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Renal function as a cofactor for risk stratification and short-term outcome in acute pulmonary embolism
Karsten Keller1, Johannes Beule2, Jörn Oliver Balzer3
1Center for thrombosis and hemostasis, University Medical Center Mainz, Johannes Gutenberg-University Mainz, Mainz, Germany; Cardiology I, Center of Cardiology, University Medical Center Mainz, Johannes Gutenberg-University Mainz, Mainz, Germany.
Background:
In addition to right ventricular dysfunction (RVD) and myocardial injury, impaired renal function is connected with poorer prognosis in pulmonary embolism (PE). We aimed to investigate renal function as a cofactor for risk stratification in PE.
Methods:
Data from 182 patients with PE, treated between May 2006 and June 2011, were analysed retrospectively. PE patients with elevated creatinine were compared with those with normal values. Logistic regression models were calculated to investigate associations between creatinine and myocardial necrosis, RVD and in-hospital death. Prognostic performance of creatinine for prediction of myocardial necrosis and RVD were computed.
Results:
Overall, 182 patients (61.5% females,aged 68.5±15.3years) with confirmed PE were included in this study; 142 patients(78.0%) showed normal creatinine, and 40(22.0%) had an elevated creatinine. Patients with elevated creatinine were older (75.9±10.7 vs. 66.5±15.7years, P=0.0003), more frequently female (77.5% vs. 57.0%,P=0.019), and had higher cardiac troponin I (0.19±0.23 vs. 0.11±0.29ng/ml,P=0.0004), systolic pulmonary artery pressure (43.18±16.69 vs. 30.83±17.53mmHG,P=0.0006) and percentage of RVD (77.1% vs. 54.1%,P=0.040). Creatinine was significantly and independently associated with myocardial necrosis (OR 10.192, 95%CI 2.850-36.452, P=0.0004), shock-index≥1.0 (OR 3.265, 95%CI 1.067-9.992, P=0.0381) and RVD (OR 5.172, 95%CI 1.387-19.295, P=0.014). Creatinine>1.25mg/dl indicated for myocardial necrosis (AUC 0.680) and RVD (AUC 0.663).
Conclusions:
Additionally, to RVD and myocardial necrosis, impaired renal function could give further information for risk stratification in PE. Cardio-pulmonary-renal interactions in PE seem to be multi-factorial.