Clinical, echocardiographic, analytic and anatomical parameters: which are the main prognostic factors in hospitalized patients with acute pulmonary embolism?

Abstract Background Acute pulmonary embolism (PE) is a life-threatening disease and an early diagnosis and herapy are crucial. Several parameters for risk stratification have been evaluated and it's important to assess their impact on clinical practice. Objective We assessed four different parameters (clinical, echocardiographic, analytical and anatomical imaging parameters) - PESI class; PESI-Echo score; lactate and troponin I values and central or peripheral thrombi location. We determined a composite outcome of adverse events: shock, acute ventilatory failure, severe bleeding events or in-hospital mortality. Methods Retrospective single center analysis including 131 patients admitted for PE. Results Mean age of 67.6 ± 15.3 years-old and 71% patients were female. Eighty patients (63.4%) had arterial hypertension, 27.4% had a recent hospitalization or surgery and 16% an active neoplasm disease. According to the PESI classification, 29.8% of the patients were in class V, 26.7% in class III and 17.6% in class II. This classification had a weak positive correlation with the outcome (P < 0.001; r = 0.37) as PESI-Echo score (p 0.018; r = 0.36). The majority (72.2%) of the in-hospital adverse events occurred in PESI class V patients. Analytic parameters determined at hospital admission had a good discriminative power to predict the outcome, mainly lactate value (AUC 0.864; P < 0.001). PESI-Echo score presented the best discriminative power (AUC 1.0), followed by PESI class (AUC 0.925) and lactate (AUC 0.856). The cut-off value for PESI-Echo was 211. Conclusion The association of clinical and echocardiographic parameters was superior as a predictor of adverse events when compared with their isolated use.