Abstract
Background: Whereas the major strength of the simplified pulmonary embolism severity index (sPESI) lies in ruling out an adverse outcome in patients with sPESI of 0, the accuracy of sPESI ≥ 1 in risk assessment remains questionable. In acute pulmonary embolism (APE), the estimated glomerular filtration rate (eGFR) can be viewed as an integrate marker reflecting not only previous chronic kidney disease (CKD) damage but also comorbid conditions and hemodynamic disturbances associated with APE. We sought to determine whether renal dysfunction assessment by eGFR improves the sPESI score risk stratification in patients with APE. Methods: 678 consecutive patients with APE were prospectively enrolled. Renal dysfunction (RD) at diagnosis of APE was defined by eGFR < 60 mL/min/1.73 m2 and acute kidney injury (AKI) by elevation of creatinine level >25% during in-hospital stay. Results: RD was observed in 26.9% of the cohort. AKI occurred in 18.8%. A stepwise increase in 30-day mortality, cardiovascular mortality and overall mortality was evident with declining renal function. Multivariate analysis identified RD and CRP (C-reactive protein) level but not sPESI score as independent predictors of 30-day mortality. AKI, 30-day mortality, overall mortality, and cardiovascular mortality were at their highest level in patients with eGFR < 60 mL/min/1.73 m2 and sPESI ≥1. Conclusion: in patients with APE, the addition of RD to the sPESI score identifies a specific subset of patients at very high mortality.
Highlights
Stratification in patients with acute pulmonary embolism (APE) remains a challenging issue, and there is an ongoing need for the identification of additional markers that can improve the predictive ability of current risk stratification schemes
Among various biochemical markers that have been proposed as an alternative tool for risk stratification, recent studies have underscored the value of renal dysfunction (RD) at diagnosis or of acute kidney injury (AKI) during hospital stay on the prognosis of patients with APE [7,8,9,10]
The cohort was split into 3 subgroups according to the estimated glomerular filtration rate (eGFR) measured on admission: Group 1 (n = 495) eGFR >60 mL/min/1.73 m2, group 2 (n = 106) eGFR 45 to 60 mL/min/1.73 m2, group 3 (n = 77) eGFR
Summary
Stratification in patients with acute pulmonary embolism (APE) remains a challenging issue, and there is an ongoing need for the identification of additional markers that can improve the predictive ability of current risk stratification schemes. The pulmonary embolism severity index (PESI) allows reliable assessment of 30-day outcome of patients with APE and performed better than the older Geneva prognostic score [1,2]. Among various biochemical markers that have been proposed as an alternative tool for risk stratification, recent studies have underscored the value of renal dysfunction (RD) at diagnosis or of acute kidney injury (AKI) during hospital stay on the prognosis of patients with APE [7,8,9,10]. Whereas the major strength of the simplified pulmonary embolism severity index (sPESI) lies in ruling out an adverse outcome in patients with sPESI of 0, the accuracy of sPESI ≥ 1 in risk assessment remains questionable. Conclusion: in patients with APE, the addition of RD to the sPESI score identifies a specific subset of patients at very high mortality
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a callDisclaimer: All third-party content on this website/platform is and will remain the property of their respective owners and is provided on "as is" basis without any warranties, express or implied. Use of third-party content does not indicate any affiliation, sponsorship with or endorsement by them. Any references to third-party content is to identify the corresponding services and shall be considered fair use under The CopyrightLaw.
