Evaluation of factors affecting 90-day mortality in patients hospitalized due to pulmonary thromboembolism

Year 2021, Volume: 4 Issue: 5, 543 - 551, 05.09.2021

Derya Hoşgün , Semih Aydemir , Can Ateş

https://doi.org/10.32322/jhsm.925332

Abstract

Background: Pulmonary thromboembolism (PTE) is a leading cause of death from vascular events. In the pathophysiology of PTE, inflammatory mediators have been shown to be upregulated and to interact with coagulation factors.In this study, we aimed to investigate the role of symptoms, clinical and radiological findings, and the blood parameters measured at presentation within the first 24 h after the onset of the symptoms in predicting 90-day mortality and intensive care unit (ICU) requirement in patients with PTE.
Methods: The retrospective study included 264 PTE patients that were followed up at our Chest Diseases clinic and ICU between 2014 and 2019.
Results: The 264 patients comprised 55.3% women and 44.7% men with a mean age of 62.80±15.95 years. Of these, 189 of them were hospitalized in the Chest Diseases clinic and the remaining 75 patients were followed up at ICU. Total mortality occurred in 8 (3%) out of 264 patients. Risk factors for 90-mortality included white blood cell count (WBC), red blood cell distribution width (RDW), mean platelet volume (MPV)/RDW ratio, right ventricular dilatation (RVD), recombinant tissue plasminogen activator (rtPA) therapy, ICU hospitalization, and increased APACHE II (Acute Physiology and Chronic Health Evaluation II) scores (p<0.05).
Conclusion: The results indicated that TTE findings, baseline hemodynamic parameters and symptoms, rtPA therapy, and CBC parameters including WBC, NE, and RDW are significant risk factors for predicting both mortality and ICU requirement.

