Mediastinal lymphadenopathy as a prognostic marker in acute pulmonary embolism.

Introduction: Computed tomography (CT) is the modality of choice to diagnose acute pulmonary embolism (PE). The present multicentric study aimed to demonstrate the prognostic role of mediastinal lymphadenopathy for short mortality within 30 days in patients with acute PE. Methods: The investigated patient sampled was comprised of 935 patients (411 female, 44%) with a mean age of 65.3 ± 16.3 years derived from three academic centers. The contrast enhanced CT pulmonalis angiography was used to assess the presence of mediastinal lymphadenopathy. The primary endpoint of this study was 30-day mortality. The simplified pulmonary embolism index (sPESI) was calculated as a clinical prognostic score. Results: A total of 98 patients (10.5%) died within the 30-day observation period. Mediastinal lymphadenopathy was present in a total of 171 of all cases (18.3%). Mediastinal lymphadenopathy was associated with 30-day mortality with an odds ratio (OR) of 1.83 (95% confidence interval [CI],1.12-2.92; p = 0.013 in univariable analysis) and 1.67 (95% CI, 1.01–2.69; p = 0.041 in multivariable analysis). Conclusion: Mediastinal lymphadenopathy represents an independent prognostic factor for 30-day mortality in patients with acute PE. The underlying pathophysiological mechanisms remain unclear and should be further investigated.