Fine – tuning of risk prediction in PE: GFR and sPESI combined – powerful predictor of survival in patients with pulmonary embolism

Fine – tuning of risk prediction in PE

Abstract

 Background/Aim. Patients with sPESI class 0 represented as a low-risk pulmonary embolism (PE). However, several laboratory and echocardiographic parameters not included in sPESI score, may represent the features of worse outcome in PE.

This study aims to investigate whether adding brain natriuretic peptide (BNP) and troponin I (TnI) levels, echocardiographic parameters or glomerular filtration rate to sPESI can improve its prognostic value in the acute PE.

Methods

The study involved 1201 consecutive patients with PE, which was confirmed using MDCT. All patients underwent echocardiography examination on admission and blood samples were collected for TnI, B-type natriuretic peptide (BNP), creatinine as for other routine laboratory analyses.

Results

The intra-hospital mortality rate was 11.5%. Using a three level sPESI model: sPESI 0, sPESI 1 and sPESI 2, patients were divided into three groups. There were statistically significant differences in mortality rates and BNP values, as well as in TnI, eGFR values and in the presence of the right ventricular dysfunction (RVD) between the groups based on sPESI score. In the Cox regression analysis the best predictor of 30-days all-cause mortality rate was eGFR [HR 2.24 (CI 1.264-3.969); p=0.006] in all three sPESI groups. Neither TnI, BNP or RVD improved risk assessment in combination with different stratification tool based on a three level sPESI model.

Conclusion

Renal dysfunction on admission, in patients with acute PE, is strongly associated with high intrahospital mortality risk. sPESI score threefold model can be used as a more accurate prognostic stratification tool in pataients with acute pulmonary embolism.