant predictors. Future investigations involve the development of a clinical prediction model that may be used as a tool to help identify those patients with hemodynamically stable PE who are at risk for adverse outcomes during hospitalization.Table 1—
Patient DemographicsAll Patients N=218Patients with Adverse Outcomes N=20Patients without Adverse Outcomes N=198Age**58.3 ± 17.960.8 ±6.858.0 ±18.0Gender No.(%)Female124 (57)10 (50)114 (58)Male94 (43)10 (50)84 (42)Race No. (%)African American176 (81)20 (100)156 (79)Caucasian34 (16)0 (0)34 (17)Other8 (4)0 (0)8 (4)Total21820 (9)198 (91)
**Mean ± SDTable 2—
Adverse Outcomes in Patients with Pulmonary EmbolismAdverse OutcomeFrequency No. (%) N=218Death9 (4)Intubation11 (5)Non-Invasive Positive Pressure Ventilation (NIPPV)11 (5)Cardio-Pulmonary Resuscitation (CPR)6 (3)Hypotension8 (4)All Adverse Outcomes20 (9)
Kevin Thompson, None.