Helical CT pulmonary angiography predictors of in-hospital morbidity and mortality in patients with acute pulmonary embolism.
OBJECTIVE
To determine if CT variables predict in-hospital morbidity and mortality in patients with pulmonary embolism (PE).


METHODS
CT scans and charts of 173 patients with CT scans positive for PE were reviewed. CT scans were reviewed for leftward ventricular septal bowing, increased right ventricle (RV) to left ventricle (LV) diameter ratio, clot burden, increased pulmonary artery to aorta diameter ratio, and oligemia. Charts were reviewed for severe morbidity and mortality outcomes: death from pulmonary emboli or any cause, and cardiac arrest. Charts were also reviewed for milder morbidity outcomes: intubation, vasopressor use, or admission to an intensive care unit (ICU) and for multiple comorbidities.


RESULTS
No CT predictor was significantly associated with severe morbidity or mortality outcomes. Ventricular septal bowing and increased RV/LV diameter ratio were both associated with subsequent admission to an ICU (P = 0.004 and P = 0.025, respectively). Oligemia (either lung) was associated with subsequent intubation; right lung oligemia was associated with the subsequent use of vasopressors. After controlling for history of congestive heart failure, ischemic heart disease, and pulmonary disease, both septal bowing and an increased RV/LV diameter ratio remained associated with admission to an ICU.


CONCLUSIONS
No CT variables predicted severe in-hospital morbidity and mortality (death from pulmonary embolism, death from any cause, or cardiac arrest) in patients with PE. However, ventricular septal bowing and increased RV/LV diameter ratio were both strongly predictive of less severe morbidity, namely, subsequent ICU admission, and oligemia was associated with subsequent intubation and vasopressor use.
Araoz
Philip A
PA
Department of Radiology, University of California, San Francisco, CA 94110, USA.
Gotway
Michael B
MB
Trowbridge
Robert L
RL
Bailey
Richard A
RA
Auerbach
Andrew D
AD
Reddy
Gautham P
GP
Dawn
Samuel K
SK
Webb
W Richard
WR
Higgins
Charles B
CB
D000208:Acute Disease; D000792:Angiography; D015897:Comorbidity; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D008168:Lung / Q000000981:diagnostic imaging; D008297:Male; D008875:Middle Aged; D009017:Morbidity; D015999:Multivariate Analysis; D011655:Pulmonary Embolism / Q000000981:diagnostic imaging* / Q000453:epidemiology; D012189:Retrospective Studies; D036542:Tomography, Spiral Computed; D018497:Ventricular Dysfunction, Right / Q000453:epidemiology