Predictive value of clinical and laboratory parameters in differentiating hypertensive pulmonary edema and acute pulmonary embolism.

Abstract

Pulmonary embolism and acute pulmonary edema can often be confused. The aim of this study is to investigate the role of clinical and laboratory parameters in the differentiation of these two pathologies. Between March 2017 and December 2021, a total of 114 patients (51 patients with acute hypertensive pulmonary edema and 63 patients with pulmonary embolism) were included in the study. The medical history, hemodynamic findings, main echocardiographic data, and routine laboratory markers were recorded, retrospectively. Coronary artery disease (CAD), chronic obstructive pulmonary disease (COPD), and recent operation histories were found as more common concomitant disorders in the pulmonary embolism group (p = 0.001, p = 0.011, p = 0.001, respectively). In addition, patients with pulmonary embolism had a higher heart rate (p = 0.001) and systolic pulmonary artery pressure (SPAP) (p = 0.001) compared to those with hypertensive pulmonary edema, while patients with hypertensive pulmonary edema had higher blood pressure (p = 0.001). While significantly low albumin levels (p = 0.001) were found among blood parameters in the pulmonary embolism group, D-Dimer, fibrinogen, troponin, alanine aminotransferase (ALT), aspartate aminotransferase (AST), lactate dehydrogenase (LDH), creatine kinase myocardial band (CK-MB), red blood cell distribution width (RDW), and creatinine values were found to be higher (p < 0.001). The most sensitive (95%) and specific (92%) clinical parameter was the SPAP with a 19.00 mmHg cut-off level. Additionally, the most sensitive (98%) and specific (97%) laboratory parameter was the D-Dimer, with a 260.5 ng/mL cut-off level. Especially simple blood parameters such as D-dimer and echocardiographic evaluation of SPAP seem to be quite effective in distinguishing pulmonary embolism from hypertensive pulmonary edema.