title: Predictors of early death in patients with acute pulmonary embolism.
abstract: OBJECTIVE
  We aimed to determine the predictors of early death in the course of acute pulmonary embolism (APE).
  
  
  METHODS
  We included 206 patients who had been admitted to our hospital between January 2011 and April 2013 with the diagnosis of APE. We derived a new model including corrected QT interval dispersion (QTcd) and P wave dispersion (Pd), echocardiographic findings, laboratory markers, and blood cell count indices to predict early death in patients with APE.
  
  
  RESULTS
  Thirty patients (14.5%) died; 176 patients (85.5%) lived after diagnosis of APE. Logistic regression (LR) analysis found that troponin I (odds ratio [OR], 1.084 [95% confidence interval {CI}, 1.009-1.165]), creatinine (OR, 4.153 [95% CI, 1.375-12.541]), mean platelet volume (OR, 1.991 [95% CI, 1.230-3.223]), neutrophil to lymphocyte ratio (NLR) (OR, 1.079 [95% CI, 1.005-1.160]), QTcd (OR, 1.084 [95% CI, 1.043-1.127]), Pd (OR, 1.049 [95% CI, 1.004-1.096]) were associated with early death in APE. New LR model (area under the curve [AUC], 0.970) performed better than the simplified pulmonary embolism severity index (sPESI) score (AUC, 0.859) in predicting early death in APE (P=.021). The predictivity of the sPESI score significantly improved after its single combination with creatinine, QTcd, or troponin I. When the combined model was constructed together with these 6 independent variables and sPESI score, stepwise LR model automatically excluded Pd and NLR, and the AUC from the rest of the combined model was 0.976, which is significantly different from the AUC of sPESI (0.859) (P=.0031).
  
  
  CONCLUSIONS
  Creatinine, troponin I, and QTcd significantly improves sPESI score. A new model with troponin I, creatinine, mean platelet volume, NLR, QTcd, and Pd seems to have greater prognostic power than the sPESI scoring system.
authors.affiliation: Department of Cardiology, Medical Faculty, Adnan Menderes University, Aydin 09100, Turkey. Electronic address: cagdasakgullu@gmail.com.
authors.forename: Çağdaş
authors.initials: Ç
authors.lastname: Akgüllü
authors.affiliation: Department of Biostatistics, Medical Faculty, Adnan Menderes University, Aydin 09100, Turkey.
authors.forename: İmran Kurt
authors.initials: İK
authors.lastname: Ömürlü
authors.affiliation: Department of Cardiology, Medical Faculty, Adnan Menderes University, Aydin 09100, Turkey.
authors.forename: Ufuk
authors.initials: U
authors.lastname: Eryılmaz
authors.affiliation: Emergency Department, Medical Faculty, Adnan Menderes University, Aydin 09100, Turkey.
authors.forename: Mücahit
authors.initials: M
authors.lastname: Avcil
authors.affiliation: Department of Cardiology, Medical Faculty, Adnan Menderes University, Aydin 09100, Turkey.
authors.forename: Evrin
authors.initials: E
authors.lastname: Dağtekin
authors.affiliation: Department of Cardiology, Medical Faculty, Adnan Menderes University, Aydin 09100, Turkey.
authors.forename: Mehmet
authors.initials: M
authors.lastname: Akdeniz
authors.affiliation: Department of Cardiology, Medical Faculty, Adnan Menderes University, Aydin 09100, Turkey.
authors.forename: Hasan
authors.initials: H
authors.lastname: Güngör
authors.affiliation: Department of Cardiology, Medical Faculty, Adnan Menderes University, Aydin 09100, Turkey.
authors.forename: Cemil
authors.initials: C
authors.lastname: Zencir
mesh_terms: D000208:Acute Disease; D003404:Creatinine / Q000097:blood; D004562:Electrocardiography; D005260:Female; D006454:Hemoglobins / Q000032:analysis; D006801:Humans; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D011655:Pulmonary Embolism / Q000097:blood / Q000401:mortality* / Q000503:physiopathology; D012307:Risk Factors; D018709:Statistics, Nonparametric; D019210:Troponin I / Q000097:blood
chemical_list: D006454:Hemoglobins; D019210:Troponin I; D003404:Creatinine