Do clinical, echocardiographic, and biochemical variables predict 30-day adverse events in patients with acute pulmonary embolism?
A simple prognostic score based on clinical findings, BNP, and echocardiography can accurately stratify the short-term risk of adverse outcomes in patients with acute pulmonary embolism.
Rationale: The short-term prognosis of pulmonary embolism (PE) depends on hemodynamic status and underlying disease. The prognostic value of right ventricular dysfunction and injury is less well established.: To evaluate prognostic factors of PE in a multicenter prospective cohort study.: Echocardiography, brain natriuretic peptide (BNP), N-terminal-proBNP and cardiac troponin I measurements were done on admission of 570 consecutive patients with an acute PE. A predictive model was based on independent predictors of 30-day adverse events defined as death, secondary cardiogenic shock, or recurrent venous thromboembolism. and Main Results: At 30 days, 42 patients (7. 4%; 95% confidence interval CI, 5. 5-9. 8%) had adverse events. On multivariate analysis, altered mental state (odds ratio OR 6. 8; 95% confidence interval CI, 2. 0-23. 3), shock on admission (OR 2. 8; 95% Cl, 1. 1-7. 5), cancer (OR 2. 9; 95% Cl, 1. 2-6. 9), BNP (OR 1. 3 for an increase of 250 ng/L; 95% Cl, 1. 1-1. 6) and right to left ventricle diameter ratio (OR 1. 2 for an increase of 0. 1; 95% Cl, 1. 1-1. 4) were associated with 30-days of adverse events. The predictive performance of the model was good (area under receiver operating characteristics curve 0. 84 95% Cl, 0. 78-0. 90), making it possible to develop a bedside prognostic score.: BNP and echocardiography may be useful determinants of the short-term outcome for patients with PE, together with clinical findings. Patients with PE can be stratified according to the initial risk of adverse outcome, using a simple score based on clinical, echocardiographic, and biochemical variables.
Sanchez et al. (Thu,) studied this question.