Risk stratification of poor short-term prognosis in patients with high-risk pulmonary embolism

Abstract

Background. Pulmonary embolism (PE) is the third leading cause of cardiovascular mortality. High-risk PE patients have more severe course of disease and poor prognosis. The question of additional factors which may be associated with prognosis in such patients remains poorly understood. The aim is to identify factors associated with mortality in high-risk PE patients and to determine contribution of these factors to the risk stratification of death. Materials and methods. A retrospective analysis of 635 medical cards of patients with PE diagnosis hospitalized in Kharkiv City Clinical Hospital 8 from January 1, 2017 to January 1, 2023 was conducted. The diagnosis was verified by multispiral computed tomography pulmonary angiography (CTPA) and/or by autopsy. Patients were divided into groups: group І — high-risk (113 — 17.8 %); group II — low-risk (522 — 82.2 %). Group I was divided into subgroups: IA — 63 (55.8 %) individuals, who were discharged from the hospital with improved status, IB — 50 (44.2 %) people, who died in hospital. Clinical, anamnestic, laboratory and instrumental parameters were measured. Statistical analysis was performed. Results. Patients from group I were older, there were more women among them. In subgroup ІВ, there are more women, more cases of obesity and deep vein thrombosis. Patients from group IB had lower blood oxygen saturation (SpO2) and systolic blood pressure (SBP), lower left ventricular ejection fraction (LVEF) measured by echocardiography. Bilateral segmental pulmonary embolism according to CTPA was more common in IB group. According to uni- and multivariate analysis, independent factors affecting in-hospital mortality in patients with high-risk PE were determined, among them: female gender, presence of bifurcation thrombus, lower SBP, SpO2, LVEF. Using the additional regression analysis, the formula for individual prediction of the risk of in-hospital mortality in high-risk PE patients was created. According to the receiver operating characteristic analysis, the sensitivity of the formula is 64.0 %, specificity is 92.1 %. The SBAFS (S — SpO2, B — Bifurcation thrombus, A — Arterial hypotension, F — left ventricular ejection Fraction, S — female Sex) score was formed, where the score of 2 or more indicates additional high risk of in-hospital mortality in high-risk PE patients. Conclusion. The high-risk PE patients who died during hospitalization had more cases of obesity, hypertension, lower SpO2, SBP, and LVEF, and there were more women among them. According to the multivariate logistic regression analysis, additional independent factors associated with in-hospital mortality in high-risk PE patients are female sex, thrombus in bifurcation of the pulmonary trunk, SpO2, SBP, LVEF. The formula for risk stratification of in-hospital death in high-risk PE patients was created and validated. The SBAFS score was formed to indicate additional high risk of in-hospital mortality in high-risk PE patients.

Keywords

• high-risk pulmonary embolism
• factors of unfavorable prognosis
• risk stratification formula for in-hospital death