Keywords

Pulmonary embolism, Mortality, İnflammatory

References

• Konstantinides SV, Meyer G, Becattini C, et al. 2019 ESC Guidelines for the diagnosis and management of acute pulmonary embolism developed in collaboration with the European Respiratory Society (ERS): The Task Force for the diagnosis and management of acute pulmonary embolism of the European Society of Cardiology (ESC). Eur Respir J 2019: 54.
• Kusumoto FM, Schoenfeld MH, Barrett C, et al. 2018 ACC/AHA/HRS Guideline on the Evaluation and Management of Patients With Bradycardia and Cardiac Conduction Delay: Executive Summary: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines, and the Heart Rhythm Society. J Am Coll Cardiol 2019; 74: 932-87.
• Weitz JI, Chan NC. Novel antithrombotic strategies for treatment of venous thromboembolism. Blood 2020; 135: 351-9.
• Zhou XY, Chen HL, Ni SS. Red cell distribution width in predicting 30-day mortality in patients with pulmonary embolism. J Crit Care 2017; 37: 197-201.
• Agarval S. Red cell distribution width, inflammatory markers and cardiorespiratory fitness: Results from the National Health and Nutrition Examination Survey. Indian Heart J 2012; 64: 380-7.
• Montagana M, Cervelin G, Meschi T, Lippi G. The role of red blood cell distribution width in cardiovascular and thrombotic disorders. Clin Chem Lab Med 2011; 50: 635-41.
• Kovacs S, Csiki Z, Zsori KS, Shemirani AH. Characteristics of platelet count and size and diagnostic accuracy of mean platelet volUme in patients with venous thromboembolism. A systematic review and meta-analysis. Platelets 2019; 30: 139-47.
• Falk E, Shah PK, Fuster V.Coronary plague disruption.Circulation 1995; 92: 657-71.
• Ishaaya E, Tapson VF. Advances in the diagnosis of acute pulmonary embolism. F1000Res 2020; 9.
• Lee K, Kwon O, Lee EJ, et al. Prognostic value of echocardiographic parameters for right ventricular function in patients with acute non-massive pulmonary embolism. Heart Vessels 2019; 34: 1187-95.
• Serra W, Crisafulli E, Syerzellati N, et al. Transthoracic echocardiography and chest computed tomography arteriography in patients with acute pulmonary embolism: a two-year follow-up study. Respiration 2016; 92: 235-40.
• Hepburn-Brown M, Darvall J, Hammerschlag G. Acute pulmonary embolism: a concise review of diagnosis and management. Intern Med J 2019; 49: 15-27.
• Manuel A, Aufico A, Africanı R, et al. Clinical profile, management and outcomes of patients with pulmonary embolism: a retrospective tertiary centre study in Angola. Cardiovasc J A fr 2017; 28 356-61.
• Keller K, Hobohm L, Ebner M, et al. Trends in thrombolytic treatment and outcomes of acute pulmonary embolism in Germany. Eur Heart J 2020 ; 41: 522-29.
• Quezada A, Jimenez D, Bikdeli B, et al. Systolic blood pressure and mortality in acute symptomatic pulmonary embolism. Int J Cardiol 2020; 302: 157-63.
• Di Nisio M, van Es N, Büller HR. Deep vein thrombosis and pulmonary embolism. Lancet 2016; 388: 3060-73.
• Verma B, Singh AK. Use of reteplase for thrombolysis in patients with massive pulmonary embolism diagnosed by bedside transthoracic echocardiography: A retrospective study of safety and efficacy. J Family Med Prim Care 2019; 8: 3155-9.
• Goldhaber SZ, Buring JE, Lipnick RJ, Hennekens CH. Pooled analyses of randomized trials of streptokinase and heparin in phlebographically documented acute deep venous thrombosis. Am J Med 1984; 76: 393-7.
• Fanikos J, Rao A, Seger AC, et al. Hospital Costs of Acute Pulmonary Embolism. Am J Med 2013; 126: 127-32.
• Donadini MP, Dentali F, Castellaneta M, et al. Pulmonary embolism prognostic factors and length of hospital stay: A cohort study. Thromb Res 2017; 156: 155-9.
• Omar HR, Mirsaeidi M, Rashad R, et al. Association of serum albumin and severity of pulmonary embolism. Medicana (Kaunas) 2020; 9: 56.
• Bazouki G, Letsas KP, Vlachos K,   et al. Simple hematological predictors of AF recurrence in patients undergoing atrial fibrillation ablation. J Geriatr Cardiol 2019; 16: 671-5.
• Galliazzo S, Nigro O, Bertü L, et al. Prognostic role of neutrophils to lymphocytes ratio in patients with acute pulmonary embolism: a systematic review and metaanalysis of the literatüre. Intern Emerg Med 2018; 13: 603-8.
• Farah R, Nseir W, Kagansky D, Khamisy-Farah R. The role of neutrophil-lymphocyte ratio and mean platelet volüme in detecting patients with acute venous thromboembolism. J Clin Lab Anal 2020; 34: e23010.
• Hammons L, Filopel J, Steiger D, Bondarsky E. A narrative review of red blood cell distribution width as a marker for pulmonary embolism. J Thromb Thrombolysis 2019 ; 48: 638-47.
• Yu FT, Armstrong JK, Tripette J, Meiselman HJ, Cloutier G. A local increase in red blood cell aggreagation ca trigger deep vein thrombosis: evidence based on quantitative cellular ultrasound imaging. J Thromb Haemost 2011; 9: 481-8.
• Moharamzadeh P, Rahmani F, Foroughifar S, Shahsavarinia K. Reliability of Platelet Indices for Diagnosing Pulmonary Embolism; a Brief Report. Adv J Emerg Med 2019; 3: e27.
• Han JS, Park TS, Cho SY, Joh JH, Ahn HJ. Increased mean platelet volume and mean platelet volüme/platelet count ratio in Korean patients with deep vein thrombosis. Platelets 2013; 24: 590-3.
• Kostrubiec M, Labyk A, Pedowska-Wloszek J, et al. Mean platelet volume predicts early death in acute pulmonary embolism. Heart 2010; 96: 460-5.
• Kheirkman-Saberghadam S, Jenab Y, Ghoreyski-Hefzabad, et al. Association between elevated red blood cell distribution width and long-term mortality in acute pulmonary embolism.Turk J Med Sci 2018; 48: 318-23.
• Han YQ, Yan L, Zhang L,  et al. Red blood cell distribution width provides additional prognostic value beyond severity scores in adult critical illness. Clin Chim Acta 2019; 498: 62-6.