Risk stratification of patients with pulmonary embolism based on pulse rate and D-dimer concentration

Abstract

To enable outpatient treatment of a selected group of patients with pulmonary embolism (PE), insight in the determinants of adverse clinical outcome is warranted. We have identified risk factors for serious adverse events (SAE) within the first 10 days of acute PE. We have retrospectively analysed data of 440 consecutive patients with acute PE. Collected data included age, gender, medical history, blood pressure, pulse rate and D-dimer concentration. The variables associated with SAE in the first 10 days in univariate analysis (p<0.15) have been included in a multivariate logistic regression model (backward conditional, p out >0.10). In 440 patients with acute PE, 20 SAEs occurred in a 10-day follow-up period. Pulse rate > or = 100 beats per minute (bpm) (OR, 6.85; 95%CI 1.43-32.81) and D-dimer concentration > or = 3,000 microg/ml (OR, 5.51; 95%CI 0.68-44.64) were significantly related to the SAEs. All SAEs were predicted by a pulse rate > or = 100 bpm and/or a D-dimer concentration > or = 3,000 microg/ml. Older age, gender, history of venous thromboembolism (VTE), heart failure, chronic obstructive pulmonary disease, cancer or a systolic blood pressure < 90 mm Hg had no significant influence on short term SAEs. Pulse rate and D-dimer concentration can be used to identify patients with acute PE, who are at risk for adverse clinical outcome during the first 10 days of hospitalisation. Outpatient treatment of PE-patients with a pulse rate > or = 100 bpm and/or a D-dimer concentration > or = 3,000 microg/ml has to be discouraged.

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

“…This study confirms the findings in our previous study that the D-dimer concentration is also an independent predictor for short-term SAE [29]. In the study of Klok et al, a D-dimer cut-off level of >3,000 lg/l FEU was a strong predictor for the two-week mortality rate [28].…”

“…The cut-off levels for D-dimer were based on previous studies in which D-dimer with a cut-off level >3,000 lg/l FEU was a strong predictor for short-term [28,29]. The chosen cut-off level for NT-proBNP of >500 pg/ml was based on our previous study in which outpatient treatment of PE-patients was based on NT-proBNP levels <500 pg/ml [30].…”

Value of Cardiac Troponin and sPESI in Treatment of Pulmonary Thromboembolism at Outpatient Setting

“…Different models have been used to select the patients who were candidates for outpatient treatment among those diagnosed with acute PTE. Potential outpatients have been determined based on PESI, Hestia criteria, and markers of myocardial injury in some studies [5,[7][8][9][10]. However, considering these risk models alone and determining a standard approach is actually not possible.…”

Pulmoner Embolide Şiddet ve Prognozun Değerlendirilmesi

“…Ghanima ve ark'ları, Ddimer ile PAOI, RV/LV ve cTnT arasında anlamlı bir ilişki tespit etmişler 70 . Litratürde yapılan başka bir çalışmada, D-dimer'in PE için güçlü bir kısa dönem prognostik belirteç olduğu gösterilmiştir 71 . Ancak yapılan farklı bir çalışmada ise kısa dönem mortalite ile D-dimer arasında bir ilişki tespit edilememiştir 72 .…”

“…Bu anlamda, NPD etkilemeksizin özellikle PPD'de anlamlı yükselmeler sağlandığı gösterilmiştir 20,21,58,66,71,78,80 . PESI ya da sPESI ile biyobelirteç ya da görüntüleme yöntemlerini birleştirmenin en uygun yöntem olacağı belirtilmektedir.…”