title: Prognostic factors for pulmonary embolism: the prep study, a prospective multicenter cohort study.
abstract: 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.
authors.affiliation: Service de Pneumologie et Soins Intensifs, Hôpital Européen Georges Pompidou, 20 rue Leblanc 75015 Paris, France. olivier.sanchez@egp.aphp.fr
authors.forename: Olivier
authors.initials: O
authors.lastname: Sanchez
authors.forename: Ludovic
authors.initials: L
authors.lastname: Trinquart
authors.forename: Vincent
authors.initials: V
authors.lastname: Caille
authors.forename: Francis
authors.initials: F
authors.lastname: Couturaud
authors.forename: Gérard
authors.initials: G
authors.lastname: Pacouret
authors.forename: Nicolas
authors.initials: N
authors.lastname: Meneveau
authors.forename: Franck
authors.initials: F
authors.lastname: Verschuren
authors.forename: Pierre-Marie
authors.initials: PM
authors.lastname: Roy
authors.forename: Florence
authors.initials: F
authors.lastname: Parent
authors.forename: Marc
authors.initials: M
authors.lastname: Righini
authors.forename: Arnaud
authors.initials: A
authors.lastname: Perrier
authors.forename: Christine
authors.initials: C
authors.lastname: Lorut
authors.forename: Bernard
authors.initials: B
authors.lastname: Tardy
authors.forename: Marie-Odile
authors.initials: MO
authors.lastname: Benoit
authors.forename: Gilles
authors.initials: G
authors.lastname: Chatellier
authors.forename: Guy
authors.initials: G
authors.lastname: Meyer
mesh_terms: 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
chemical_list: D010446:Peptide Fragments; D019210:Troponin I; C109794:pro-brain natriuretic peptide (1-76); D020097:Natriuretic Peptide, Brain