Risk Stratification in Pulmonary Embolism: Prognostic Value of PESI, WELLS, PADUA, and IMPROVE Scores in Relation to Laboratory Markers

Background: Pulmonary embolism (PE) is a major cause of morbidity and in-hospital mortality and requires rapid clinical assessment for diagnosis, risk stratification, and management. Several validated clinical prediction tools, including the Pulmonary Embolism Severity Index (PESI), WELLS, PADUA, and IMPROVE scores, are commonly used to evaluate thromboembolic risk and predict clinical outcomes. Methods: A retrospective observational study was conducted on a cohort of 538 patients diagnosed with PE, all recruited between January 2020–December 2025. Group comparisons between survivors and non-survivors were performed using independent samples t-tests and Mann–Whitney U tests. Receiver operating characteristic (ROC) curve analysis was used to evaluate the predictive performance of clinical scores. Multivariable logistic regression analysis was performed to identify independent predictors of in-hospital mortality. Results: Mean age was 69 years, and overall death-rate was 18.4%. Significant differences between survivors and non-survivors were observed for age and clinical scores. White blood cell count, neutrophils, lymphocytes, platelet count, total bilirubin, aspartate aminotransferase (AST), alanine aminotransferase (ALT), gamma-glutamyl transferase (GGT), procalcitonin, and international normalized ratio (INR), were significantly associated with in-hospital mortality. ROC curve analysis demonstrated predictive performance of the evaluated clinical scores. Logistic regression identified PESI score, procalcitonin levels, and white blood cell count as independent predictors of unfavorable outcome. mortality. Conclusions: Clinical risk scores and specific laboratory biomarkers were associated with in-hospital mortality in patients with pulmonary embolism. The PESI score, procalcitonin, and white blood cell count showed independent predictive value for death rate in this cohort.