Predictors of inhospital prognosis in acute pulmonary embolism

Abstract

The assessment of commonly available demographic, clinical, and easily calculable investigational parameters instead of the conventional complicated indices for prognosis in acute pulmonary embolism may help in triage in a simple and cost-effective way. Clinical, demographic, and investigational parameters were collected and utilized for the assessment of inhospital prognosis of acute pulmonary embolism in 200 consecutive patients admitted to our institute. Overall mortality was 18% and poor outcome at discharge was seen in another 18.5%. In univariate analysis, predominant presenting symptom of fatigue, sudden onset of symptoms, overt right ventricular failure, hypoxemia at admission, low SBP and DBP, coexistent pulmonary or cardiac illness, ECG evidence of right axis deviation, SIQ3T3 pattern, conduction blocks, echocardiographic evidence of right ventricular dysfunction, decreased inspiratory collapse of inferior vena cava, severe pulmonary arterial hypertension, visible thrombus in pulmonary artery, significant tricuspid regurgitation, computed tomographic evidence of total occlusion of major pulmonary arteries, diameter of main pulmonary artery, acute or chronic pulmonary embolism, renal and hepatic dysfunction, hyponatremia, hyperkalemia, troponin elevation, use of fibrin-specific agent, requirement of inotropic support, and mechanical ventilation were the variables found to significantly predict adverse outcome. In multivariate analysis, hypoxemia, no improvement after lysis, deranged liver function test, conduction blocks, and signs of right ventricular failure were the significant variables, while inotropic support requirement had a trend toward significance. Clinical, demographic, and routine investigational parameters help to risk-stratify the patients presenting with acute pulmonary embolism and to prognosticate and manage in a simpler yet effective way.

The value of electrocardiography in prognosticating clinical deterioration and mortality in acute pulmonary embolism: A systematic review and meta‐analysis

“…Twenty studies (4898 patients) reported data on in‐hospital mortality . Several ECG features were meta‐analyzed for this outcome (Table ).…”

“…Twenty studies (4898 patients) reported data on in-hospital mortality. [4][5][6][7]9,10,[13][14][15][16][17][18][19][20][21][22][23][24][25][26] Several ECG features were meta-analyzed for this outcome ( Table 2). Figure 2 shows 4 sample forest plots for the association between in-hospital mortality and each of the following ECG findings: S1Q3T3, any RBBB, TWI in precordial leads, and TWI in precordial or inferior leads.…”

“…Since the publication of the Daniel score, several other studies have investigated the use of ECG as a tool for PE prognostication. These studies expanded the use of ECG and included findings not included in the Daniel score, such as ST‐segment depression, ST‐segment elevation (STE), Qr in lead V 1 , right axis deviation (RAD), and P pulmonale, among others . A recent consensus article by the International Society of Electrocardiology, the International Society for Holter and Noninvasive Electrocardiology, and the Iberoamerican Forum of Arrhythmias in the Internet demonstrated the need for a formal and comprehensive evaluation of the evidence for the use of ECG to prognosticate PE …”

“…These studies expanded the use of ECG and included findings not included in the Daniel score, such as ST-segment depression, ST-segment elevation (STE), Qr in lead V 1 , right axis deviation (RAD), and P pulmonale, among others. [5][6][7][8][9][10] A recent consensus article by the International Society of Electrocardiology, the International Society for Holter and Noninvasive Electrocardiology, and the Iberoamerican Forum of Arrhythmias in the Internet demonstrated the need for a formal and comprehensive evaluation of the evidence for the use of ECG to prognosticate PE. 11 We aimed to comprehensively evaluate the data on ECG as a tool to prognosticate PE by performing a systematic review and meta-analysis of the available evidence.…”

Significance of ST-segment deviation in patients with acute pulmonary embolism and negative T waves

“…STDV is considered a common, but non--specific, ECG manifestation in patients with APE by some authors [11,12]. However, the literature suggests that the distribution of STDV has consistent regularity and mechanisms [6][7][8][9][13][14][15][16].…”