Predictors of Mortality in Pulmonary Embolism: A Real-Life Study


Abstract views: 187 / PDF downloads: 187

Authors

DOI:

https://doi.org/10.58600/eurjther1818

Keywords:

pulmonary embolism, Mortality, Risk Factors, Prognosis

Abstract

Objective: The primary aim of this study was to investigate the mortality and associated factors in patients with pulmonary embolism.

Methods: A retrospective analysis was performed on adult patients with pulmonary embolism who applied to X University Hospital between January 1, 2017, and January 1, 2023. All-cause mortality and related factors in pulmonary embolism patients were determined.

Results: This study included 152 patients with a median age of 59 years and 81 (53.3%) women. The all-cause mortality rate was 25.7%, and pulmonary embolism-related deaths were 1.3%. Age (p<0.001), chronic obstructive pulmonary disease (COPD) (p=0.013), heart failure (p=0.018), atrial fibrillation (p=0.015), massive pulmonary embolism (p=0.029), hemoglobin level (p<0.001) and NT-Pro BNP level (p<0.001) were significantly associated with increased all-cause mortality. In binary logistic regression analysis, for each unit of increasing pulmonary embolism severity index (PESI) score, mortality increased 2.2-fold (95% CI:1.03-5.09), massive PTE 1.6-fold (95% CI:0.14-17.86), anticoagulant duration (daily) 0.98-fold (95% CI:0.98-0.99) and Hb level (per unit Hb reduction) 0.67-fold (95% CI:0.45-1.02) mortality was increasing. There was no statistical difference between the number of hospitalization days for patients with low and high PESI and simplified PE severity index (sPESI) scores.

Conclusions: All-cause mortality in patients with pulmonary embolism increased with age, cardiac diseases, and COPD comorbidities. The PESI and sPESI scores used in the acute phase of PTE were found to be highly reliable in predicting all-cause mortality in PE patients. The diagnosis of massive PE and elevated NT-proBNP levels, a marker of right ventricular dysfunction, were factors that increased mortality.

Metrics

Metrics Loading ...

References

Arseven O, Bingöl Z, Öngen HG, Uzun O, Okumuş NG, Çöplü L, Erol S, Oğuzülgen İK, Önen ZP, Özgür ES, Sevinç C, Topçu F, Uçar EY, Yıldızeli B (2021) Türk Toraks Derneği Pulmoner Tromboembolizm Tanı Ve Tedavi Uzlaşı Raporu 2021. Optimus Yayıncılık. pp.1-124. https://toraks.org.tr/site/community/library/dwkHt8qc8GMSPZfT

Konstantinides SV, Meyer G, Becattini C, Bueno H, Geersing GJ, V.-P. Harjola VP, Huisman MV, Humbert M, Jennings CS, Jiménez D, Kucher N, Lang IM, Lankeit M, Lorusso R, Mazzolai L, Meneveau N, Ní Áinle F, Prandoni P, Pruszczyk P, Righini M, Torbicki A, Van Belle E, Zamorano JL (2020) ESC Scientific Document Group, 2019 ESC Guidelines for the diagnosis and management of acute pulmonary embolism developed in collaboration with the European Respiratory Society (ERS). Eur Heart J. 41:543–603. https://doi.org/10.1093/eurheartj/ehz405.

Laporte S, Mismetti P, Décousus H, Uresandi F, Otero R, Lobo JL, Monreal M, the RIETE Investigators (2008) Clinical Predictors for Fatal Pulmonary Embolism in 15 520 Patients With Venous Thromboembolism. Circulation. 117: 1711–6. https://doi.org/10.1161/CIRCULATIONAHA.107.726232.

Wicki J, Perrier A, Perneger TV, Bounameaux H, Junod AF (2000) Predicting adverse outcome in patients with acute pulmonary embolism: a risk score. Thromb Haemost. 84: 548–52.

Aujesky D, Obrosky DS, Stone RA, Auble TE, Perrier A, Cornuz J, Roy PM, Fine MJ (2005) Derivation and validation of a prognostic model for pulmonary embolism. Am J Respir Crit Care Med. 172: 1041–6. https://doi.org/10.1164/rccm.200506-862OC.

Lankeit M, Gómez V, Wagner C, Aujesky D, Recio M, Briongos S, Moores CLK, Yusen RD, Konstantinides S, Jiménez D, Instituto Ramón y Cajal de Investigación Sanitaria Pulmonary Embolism Study Group (2012) A strategy combining imaging and laboratory biomarkers in comparison with a simplified clinical score for risk stratification of patients with acute pulmonary embolism. Chest. 141:916–22. https://doi.org/10.1378/chest.11-1355.

Mastroiacovo D, Dentali F, di Micco P, Maestre A, Jiménez D, Soler S, Sahuquillo JC, Verhamme P, Fidalgo A, López-Sáez JB, Skride A, Monreal M, RIETE Investigators (2019) Coordinator of the RIETE Registry: Manuel Monreal (Spain). RIETE Steering Committee Members:, Members of the RIETE Group are as follows. Spain:, Rate and duration of hospitalisation for acute pulmonary embolism in the real-world clinical practice of different countries: analysis from the RIETE registry, Eur Respir J. 53:1801677. https://doi.org/10.1183/13993003.01677-2018.

Jiménez D, Miguel-Díez J, Guijarro R, Trujillo-Santos J, Otero R, Barba R, Muriel A, Meyer G, Yusen RD, Monreal M, RIETE Investigators (2016) Trends in the Management and Outcomes of Acute Pulmonary Embolism: Analysis From the RIETE Registry, J Am Coll Cardiol. 67:162–170. https://doi.org/10.1016/j.jacc.2015.10.060.

