Evaluation of factors affecting 90-day mortality in patients hospitalized due to pulmonary thromboembolism

Q: What are the key findings of this study?

Elevated baseline WBC (p=0.032), RDW (p=0.041), and lower MPV/RDW ratio (p=0.039), along with RV dilatation and APACHE II score, were significantly associated with 90-day mortality (3.0%) in acute PTE.

Q: What is the clinical evidence from this study?

Study design: Cohort. Population: Acute pulmonary thromboembolism (PTE) (n=264). Intervention: Baseline clinical, echocardiographic, and CBC inflammatory parameters (WBC, RDW, MPV/RDW ratio) vs. Survivors vs non-survivors at 90 days (and non-ICU vs ICU admission). Primary outcome: 90-day mortality (p=<0.05).

Q: What does this research mean for the field?

Elevated baseline WBC, RDW, and lower MPV/RDW ratio, along with right ventricular dilatation and higher APACHE II scores, are significantly associated with 90-day mortality in patients with acute pulmonary thromboembolism. Novelty: ClaimNovelty.INCREMENTAL. Consensus alignment: ConsensusAlignment.NEUTRAL.

Q: What question did this study set out to answer?

To evaluate the role of symptoms, clinical and radiological findings, and baseline complete blood count parameters measured within 24 hours of presentation in predicting 90-day mortality and intensive care unit requirement in patients with pulmonary thromboembolism.

Derya Hoşgün; Semih Aydemir; Can Ateş

doi:10.32322/jhsm.925332

September 5, 2021Journal of Health Sciences and MedicineOpen Access

Evaluation of factors affecting 90-day mortality in patients hospitalized due to pulmonary thromboembolism

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Key result

Elevated WBC, RDW, and RV dilatation are associated with increased 90-day mortality in acute PE.

P<0.05
n=264

Why the study?

Pulmonary thromboembolism is a leading cause of vascular death with inflammatory mediators involved, prompting investigation into whether presentation findings and blood parameters predict 90-day mortality and ICU requirement.

Do baseline symptoms, echocardiographic findings, and complete blood count inflammatory parameters within 24 hours of presentation predict 90-day mortality and ICU requirement in patients hospitalized with acute pulmonary thromboembolism?

Key Points

To evaluate the role of symptoms, clinical and radiological findings, and baseline complete blood count parameters measured within 24 hours of presentation in predicting 90-day mortality and intensive care unit requirement in patients with pulmonary thromboembolism.
Retrospective study of 264 pulmonary thromboembolism patients (55.3% women, 44.7% men; mean age 62.80±15.95 years) admitted to a chest diseases clinic (n=189) or intensive care unit (n=75) between 2014 and 2019.
Baseline complete blood count parameters, computed tomography pulmonary angiography, lower-extremity compression ultrasonography, and transthoracic echocardiography findings were evaluated.
Total 90-day mortality occurred in 8 of 264 patients (3.0%), with hospital mortality at 1.9% and intensive care unit mortality at 1.1%.
Significant risk factors for 90-day mortality included white blood cell count, red blood cell distribution width, mean platelet volume to red cell distribution width ratio, right ventricular dilatation, rtPA therapy, intensive care unit hospitalization, and increased APACHE II scores (p<0.05).
Treatment-related complications occurred in 14 of 264 patients (5.4%), comprising 7 patients (3.4%) receiving low-molecular-weight heparin and 7 patients (13.0%) receiving rtPA therapy.

Study Design

Type

Cohort (n=264)

Multicenter

No

Structured PICO

Do baseline symptoms, echocardiographic findings, and complete blood count inflammatory parameters within 24 hours of presentation predict 90-day mortality and ICU requirement in patients hospitalized with acute pulmonary thromboembolism?

P

Population

264 adults hospitalized with acute pulmonary thromboembolism (mean age 62.8 years, 55.3% female) in Turkey, followed for 90 days.

E

Exposure

Baseline clinical, hemodynamic, transthoracic echocardiographic (RVD, PAP, paradoxical septal motion), and complete blood count parameters (WBC, HB, HCT, PLT, RDW, NE, LY, MPV, NLR, PLR, MPV/PLT, MPV/RDW) measured within 24 hours of presentation, alongside acute treatment (rtPA 50 mg or 100 mg in 21.6%, LMWH in 78.4%).

