Abstract
BackgroundRapid stratification and appropriate treatment on admission are critical to saving lives of patients with acute pulmonary embolism (PE). None of the clinical prediction tools perform well when applied to all patients with acute PE. It may be important to integrate respiratory features into the 2014 European Society of Cardiology model. First, we aimed to assess the relationship between the arterial partial pressure of oxygen/fraction of inspired oxygen (PaO2/FIO2) ratio and in-hospital mortality, determine the optimal cutoff value of PaO2/FIO2, and determine if this value, which is quick and easy to obtain on admission, is a predictor of in-hospital mortality in this population. Second, we aimed to evaluate the potential additional determinants including laboratory parameters that may affect the in-hospital mortality.We hypothesized that the PaO2/FiO2 ratio would be a clinical prediction tool for in-hospital mortality in patients with acute PE.MethodsA prospective single-center observational cohort study was conducted in Beijing Hospital from January 2010 to November 2017. Arterial blood gas analysis data captured on admission, clinical characteristics, risk factors, laboratory data, imaging findings, and in-hospital mortality were compared between survivors and non-survivors. The area under the receiver operating characteristic curve (AUC) for in-hospital mortality based on the PaO2/FiO2 value was determined, and the association between the parameters and in-hospital mortality was analyzed by using logistic regression analysis.ResultsBody mass index, history of cancer, PaO2/FiO2 value, pulse rate, cardiac troponin I level, lactate dehydrogenase level, white blood cell count, D-dimer level, and risk stratification measurements differed between survivors and non-survivors. The optimal cutoff value of PaO2/FiO2 for predicting mortality was 265 (AUC = 0.765, P < 0.001). Only a PaO2/FiO2 ratio < 265 (95% confidence interval [CI] 1.823–21.483, P = 0.004), history of cancer (95% CI 1.161–15.927, P = 0.029), and risk stratification (95% CI 1.047–16.957, P = 0.043) continued to be associated with an increased risk of in-hospital mortality of acute PE.ConclusionA simple determination of the PaO2/FiO2 ratio at <265 may provide important information on admission about patients’ in-hospital prognosis, and PaO2/FiO2 ratio < 265, history of cancer, and risk stratification are predictors of in-hospital mortality of acute PE.
Highlights
Rapid stratification and appropriate treatment on admission are critical to saving lives of patients with acute pulmonary embolism (PE)
Exclusion criteria were patients who were currently enrolled in a therapeutic clinical trial with a blinded therapy or unable to be followed for 3 months, patients with acute myocardial infarction with an elevated troponin I (TNI) or creatine kinase (CK) level, and patients missing any of the variables necessary to calculate PaO2/FIO2
Among the 368 patients diagnosed with acute PE by lung scintigraphy or computed tomographic pulmonary angiography (CTPA) during the study period, 317 (86.1%) had acute PE confirmed by contrast-enhanced Computed tomography (CT), and 51 (13.9%) had acute PE confirmed by ventilation/perfusion lung scan
Summary
Rapid stratification and appropriate treatment on admission are critical to saving lives of patients with acute pulmonary embolism (PE). Most deaths in patients with shock occur within the first few hours after admission [2]; rapid stratification and appropriate treatment are critical to save patients’ lives. Of all the clinical prediction tools evaluated, the one proposed by the European Society of Cardiology (ESC) is the best at risk stratifying patients [5]. Several studies have still shown that more than 50% of patients with acute PE are hemodynamically stable on admission but have a high risk of death according to clinical models [6,7,8]. Another research study that assessed the ability of the 2014 ESC model to predict 30-day death after acute PE showed that stratification of patients at intermediate risk requires further improvement [9]. As more studies support the hypothesis of PE severity as a clinical continuum, it is important to find more scores, parameters, or biomarkers that would enable more accurate risk stratification in patients with acute PE [10]
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