Abstract 13359: Acute Phase Predictors for In-hospital Mortality and Chronic Thromboembolic Pulmonary Hypertension in Acute Pulmonary Embolism Patients

Abstract

Background: Various predictors in patients with acute pulmonary embolism (PE) have been reported for in-hospital mortality and chronic thromboembolic pulmonary hypertension (CTEPH), but none have been established conclusively. Methods and Results: We retrospectively analyzed data that might be associated with in-hospital mortality and CTEPH from patients with acute PE who were admitted to our hospital. Among 163 patients (aged 69.3± 14.6 years) with acute PE, 11 patients (6.7%) died in the hospital. We examined the following acute and chronic-phase data: vital signs, echocardiography values, medications, laboratory test results, blood gas data and heparin infusion time. Multivariate logistic regression analysis showed that the acute-phase levels of plasma B-type natriuretic peptide (BNP) (odds ratio (OR), 1.003; 95% confidence interval (CI), 1.0004-1.0053; P = 0.034,) and arterial blood gas lactate (OR, 1.306; 95% CI, 1.056-1.615; P = 0.014) were significant independent predictors of in-hospital mortality. The area under the receiver operating characteristic (AUROC) curves of BNP and arterial blood lactate levels for in-hospital mortality were 0.846 and 0.921, respectively. (BNP, 400.65 pg/mL [sensitivity 77.8%, specificity 84.6%]; lactate 7.9 mmol/L [sensitivity 81.8%, specificity 89.5%]). In univariate logistic regression analysis, the plasma BNP level > 400.65 pg/mL and lactate level > 7.9 mmol/L on admission were significant predictors for in-hospital mortality (OR 62.5, 95% CI 10.0-390.3; P = 0.0001). Among 152 patients (aged 68.9±14.6 years) with acute PE who did not die in-hospital, 15 (9.8%) patients progressed to CTEPH. Multivariate logistic regression analysis showed that right ventricular systolic pressure (RVSP) at admission was an independent and significant predictor for CTEPH (OR, 1.183; 95% CI, 1.090-1.285; P = 0.0001). The AUROC curve of RVSP for developing CTEPH was 0.944. (RVSP, 51.4 mm Hg [sensitivity 86.7%, specificity 83.8%]). Conclusions: In patients with acute PE, the acute-phase BNP and arterial blood lactate levels are effective predictors of in-hospital mortality. And RVSP during the acute phase, but not during the chronic phase is an effective predictor of progression to CTEPH.