Aujesky D, Roy PM, Verschuren F, Righini M, Osterwalder J, Egloff M, Renaud B, Verhamme P, Stone RA, Legall C, Sanchez O, Pugh NA, N’gako A, Cornuz J, Hugli O, Beer HJ, Perrier A, Fine MJ, Yealy DM (2011) Outpatient versus inpatient treatment for patients with acute pulmonary embolism: an international, open-label, randomised, non-inferiority trial. Lancet. 378:41–48. https://doi.org/10.1016/S0140-6736(11)60824-6.

Piran S, Le Gal G, Wells PS, Gandara E, Righini M, Rodger MA, Carrier M (2013) Outpatient treatment of symptomatic pulmonary embolism: a systematic review and meta-analysis. Thromb Res. 132: 515–9. https://doi.org/10.1016/j.thromres.2013.08.012.

Gupta R, Ammari Z, Dasa O, Ruzieh M, Burlen JJ, Shunnar KM, Nguyen HT, Xie Y, Brewster P, Chen T, Aronow HD, Cooper CJ (2020) Long-term mortality after massive, submassive, and low-risk pulmonary embolism. Vasc Med. 25:141–149. https://doi.org/10.1177/1358863X19886374.

Ng ACC, Chung T, A. Sze Chiang Yong A, Siu Ping Wong H, Chow V, Celermajer DS, Kritharides L (2011) Long-Term Cardiovascular and Noncardiovascular Mortality of 1023 Patients With Confirmed Acute Pulmonary Embolism, Circulation: Cardiovascular Quality and Outcomes. 4:122–8. https://doi.org/10.1161/CIRCOUTCOMES.110.958397.

Sandal A, Korkmaz ET, Aksu F, Köksal D, Selçuk ZT, Demir AU, Emri S, Çöplü L (2021) Performance of pulmonary embolism severity index in predicting long-term mortality after acute pulmonary embolism. Anatol J Cardiol. 25:544–554. https://doi.org/10.5152/AnatolJCardiol.2021.99345.

S. Barco B, Valerio L, Gallo A, Turatti G, Mahmoudpour SH, Ageno W, Castellucci LA, Cesarman-Maus G, Ddungu H, De Paula EV, Dumantepe M, Goldhaber SZ, Guillermo Esposito MC, Klok FA, Kucher N, McLintock C, Ní Áinle F, Simioni P, Spirk D, Spyropoulos AC, Urano T, Zhai ZG, Hunt BJ, Konstantinides SV (2021) Global reporting of pulmonary embolism-related deaths in the World Health Organization mortality database: Vital registration data from 123 countries. Res Pract Thromb Haemost.5: e12520. https://doi.org/10.1002/rth2.12520.

Gupta R, Fortman DD, Morgenstern DR, Cooper CJ (2018) Short- and Long-term Mortality Risk After Acute Pulmonary Embolism. Curr Cardiol Rep. 20:135. https://doi.org/10.1007/s11886-018-1084-6.

Coutance G, Cauderlier E, Ehtisham J, Hamon M, Hamon M (2011) The prognostic value of markers of right ventricular dysfunction in pulmonary embolism: a meta-analysis. Crit Care. 15: R103. https://doi.org/10.1186/cc10119.

Kasper W, Konstantinides S, Geibel A, Olschewski M, Heinrich F, Grosser KD, Rauber K, Iversen S, Redecker M, Kienast J (1997) Management strategies and determinants of outcome in acute major pulmonary embolism: results of a multicenter registry. J Am Coll Cardiol. 30: 1165–71. https://doi.org/10.1016/s0735-1097(97)00319-7.

Kucher N, Rossi E, De Rosa M, Goldhaber SZ (2006) Massive pulmonary embolism. Circulation. 113 (2006) 577–82. https://doi.org/10.1161/CIRCULATIONAHA.105.592592.

Konstantinides SV, Vicaut E, Danays T, Becattini C, Bertoletti L, Beyer-Westendorf J, Bouvaist H, Couturaud F, Dellas C, Duerschmied D, Empen K, Ferrari E, Galiè N, Jiménez D, Kostrubiec M, Kozak M, Kupatt C, Lang IM, Lankeit M, Meneveau N, Palazzini M, Pruszczyk P, Rugolotto M, Salvi A, Sanchez O, Schellong S, Sobkowicz B, Meyer G (2017) Impact of Thrombolytic Therapy on the Long-Term Outcome of Intermediate-Risk Pulmonary Embolism, J Am Coll Cardiol. 69:1536-44. https://doi.org/10.1016/j.jacc.2016.12.039.

Henzler T, Roeger S, Meyer M, Schoepf UJ, Nance JW, Haghi D, Kaminski WE, Neumaier M, Schoenberg SO, Fink C (2012)Pulmonary embolism: CT signs and cardiac biomarkers for predicting right ventricular dysfunction, Eur Respir J. 39 919–926. https://doi.org/10.1183/09031936.00088711.

Downloads

Published

2023-08-31

How to Cite

Fakılı, F., Taylan, M., Bilgiç, İrem Z., & Düzen, İrfan V. (2023). Predictors of Mortality in Pulmonary Embolism: A Real-Life Study. European Journal of Therapeutics, 29(3), 588–596. https://doi.org/10.58600/eurjther1818

Issue

Section

Original Articles

Categories