C

Comparator

Patients without 90-day mortality (n=256) vs patients with 90-day mortality (n=8); and patients hospitalized in Chest Diseases clinic (n=189) vs patients requiring ICU care (n=75).

O

Outcome

90-day all-cause mortalityhard clinical

Main Result

p-value: p=<0.05

Routine baseline CBC markers (specifically WBC, RDW, and MPV/RDW ratio) alongside echocardiography and hemodynamic status help identify acute pulmonary thromboembolism patients at higher risk for ICU admission and 90-day mortality.

Limitations

Retrospective single-center study design
Non-standardized compression ultrasonography that could not be repeated at 3-5-7 days
Transthoracic echocardiography performed by different cardiologists on different devices without standardization
Absence of a fixed timing schedule for baseline blood sample collection and lack of serial biomarker measurements
Failure to analyze time-dependent biomarkers such as MPV within one hour after blood collection
Retrospective study design
2-point compression ultrasonography of the lower extremity could not be standardized or repeated at 3-5-7 days
TTE findings were examined by different cardiologists using different devices without standardization
Nonstandardization of timing for baseline serum sample collection at hospital presentation and failure to analyze time-dependent biomarkers like MPV within one hour
Absence of serial measurements of inflammatory markers (e.g., at 3, 24, and 48 hours)

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Implication

These CBC parameters were associated with 90-day mortality in acute PTE; leaves open incremental value for risk stratification pending validation.

Abstract

Background: Pulmonary thromboembolism (PTE) is a leading cause of death from vascular events. In the pathophysiology of PTE, inflammatory mediators have been shown to be upregulated and to interact with coagulation factors.In this study, we aimed to investigate the role of symptoms, clinical and radiological findings, and the blood parameters measured at presentation within the first 24 h after the onset of the symptoms in predicting 90-day mortality and intensive care unit (ICU) requirement in patients with PTE. Methods: The retrospective study included 264 PTE patients that were followed up at our Chest Diseases clinic and ICU between 2014 and 2019. Results: The 264 patients comprised 55.3% women and 44.7% men with a mean age of 62.80±15.95 years. Of these, 189 of them were hospitalized in the Chest Diseases clinic and the remaining 75 patients were followed up at ICU. Total mortality occurred in 8 (3%) out of 264 patients. Risk factors for 90-mortality included white blood cell count (WBC), red blood cell distribution width (RDW), mean platelet volume (MPV)/RDW ratio, right ventricular dilatation (RVD), recombinant tissue plasminogen activator (rtPA) therapy, ICU hospitalization, and increased APACHE II (Acute Physiology and Chronic Health Evaluation II) scores (p<0.05). Conclusion: The results indicated that TTE findings, baseline hemodynamic parameters and symptoms, rtPA therapy, and CBC parameters including WBC, NE, and RDW are significant risk factors for predicting both mortality and ICU requirement.

Discussion

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Cite This Study

Hoşgün et al. (2021) conducted a cohort in Acute pulmonary thromboembolism (PTE) (n=264). Baseline clinical, echocardiographic, and CBC inflammatory parameters (WBC, RDW, MPV/RDW ratio) vs. Survivors vs non-survivors at 90 days (and non-ICU vs ICU admission) was evaluated on 90-day mortality (p=<0.05). Elevated baseline WBC (p=0.032), RDW (p=0.041), and lower MPV/RDW ratio (p=0.039), along with RV dilatation and APACHE II score, were significantly associated with 90-day mortality (3.0%) in acute PTE.

synapsesocial.com/papers/6a6f3333af0c21e939275ec7 https://doi.org/10.32322/jhsm.925332

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Evaluation of factors affecting 90-day mortality in patients hospitalized due to pulmonary thromboembolism

Key Points

Study Design

Structured PICO

Main Result

Limitations

Ask about this paper

Implication

Abstract

Discussion

Cite This Study

Evaluation of factors affecting 90-day mortality in patients hospitalized due to pulmonary thromboembolism

Key Points

Study Design

Structured PICO

Main Result

Limitations

Ask about this paper

Implication

Abstract

Discussion

Cite This Study

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