Association between clinical parameters and severity of acute pulmonary embolism: a retrospective study

BACKGROUND: Acute pulmonary embolism (APE) is the third most frequent life-threatening cardiovascular disease. Which clinical parameters correlate with APE severity are still unclear. This study aimed to investigate the association between clinical parameters and APE severity, and to detect the parameters that could predict severe (intermediate high- and high-risk) APE. METHODS: Clinical data from 612 hospitalized APE patients from two centres in China were collected. Univariate or multivariate ordinal logistic regression analyses were used to detect the relationship between clinical parameters and APE severity. Receiver-operating characteristic (ROC) curves were used to calculate the predictive values of single or combined parameters in predicting severe APE or 30-day mortality in a discovery cohort (n = 368) and a validation cohort (n = 244). RESULTS: Age (odds ratio OR, 1.462; 95% confidence interval CI: 1.241-1.723, P < 0.0001), coronary atherosclerotic heart disease (CAD) (OR, 3.103; 95% CI 1.946-4.950, P < 0.0001), total affected arteries (OR,1.365; 95%CI 1.201-1.551, P < 0.0001) and D-dimer (OR, 1.071; 95% CI 1.039-1.104, P < 0.0001) were independently correlated with APE severity. A combination of total affected arteries (TAA) more than 2, CAD, and D-dimer more than 2.99 mg/L represented the largest area under the curves (AUC = 0.860, sensitivity = 75.37%, specificity = 83.76%) in predicting severe APE. For 30-day mortality prediction, older than 77 years combined with TAA more than 2 showed an excellent performance in both the discovery cohort (AUC = 0.838, P < 0.0001) and validation cohort (AUC = 0.776, P < 0.001). CONCLUSIONS: Patients with CAD, more than 2 central affected arteries, and D-dimer more than 2.99 mg/L have an increased risk of developing severe APE. Patients older than 77 years with more than 2 central affected arteries suffer an increased risk of death within 30 days of APE.