Highlights
- •Risk stratification for acute pulmonary embolism ignores respiratory function.
- •PO2 and DLCO%pred correlated with indicators used for risk stratification.
- •PO2, PO2*DLCO%pred, and PO2 of <8 kPa were predictors of 30-day all-cause death.
Abstract
Background
Risk stratification for acute pulmonary embolism (PE) ignores the roles of respiratory
function and gas exchange. We aimed to identify the role of arterial partial pressure
of oxygen (PO2) and diffusion function as prognostic biomarkers.
Methods
We collected the data from hospitalised patients with acute PE. We used Spearman's
correlation coefficient and Cox regression analysis to explore the clinical and prognostic
values of PO2 and predicted percentage diffusing lung capacity for carbon monoxide (DLCO%pred)
to predict the 30-day mortality.
Results
We included 309 patients (mean age: 67.93 ± 13.31 years); 46.6% were men, and 12.62%
were haemodynamically unstable. The 30-day all-cause mortality rates in the high-,
intermediate high-, intermediate low-, and low-risk groups were 7.7%, 4.7%, 2.9%,
and 0.0%, respectively (P < 0.05). PO2 (P = 0.012) and DLCO%pred (P = 0.036) were significantly different between the four
risk groups. There were strong correlations between PO2, DLCO%pred, PO2*DLCO%pred, and other markers (P < 0.05), especially troponin I, N-terminal pro-brain
natriuretic peptide, and systolic pulmonary artery pressure. PO2 and PO2*DLCO%pred were prognostic factors for death in haemodynamically stable patients (hazard
ratio [HR] 0.618, 95% confidence interval [CI] 0.389–0.980, P = 0.041, and HR 0.501,
95% CI 0.26–0.96, P = 0.036, respectively). A lower PO2 (<8 kPa) was associated with a higher risk of mortality in all patients and in haemodynamically
stable ones (HR 9.462, 95% CI 2.365–37.860, P = 0.001, and HR 6.597, 95% CI 1.102–39.495,
P = 0.039, respectively).
Conclusions
PO2, PO2*DLCO%pred, and PO2 < 8 kPa were predictors of 30-day all-cause mortality in all patients and haemodynamically
stable ones.
Trial registration
ChiCTR2000030448.
Keywords
Abbreviations:
PE (pulmonary embolism), PO2 (partial pressure of oxygen), DLCO%pred (predicted percentage diffusing lung capacity for carbon monoxide), VTE (venous thromboembolism), V/Q (ventilation-perfusion), CTPA (computed tomographic pulmonary angiography), CKD-EPI (Chronic Kidney Disease Epidemiology Collaboration), TNI (troponin I), NT-proBNP (N-terminal pro-brain natriuretic peptide), SD (standard deviation), IQR (interquartile range), HR (hazard ratio), CI (confidence interval), PESI (Pulmonary Embolism Severity Index), sPESI (simplified Pulmonary Embolism Severity Index)To read this article in full you will need to make a payment
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Article info
Publication history
Published online: February 26, 2022
Accepted:
February 24,
2022
Received in revised form:
February 23,
2022
Received:
September 25,
2021
Identification
Copyright
© 2022 Elsevier Ltd. All rights reserved.
