Five-year mortality after acute pulmonary embolism: clinical predictors from a real-world cohort

Introduction Pulmonary embolism (PE) remains a leading cause of morbidity and mortality. Despite advances in acute management, data on long-term outcomes in unselected real-world cohorts are scarce. Identifying simple, readily available predictors may support risk stratification and follow-up strategies. Purpose This study aimed to characterise patients hospitalised with acute PE and to identify independent predictors of five-year all-cause mortality. Methods We retrospectively analysed 183 patients admitted with confirmed acute PE between 2013 and 2016 at a tertiary care centre. Clinical and laboratory data at admission were retrieved from electronic health records. Five-year all-cause mortality was assessed through institutional databases. Comparisons were performed using the t-test or Chi-square test, and variables with p < 0.10 were entered into multivariate logistic regression. Model calibration and discrimination were evaluated by the Hosmer–Lemeshow test and Nagelkerke R². Results Mean age was 73.9 ± 13.0 years, and 61.7% of patients were women. Central PE was diagnosed in 44.3% of patients, and right ventricular dysfunction was present in 47%. During follow-up, 78 patients (42.6%) died. Non-survivors were older (p < 0.001) and had higher lactate (p = 0.005), NT-proBNP (p = 0.033), and creatinine (p = 0.015) levels. Oxygen desaturation <90% was associated with increased mortality (p = 0.014), whereas systolic blood pressure <110 mmHg showed a non-significant trend (p = 0.073). In the multivariate model, only age (p < 0.001) and desaturation (p = 0.016) independently predicted mortality (OR 2.97, 95% CI 1.23–7.18). The model showed good calibration (Hosmer–Lemeshow p = 0.307) and moderate discrimination (Nagelkerke R² = 0.369). Conclusion In this real-world cohort of patients with acute PE, age and initial oxygen desaturation were the only independent predictors of five-year mortality. These simple clinical parameters remain powerful prognostic tools and may guide post-discharge risk assessment and long-term management.