Prognostic factors for pulmonary embolism: the prep study, a prospective multicenter cohort study

Area of Science:

• Cardiology
• Pulmonary Medicine
• Critical Care Medicine

Background:

• Short-term prognosis for pulmonary embolism (PE) is influenced by hemodynamic status and comorbidities.
• The prognostic significance of right ventricular dysfunction and injury in PE remains less understood.

Purpose of the Study:

• To identify and evaluate prognostic factors for adverse outcomes in patients with acute pulmonary embolism (PE).
• To develop a predictive model for 30-day adverse events in PE patients using a multicenter prospective cohort.

Main Methods:

• Prospective enrollment of 570 consecutive patients diagnosed with acute PE.
• Collected data included echocardiography, brain natriuretic peptide (BNP), N-terminal-proBNP, and cardiac troponin I levels on admission.
• A predictive model was constructed using independent predictors of 30-day adverse events (death, shock, or recurrent VTE).

Main Results:

• The 30-day adverse event rate was 7.4% (42 patients).
• Independent predictors of adverse events included altered mental state, shock on admission, cancer, elevated BNP, and increased right/left ventricle diameter ratio.
• The predictive model demonstrated good performance (AUC 0.84), enabling the development of a bedside prognostic score.

Conclusions:

• Brain natriuretic peptide (BNP) and echocardiographic findings are valuable in determining short-term outcomes for PE patients.
• A simple prognostic score integrating clinical, echocardiographic, and biochemical variables can stratify PE patients by initial risk of adverse outcomes.