Prognostic Value of Renal Dysfunction Indicators in Normotensive Patients With Acute Pulmonary Embolism

Glomerular filtration rate (GFR) and blood urea nitrogen (BUN) are important prognostic indicators for cardiovascular disease. However, data on the relationship between renal dysfunction (RD) and prognosis in patients with acute pulmonary embolism (APE) are limited. The estimated-GFR (eGFR), based on the Modification of Diet in Renal Disease (MDRD) equation, has been suggested as a possible prognostic marker in patients with APE; however, at present, the Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) equation is thought to be more accurate than the MDRD equation for the estimation of RD.

We investigated whether eGFR_CKD-EPI or BUN could predict adverse outcomes (AOs) better than eGFR_MDRD in normotensive patients with APE.

Ninety-nine normotensive patients with APE (aged 22-96, 56% male) were enrolled in the study retrospectively. Adverse outcomes were defined as the occurrence of any of the following: death, cardiopulmonary resuscitation, use of vasopressors, thrombolysis, or mechanical ventilation.

In univariate analyses, age, gender (male), heart rate (>110 bpm), serum creatinine, BUN, cardiac troponin (cTn) positivity, right ventricle-left ventricle ratio, eGFR_MDRD, and eGFR_CKD-EPI were found to be significantly different between those with and without AOs. Comparing area under the curves for AO, we found statistically significant differences between eGFR_CKD-EPI and eGFR_MDRD ( P = .01) but not between BUN and eGFR_CKD-EPI or BUN and eGFR_MDRD. Furthermore, 30-day mortality was 36% versus 11% in cTn-positive patients with an eGFR_CKD-EPI < and ≥ 60 mL/min, respectively.

There is a close relationship between RD and APE prognosis. We conclude eGFR_CKD-EPI is a potential prognostic marker for risk stratification in normotensive patients with APE.