Clinical and laboratory characteristics in the patients with pulmonary embolism

Abstract

Pulmonary embolism is a common disorder that is accompanied by significant morbidity and mortality. This study attempts to determine the clinical and laboratory characteristics of established acute pulmonary embolism in the medical intensive care unit. Between 1 January 2002 and 1 November 2003, 33 consecutive patients admitted to the Medical ICU had a diagnosis of acute pulmonary embolism proved by angiography. There were 21 men (63%) and 12 women (37%), with a mean age of 63.7 ± 12.6 years (range, 23–90 years). Whereas only eight of these 33 patients had associated deep vein thrombosis, 11 patients had heart failure, nine had diabetes mellitus, eight had associated malignancy, and seven patients had hypertension. Sudden onset dyspnea (69%), palpitations (21%), cough (18%), and pleuritic chest pain (12%) were the most common comlaints. Tachycardia (33%), tachypnea (27%), and crackles (15%) were the most common findings on physical examination. Fourteen of 33 patients had normal effusion, nine had pleural effusion and five had hilar effusion, and seven had atelectasia findings on chest X-ray. ECG findings were normal in eight patients (24%), inverted precordial T waves in nine patients (27%), atrial fibrillation in seven patients (21%), and nonspecific ST segment abnormalities in four patients (12%). Echocardiografic examination of patients revealed that 18 of 33 patients had normal findings (54%), 10 patients had pulmonary hypertension (30%) and five of them had right atrial enlargement (16%). Biochemical analysis results were within normal range in nine patients (27%), whereas LDH elevation in 17 (51%) and AST elevation in 13 patients (40%) were detected. Arterial blood gas analysis results gave that CO2 and O2 levels were below the reference values in 27 of 33 patients (81%). Mean APACHE II scores were 13.03 ± 4.01 points (range 5–17). The average ICU length of stay was 11.7 ± 3.3 days, and 24 of 33 patients (72%) were discharged home after that period. Nine of 10 patients diagnosed with massive embolism and complicated conditions (e.g. diabetes, heart failure) died before day 3 (28%). This study's results showed, similar to the literature, that pulmonary embolism has challenges with a considerably high mortality rate. Future research should be planned on more accurate and specific diagnostic tests, which probably will improve mortality rates.