The risk factors for all-cause in-hospital death in patients with acute pulmonary embolism

Abstract

Introduction: Patient risk stratification is important in managing individuals with suspected acute pulmonary embolism (APE). The aim of this study was to determine risk factors for in-hospital mortality among real-world patients who had undergone computed tomography pulmonary angiography (CTPA) due to suspected APE. Material and methods: Retrospective analysis of clinical data extracted from the medical documentation of 700 consecutive patients in whom CTPA was performed due to APE suspicion. Results: APE was confirmed in 22.7% of the patients in the sample. In-hospital death was recorded in 10.1% and 12.4% of patients with and without APE confirmed in CTPA, respectively. APE-related death was diagnosed in 37.5% of the APE patients who died during hospitalization. Compared to patients who were discharged from hospital, those who died during hospitalization had a greater prevalence of comorbidities (e.g., neoplasm) and higher values of laboratory determinations and prognostic rule scores. An age-adjusted high-sensitivity troponin I (hs-TNI) cut-off and Pulmonary Embolism Severity Index (PESI) score were found to be independent risk factors of in-hospital death, but only in the whole study group and in patients without APE confirmed in CTPA. The area-under-the-curve value for all the parameters studied was lower than 0.6. Conclusions: Age-adjusted hs-TNI cut-off and PESI score were independent risk factors for in-hospital death in patients with APE suspicion. The predictive power of standard stratifying tools is insufficient in real-world patients with suspected APE. Patients with suspected APE require careful diagnosis and management of comorbidities because these may affect the in-hospital mortality rate.