Outcomes and incremental prognostic value of renal dysfunction after acute pulmonary embolism

Abstract

Outcomes in patients with acute pulmonary embolism (PE) and renal function impairment are unknown. We explored the relation between adverse outcomes after acute PE and renal dysfunction classified by estimated glomerular filtration rate (eGFR) using the CKD-EPI equation. In addition, the incremental value of adding eGFRCKD-EPI to the European Society of Cardiology (ESC) score for predicting 30-day mortality. Prospective, observational, multicenter, study including 1664 acute PE admitted from 01/2011 to 12/2017. Patients were categorized in 4 groups according to eGFR: Group 1 (eGFR ≥ 60 ml/min/1.73 m 2 , n = 1178), group 2 (45–59 ml/min/1.73 m 2 , n = 257); group 3 (30–44 ml/min/1.73 m 2 , n = 150) and group 4 (≤ 29 ml/min/1.73m 2 , n = 79). All-cause and cardiovascular death at 30 days and 6 months was higher in group 3 ( P = 0.005 and P = 0.03 respectively) and in group 4 ( P < 0.001 and P < 0.001 respectively) versus group 1. Major bleeding at 30 days and 6 months was higher in group 2 ( P = 0.003) versus group 1 ( P = 0.003 and P = 0.003, respectively). Renal function impairment combined with the ESC prognostic algorithm for the prediction of 30-day mortality improved the discriminatory capacity of the model and enabled reclassification in different risk categories in 27% of the patients ( Table 1 ). Renal function impairment increases the rate of adverse events after acute PE. Combined with the ESC early mortality risk score, eGFR improves risk classification. Model fit, discrimination, prognostic performances, and reclassification indices when eGFRCKD-EPI is added to the European Society of Cardiology prognostic algorithm for the prediction of the 30-day all-cause death after an acute pulmonary embolism.