Prognostic factors for pulmonary embolism: the prep study, a prospective multicenter cohort study.
BACKGROUND
The short-term prognosis of pulmonary embolism (PE) depends on hemodynamic status and underlying disease. The prognostic value of right ventricular dysfunction and injury is less well established.


OBJECTIVE
To evaluate prognostic factors of PE in a multicenter prospective cohort study.


METHODS
Echocardiography, brain natriuretic peptide (BNP), N-terminal-proBNP and cardiac troponin I measurements were done on admission of 570 consecutive patients with an acute PE. A predictive model was based on independent predictors of 30-day adverse events defined as death, secondary cardiogenic shock, or recurrent venous thromboembolism.


RESULTS
At 30 days, 42 patients (7.4%; 95% confidence interval [CI], 5.5-9.8%) had adverse events. On multivariate analysis, altered mental state (odds ratio [OR] 6.8; 95% confidence interval [CI], 2.0-23.3), shock on admission (OR 2.8; 95% CI, 1.1-7.5), cancer (OR 2.9; 95% CI, 1.2-6.9), BNP (OR 1.3 for an increase of 250 ng/L; 95% CI, 1.1-1.6) and right to left ventricle diameter ratio (OR 1.2 for an increase of 0.1; 95% CI, 1.1-1.4) were associated with 30-days of adverse events. The predictive performance of the model was good (area under receiver operating characteristics curve 0.84 [95% CI, 0.78-0.90]), making it possible to develop a bedside prognostic score.


CONCLUSIONS
BNP and echocardiography may be useful determinants of the short-term outcome for patients with PE, together with clinical findings. Patients with PE can be stratified according to the initial risk of adverse outcome, using a simple score based on clinical, echocardiographic, and biochemical variables.
Sanchez
Olivier
O
Service de Pneumologie et Soins Intensifs, Hôpital Européen Georges Pompidou, 20 rue Leblanc 75015 Paris, France. olivier.sanchez@egp.aphp.fr
Trinquart
Ludovic
L
Caille
Vincent
V
Couturaud
Francis
F
Pacouret
Gérard
G
Meneveau
Nicolas
N
Verschuren
Franck
F
Roy
Pierre-Marie
PM
Parent
Florence
F
Righini
Marc
M
Perrier
Arnaud
A
Lorut
Christine
C
Tardy
Bernard
B
Benoit
Marie-Odile
MO
Chatellier
Gilles
G
Meyer
Guy
G
D000208:Acute Disease; D000368:Aged; D002423:Cause of Death; D015331:Cohort Studies; D004452:Echocardiography; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D008297:Male; D008875:Middle Aged; D015233:Models, Statistical; D015999:Multivariate Analysis; D020097:Natriuretic Peptide, Brain / Q000097:blood; D010446:Peptide Fragments / Q000097:blood; D011379:Prognosis; D011446:Prospective Studies; D011655:Pulmonary Embolism / Q000235:genetics* / Q000503:physiopathology*; D012008:Recurrence; D018570:Risk Assessment; D012770:Shock, Cardiogenic / Q000401:mortality / Q000503:physiopathology; D015996:Survival Rate; D019210:Troponin I / Q000097:blood; D054556:Venous Thromboembolism / Q000401:mortality / Q000503:physiopathology
D010446:Peptide Fragments; D019210:Troponin I; C109794:pro-brain natriuretic peptide (1-76); D020097:Natriuretic Peptide, Brain