Predictors of hospital mortality in hemodynamically stable patients with pulmonary embolism.
BACKGROUND
Pulmonary embolism is associated with high mortality in patients with hypotension or circulatory shock. However, the association between some clinical variables and mortality is still unclear in hemodynamically stable patients.


OBJECTIVE
To derive an in-hospital mortality risk stratification model in hemodynamically stable patients with pulmonary embolism.


METHODS
This is a prospective multicenter cohort study of 582 consecutive patients admitted in emergency units or intensive care units with clinically suspected pulmonary embolism and whose diagnosis was confirmed by one or more of the following tests: pulmonary arteriography, spiral CT angiography, magnetic resonance angiography, Doppler echocardiography, pulmonary scintigraphy, or venous duplex scan. Data on demographics, comorbidities and clinical manifestations were collected and included in a logistic regression analysis so as to build the prediction model.


RESULTS
Overall mortality was 14.1%. The following parameters were identified as independent death risk variables: age > 65 years, bed rest > 72h, chronic cor pulmonale, sinus tachycardia, and tachypnea. After risk stratification, mortalities of 5.4%, 17.8%, and 31.3% were found in the low, moderate and high-risk subgroups, respectively. The model showed 65.5% sensitivity and 80% specificity, with a 0.77 area under the curve.


CONCLUSIONS
In hemodynamically stable patients with pulmonary embolism, age > 65 years, bed rest > 72h, chronic cor pulmonale, sinus tachycardia and tachypnea were independent predictors of in-hospital mortality. However, further validation of the prediction model in other populations is required so that it can be incorporated into the clinical practice.
Hospital Pró-Cardíaco, Rio de Janeiro, RJ, Brazil. volschan@cardiol.br
André
A
Volschan
Denilson
D
Albuquerque
Bernardo Rangel
BR
Tura
Marcos
M
Knibel
José Péricles
JP
Esteves
Luiz Carlos
LC
Bodanese
Francisco
F
Silveira
João
J
Pantoja
Paulo Cesar Pereira da Silva e
PC
Souza
João
J
Mansur
Evandro Tinoco
ET
Mesquita
D000293:Adolescent; D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D001510:Bed Rest / Q000009:adverse effects; D002908:Chronic Disease; D004812:Epidemiologic Methods; D005260:Female; D006439:Hemodynamics; D017052:Hospital Mortality; D006801:Humans; D008297:Male; D008875:Middle Aged; D011655:Pulmonary Embolism / Q000175:diagnosis / Q000401:mortality*; D011660:Pulmonary Heart Disease / Q000150:complications; D012893:Sleep Wake Disorders / Q000150:complications; D013616:Tachycardia, Sinus / Q000150:complications; D055815:Young Adult