Clinical predictors for fatal pulmonary embolism in 15,520 patients with venous thromboembolism: findings from the Registro Informatizado de la Enfermedad TromboEmbolica venosa (RIETE) Registry.
BACKGROUND
Clinical predictors for fatal pulmonary embolism (PE) in patients with venous thromboembolism have never been studied.


RESULTS
Using data from the international prospective Registro Informatizado de la Enfermedad TromboEmbolica venosa (RIETE) registry about patients with objectively confirmed symptomatic acute venous thromboembolism, we determined independent predictive factors for fatal PE. Between March 2001 and July 2006, 15 520 consecutive patients (mean age+/-SD, 66.3+/-16.9 years; 49.7% men) with acute venous thromboembolism were included. Symptomatic deep-vein thrombosis without symptomatic PE was observed in 58.0% (n=9008) of patients, symptomatic nonmassive PE in 40.4% (n=6264), and symptomatic massive PE in 1.6% (n=248). At 3 months, the cumulative rates of overall mortality and fatal PE were 8.65% and 1.68%, respectively. On multivariable analysis, patients with symptomatic nonmassive PE at presentation exhibited a 5.42-fold higher risk of fatal PE compared with patients with deep-vein thrombosis without symptomatic PE (P<0.001). The risk of fatal PE was multiplied by 17.5 in patients presenting with a symptomatic massive PE. Other clinical factors independently associated with an increased risk of fatal PE were immobilization for neurological disease, age >75 years, and cancer.


CONCLUSIONS
PE remains a potentially fatal disease. The clinical predictors identified in the present study should be included in any clinical risk stratification scheme to optimally adapt the treatment of PE to the risk of the fatal outcome.
Laporte
Silvy
S
Clinical Pharmacology Department, Thrombosis Research Group, EA 3065, University Hospital of Saint-Etienne Bellevue, 42055 Saint-Etienne cedex 02, France. silvy.laporte@chu-st-etienne.fr
Mismetti
Patrick
P
Décousus
Hervé
H
Uresandi
Fernando
F
Otero
Remedios
R
Lobo
Jose Luis
JL
Monreal
Manuel
M
D000368:Aged; D000369:Aged, 80 and over; D015331:Cohort Studies; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D038622:Internationality; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D011446:Prospective Studies; D011655:Pulmonary Embolism / Q000150:complications / Q000401:mortality*; D012042:Registries; D012307:Risk Factors; D013030:Spain / Q000453:epidemiology; D020246:Venous Thrombosis / Q000150:complications / Q000401:mortality*