Cardiology Letters 2023, 32(5):301-312

The significance of laboratory parameters in predicting short-term mortality in patients with acute pulmonary embolism

Čambál D¹, Petruš P¹, Haršány J², Klepanec A², Hromec J³

¹ Oddelenie kardiológie, FN Trnava

² Rádiologická klinika, FN Trnava

³ Trnavská univerzita v Trnave, Fakulta zdravotníctva a sociálnej práce, Trnava, Slovenská republika

Introduction: Pulmonary embolism (PE) is a relatively common disease with diverse prognoses. The success of treatment is conditioned by rapid diagnosis and accurate risk stratification. Risk stratification is crucial not only from the perspective of therapeutic strategies but also from the perspective of patient management, which is reflected primarily in the economic costs of treatment. In this work, we have focused on identifying laboratory markers of unfavourable prognosis in patients with PE.

Methodology: We prospectively followed patients with PE for 30 days. We analyzed selected laboratory markers as D-dimer, high sensitivity troponin I (hs-TnI), N-terminal prohormone of brain natriuretic peptide (NT-proBNP), C-reactive protein (CRP) and arterial lactate (LAK) for their prognostic potential. The markers were collected at the time of PE diagnosis and processed using standard procedures in the local laboratory. We subsequently investigated their significance in determining short-term (30-day) mortality.

Results: 105 patients with PE were included in the prospective study, with a median age of 69 years, with women accounting for 60% of the patients. According to the sPESI clinical score, 51.4% of the patients had low mortality risk and 64.8% of the patients had right ventricular dysfunction. Within 30 days of diagnosis, 11 (10.5%) patients died. Patients who died within 30 days had significantly higher levels of D-dimer (20.110 vs 6.785 mg/LFEU, p = 0.035), NT-proBNP (3146 vs 700.0 pg/ml, p = 0.022), CRP (82.44 vs 32.42 mg/ml, p = 0.031) and LAK (3.410 vs 1.795 mmol/l, p = 0.002). Hs-TnI did not show a difference in terms of short-term mortality (124.81 vs 57.340 ng/l, p = 0.234). Subsequently, based on the set of independent predictors, an application formula was developed to derive the mean probability of short-term mortality in patients with PE. We identified a threshold value (pmortality ≥ 0.1), which indicates a significant risk of mortality. In our own cohort the short-term mortality of patients (pmortality ≥ 0.1) was 35.7%. Patients with low mortality risk (pmortality < 0.1) had a short-term mortality rate of 1.2%.

Conclusion: Despite advances in the diagnosis and treatment, the mortality rate of PE remains high. In our study, we confirmed the significance of laboratory parameters in predicting short-term prognosis in patients with PE. The clinical significance lies in the evaluation of multiple laboratory parameters simultaneously, which can refine risk stratification and improve the management of patients with PE.

Keywords: pulmonary embolism; risk stratification; troponin; lactate; D-dimer

Published: May 1, 2023  Show citation