LDH as a predictor of in-hospital and late mortality in acute pulmonary embolism

Abstract

Purpose: Acute pulmonary embolism (PE) is a common cardiovascular emergency, which can be acute life-threatening and can have a dismal long-term prognosis. Prognostic assessment of these patients is based mainly on hemodynamic status, echocardiography findings and biochemical markers of myocardial injury. However, LDH measurement may have a role in the risk stratification of the patients. The aim of this study was to assess the value of LDH as a mortality predictor in acute PE. Methods: Retrospective, observational study including 165 patients with acute PE (age 72.8±16.4; 76 males), diagnosed by pulmonary CT angiography in the emergency department, between January 2010 and December 2010. The studied endpoints were in-hospital mortality and follow-up all-cause mortality. A receiver operating characteristics (ROC) curve was used to define the best cut-off between two groups [group 1 (LDH > 310 U/L, n=53) and group 2 (LDH ≤ 310 U/L, n=112)], regarding all-cause mortality. Mean follow-up time was 415±358 days. Results: No differences were found between the 2 groups regarding demographic data, symptoms and cardiovascular risk factors. Area under the ROC curve (AUC) was 0.626. The best cut off value was 310 U/L (sensitivity 54.5%, specificity 71.3%). In univariate regression analysis, a LDH higher than 310 U/L was found to be strongly associated with worse outcome [Hazard-ratio: 2.841 (95% CI, 1.226 – 6.584), p=0.015]. Patients from group 1 had a significantly higher in-hospital (18.2% vs. 7.4%, p<0.05) and long-term mortality (22.6% vs. 8.9%, Log-rank p<0.02). ![Figure][1] Kaplan-Meier survival analysis Conclusions: LDH is a predictor of both in-hospital and all-cause mortality at follow-up after acute PE. Its addition to current risk stratifying systems may be of interest. [1]: pending:yes