Blood pressure for outcome prediction and risk stratification in acute pulmonary embolism.
BACKGROUND
Risk stratification of patients with acute pulmonary embolism (PE) is crucial in deciding appropriate therapy management. Blood pressure (BP) is rapidly available and a reliable parameter. We aimed to investigate BP for short-term outcome in acute PE.


METHODS
Data of 182 patients with acute PE were analyzed retrospectively. Logistic regression models were calculated to investigate associations between BP and in-hospital-death as well as myocardial necrosis. Moreover, receiver operating characteristic (ROC) curves and cutoff values for systolic and diastolic BPs predicting in-hospital death and myocardial necrosis were computed.


RESULTS
A total of 182 patients (61.5% female; mean age, 68.5 ± 15.3 years) with acute PE event were included in the study. Five patients (2.7%) died in the hospital. Logistic regression models showed a significant association between in-hospital death and systolic BP ≤ 120 mm Hg (odds ratio [OR], 22.222; 95% confidence interval [CI], 2.370-200.00; P = .00660), systolic BP ≤ 110 mm Hg (OR, 22.727; 95% CI, 3.378-142.857; P = .00130), systolic BP ≤ 100 mm Hg (OR, 16.129; 95% CI, 2.304-111.111; P = .00513), systolic BP ≤ 90 mm Hg (OR, 22.727; 95% CI, 3.086-166.667'; P = .00220), and diastolic BP ≤65 mm Hg (OR, 14.706; 95% CI, 1.572-142.857; P = .0184), respectively. Association between myocardial necrosis and systolic BP0 >100 mm Hg (OR, 5.444; 95% CI, 1.052-28.173; P = .0433) was also significant. Receiver operating characteristic analysis for systolic BP predicting in-hospital death revealed an area under the curve of 0.831 with a cutoff value of 119.5 mm Hg. Receiver operating characteristic analysis for diastolic BP predicting in-hospital death showed an area under the curve of 0.903 with a cutoff value of 66.5 mm Hg.


CONCLUSIONS
Systolic and diastolic BPs are excellent prognosis predictors of patients with acute PE. Systolic BP of 120 mm Hg or less and diastolic BP of 65 mm Hg or less at admission are connected with elevated risk of in-hospital death.
Department of Medicine II, University Medical Center Mainz, Johannes Gutenberg-University Mainz, Mainz, Germany; Center for Thrombosis and Hemostasis, University Medical Center Mainz, Johannes Gutenberg-University Mainz, Mainz, Germany. Electronic address: Karsten.Keller@unimedizin-mainz.de.
Karsten
K
Keller
Department of Internal Medicine, St. Vincenz and Elisabeth Hospital Mainz (KKM), Mainz, Germany.
Johannes
J
Beule
Department of Radiology and Nuclear Medicine, Catholic Clinic Mainz (KKM), Mainz, Germany; Department of Diagnostic and Interventional Radiology, University Clinic, Johann Wolfgang Goethe-University Frankfurt/Main, Frankfurt, Germany.
Jörn Oliver
JO
Balzer
Department of Internal Medicine, St. Vincenz and Elisabeth Hospital Mainz (KKM), Mainz, Germany.
Wolfgang
W
Dippold
D000208:Acute Disease; D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001794:Blood Pressure; D001795:Blood Pressure Determination; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D009206:Myocardium / Q000473:pathology*; D009336:Necrosis / Q000209:etiology; D011379:Prognosis; D011655:Pulmonary Embolism / Q000150:complications / Q000175:diagnosis / Q000401:mortality / Q000503:physiopathology*; D012372:ROC Curve; D012189:Retrospective Studies; D018570:Risk Assessment; D055815:Young Adult