Hypoxia as an independent predictor of adverse outcomes in pulmonary embolism

Abstract

Background The purpose of this study was to investigate the correlation between the computed tomography pulmonary artery obstruction index and parameters of functional lung impairment in acute pulmonary embolism, and establish the value of these parameters in prognosticating right ventricular dysfunction and 30-day mortality. Methods This study included 322 consecutive patients (mean age 45.6 ± 13.2 years, 46.9% male) with acute pulmonary embolism, free of other cardiopulmonary disease, who underwent computed tomography pulmonary angiography. Correlations of arterial CO, O, and alveolar-arterial oxygen gradient with the computed tomography pulmonary artery obstruction index, measured using the Qanadli score, were analyzed. Logistic regression was used to identify independent predictors of right ventricular dysfunction and 30-day mortality. Results Of the 322 patients, 196 (60.9%) had right ventricular dysfunction, and 58 (18.0%) died within 30 days. The pulmonary artery obstruction index had a significant correlation with partial pressures of arterial O ( r = -0.887, p < 0.001) and CO ( r = -0.618, p = 0.019) and alveolar-arterial oxygen gradient ( r = +0.874, p < 0.001). Arterial O pressure had a good predictive accuracy and discriminative power for both right ventricular dysfunction (sensitivity 80.6%, specificity 85.1%, area under the curve 0.91) and 30-day mortality (sensitivity 77.8%, specificity 82.0%, area under the curve 0.89). Conclusions In patients with acute pulmonary embolism, free of other cardiopulmonary disease, parameters of functional impairment have a strong correlation with computed tomography pulmonary artery obstruction index. Hypoxia is an independent predictor of both right ventricular dysfunction and 30-day mortality in these patients.

SpO2/FIO2 on Presentation as a Predictor for Early Hemodynamic Deterioration in Intermediate Risk Acute Pulmonary Embolism

“…In a series of 20 subjects free of previous cardiopulmonary disease and diagnosed with acute pulmonary embolism, McIntyre and Sasahara 14 observed a good correlation between P aO 2 and both cardiac index and the degree of pulmonary vascular obstruction measured by pulmonary angiography. Clinical studies also showed an association between hypoxemia and right-ventricular dysfunction 16,18 or elevated troponin levels, 10 both markers of the hemodynamic impact of acute pulmonary embolism.…”

“…Clinical studies that investigated the relationship between hypoxemia on presentation and outcome during acute pulmonary embolism brought mixed results: most studies reported lower P aO 2 in subjects with worse outcomes in all-risk 8,16 or intermediate-risk acute pulmonary embolism 24 ; however, hypoxemia was not an independent predictor of mortality in multivariate analyses. 18 In a study that focused on factors associated with early (5 d) clinical deterioration in 298 subjects with all-risk acute pulmonary embolism, factors independently associated with a severe outcome (as defined by the occurrence of either death, advanced cardiac life support, ventricular tachycardia or fibrillation, mechanical ventilation, vasopressors, thrombolysis, or thrombectomy) were systolic blood pressure Ͻ 90 mm Hg in the emergency department, elevated Nterminal pro-brain natriuretic peptide and right-ventricular strain on echocardiogram.…”

“…The severity of hypoxemia has generally been considered to be related to the degree of arterial obstruction 14 despite the lack of strong evidence and the observation that this may not be true in the presence of shock. 15 Hypoxemia has been associated with the presence of right-ventricular dysfunction, 16,17 and several studies reported more-frequent and/or severe hypoxemia in unselected subjects with pulmonary embolism and with a fatal outcome, although hypoxemia was not an independent predictor of mortality for most of these studies 7,8,10,18 A naturally arising question is whether hypoxemia on presentation is associated with an increased risk of hemodynamic deterioration in intermediate-risk pulmonary embolism. Indeed, in submassive pulmonary embolism not treated with thrombolytics, ϳ10% of patients develop worsening shock within a few days; 18 these patients may benefit from delayed thrombolytic therapy but mortality in this setting is significant, and tools to predict this clinical deterioration and perhaps guide early administration of thrombolytics are lacking.…”

MELD-Albumin score predicts 30-day mortality in high-risk patients with acute pulmonary embolism admitted to intensive care units

“…Renal and liver function may be compromised in patients with APE due to hemodynamic instability and decreased organ perfusion [30,31]. Moreover, the disturbed oxygenation may cause tissue hypoxia and further impair renal and hepatic function [32,33]. These ndings highlight the strong relationship between the MELD scores and mortality.…”

Discussion on Curative Effect and Safety of Small-dosage Alteplase Combined with Urokinase in Treatment of Acute Pulmonary Embolism

“…As time went on, patients' life safety would be threatened [4][5][6] . Niu Hongxia et al [7] indicated that, the state of pulmonary embolism is dangerous, pathogenesis is complex and clinical manifestations are not typical, so misdiagnosis and missed diagnosis cannot be avoided. The fatality rate can reach 20%-30%.…”