A prognostic model for short term adverse events in normotensive patients with pulmonary embolism

Abstract

Risk stratification of patients with PE has gained interest in terms of the identification of patients in whom treatment on an outpatient base can be considered. Previous studies are of limited value due to their focus on adverse clinical events within several months after diagnosis of PE. We developed a prognostic model, based on easily accessible, clinical, and laboratory parameters, to predict adverse events during the first 10 days after the diagnosis of acute PE. We have analyzed the data of 210 outpatients with confirmed PE. Collected data included medical history, pulse rate, blood pressure, NT-proBNP, and D-dimer concentrations. The primary outcome was the occurrence of adverse clinical events in a 10 day follow-up period. Our final prognostic model to predict short-term adverse events consists of NT-proBNP levels, D-dimer concentrations, pulse rate, and the occurrence of active malignancy; the total score ranges from 0 to 37 points. Patients with a low score (no active malignancy, pulse rate <90 bpm, NT-proBNP <500 pg/ml, and D-dimer <3,000 lg/l FEU) have a 10-day adverse event risk <1.5%. This risk increases to over 30% in patients with a maximum score, based on high pulse rate, D-dimer concentrations, and NT-proBNP levels. Our prognostic model, once prospectively validated in an independent sample of patients, can be used in the early risk stratification of PE to estimate the risk of adverse events and to differentiate between candidates for in-or out-hospital treatment. Am. J. Hematol. 86:646-649, 2011. V

White blood cell count and mortality in patients with acute pulmonary embolism

“…Evidence also suggests that the WBC count correlates with levels of fibrinogen, factor VII, and factor VIII [18]. Thus, an elevated WBC may be a marker for hypercoagulability, which may carry a worse prognosis [26]. Future prospective studies should examine whether an elevated WBC count reflects right ventricular dysfunction and hypercoagulability in patients with acute PE.…”

Validation of N-terminal pro-brain natriuretic peptide cut-off values for risk stratification of pulmonary embolism

“…However, only three analyses focused on haemodynamically stable patients [24,26,27]. To our best knowledge, a total of six studies have investigated the prognostic value of NT-proBNP concentrations on admission with regard to short-term clinical outcome in normotensive patients with acute pulmonary embolism [8,11,13,15,16,18]. These studies are summarised in table S1.…”

“…Concentrations of NT-proBNP were measured centrally in the laboratory of the Dept of Clinical Chemistry of the University of Göttingen, using a quantitative electrochemiluminescence assay (Elecsys 2010 analyser; Roche Diagnostics, Mannheim, Germany) as previously described [14]. Elevated NT-proBNP levels were defined as concentrations o300 pg?mL -1 [7], o500 pg?mL -1 [8][9][10], o600 pg?mL -1 [11][12][13] and o1000 pg?mL -1 [14][15][16]. Routine laboratory parameter measurements were performed at the Dept of Clinical Chemistry of the University of Göttingen, the Central Laboratory of Infant Jesus Teaching Hospital (Warsaw, Poland) and the Biochemistry Dept at Ramó n y Cajal Hospital.…”

“…However, the optimal cut-off values and, thus the contribution of NT-proBNP to clinical decision making, remain controversial. Four different NT-proBNP cut-off values have been proposed to distinguish between patients with low and elevated risk of short-term clinical adverse outcome: o300 pg?mL -1 [7], o500 pg?mL -1 [8][9][10], o600 pg?mL -1 [11][12][13], and o1000 pg?mL -1 [14][15][16]. Additionally, some authors investigated combination models based on NT-proBNP plus evidence of RV dysfunction on echocardiography [14,15,17], RV enlargement (right/left ventricle ratio o1.0) on computed tomography [11], or cardiac troponin T elevation [13,18].…”

Pulmonary embolism: clinical guidelines of European Society of Cardiology (2014).The Task Force of the European Society of Cardiology for diagnosis and management of pulmonary embolism

“…Вследствие этого для улучшения стратификации больных в регистровых и когортных исследованиях изучались различные сочетания клинических дан ных, визуализационных и лабораторных показа телей [222,246,[254][255][256][257][258][259]. Требуется дальнейшее изучение клинического значения большинства этих методов прогноза и шкал, особенно применительно к лечебной тактике.…”