Related Experiment Video
Updated: Jul 29, 2025
A Porcine Model of Acute Autologous Pulmonary Embolism
Published on: September 6, 2024
Acute Infections and Inflammatory Biomarkers in Patients with Acute Pulmonary Embolism
Ann-Sophie Eggers1,2, Alaa Hafian3, Markus H Lerchbaumer4
1Department of Cardiology, Angiology and Intensive Care Medicine, Charité Campus Virchow-Klinikum Mittelallee, German Heart Center of the Charité-University Medicine Berlin, 13353 Berlin, Germany.
Abstract:
Although infections are frequent in patients with pulmonary embolism (PE), its effect on adverse outcome risk remains unclear. We investigated the incidence and prognostic impact of infections requiring antibiotic treatment and of inflammatory biomarkers (C-reactive protein [CRP] and procalcitonin [PCT]) on in-hospital adverse outcomes (all-cause mortality or hemodynamic insufficiency) in 749 consecutive PE patients enrolled in a single-centre registry. Adverse outcomes occurred in 65 patients. Clinically relevant infections were observed in 46.3% of patients and there was an increased adverse outcome risk with an odds ratio (OR) of 3.12 (95% confidence interval [CI] 1.70-5.74), comparable to an increase in one risk class of the European Society of Cardiology (ESC) risk stratification algorithm (OR 3.45 [95% CI 2.24-5.30]). CRP > 124 mg/dL and PCT > 0.25 µg/L predicted patient outcome independent of other risk factors and were associated with respective ORs for an adverse outcome of 4.87 (95% CI 2.55-9.33) and 5.91 (95% CI 2.74-12.76). In conclusion, clinically relevant infections requiring antibiotic treatment were observed in almost half of patients with acute PE and carried a similar prognostic effect to an increase in one risk class of the ESC risk stratification algorithm. Furthermore, elevated levels of CRP and PCT seemed to be independent predictors of adverse outcome.
Insights
Infections requiring antibiotics in pulmonary embolism (PE) patients significantly increase adverse outcome risk, similar to a higher European Society of Cardiology risk class. Elevated C-reactive protein (CRP) and procalcitonin (PCT) also predict poor outcomes.
Area of Science:
- Cardiology
- Infectious Diseases
- Critical Care Medicine
Background:
- Infections are common in pulmonary embolism (PE) patients, but their impact on adverse outcomes is not fully understood.
- Inflammatory biomarkers like C-reactive protein (CRP) and procalcitonin (PCT) are often elevated in PE, but their independent prognostic value requires clarification.
Purpose of the Study:
- To determine the incidence and prognostic significance of infections and inflammatory biomarkers on in-hospital adverse outcomes in PE patients.
- To compare the prognostic impact of infections with the European Society of Cardiology (ESC) risk stratification algorithm.
- To assess the independent predictive value of CRP and PCT for adverse outcomes in PE.
Main Methods:
- A single-center registry study included 749 consecutive patients with acute pulmonary embolism (PE).
- Data collected included incidence of infections requiring antibiotic treatment, C-reactive protein (CRP) levels, procalcitonin (PCT) levels, and in-hospital adverse outcomes (all-cause mortality or hemodynamic insufficiency).
- Statistical analysis involved calculating odds ratios (ORs) with 95% confidence intervals (CIs) to assess risk.
Main Results:
- Clinically relevant infections were present in 46.3% of PE patients, significantly increasing adverse outcome risk (OR 3.12).
- This infection-related risk was comparable to an increase of one risk class in the ESC stratification algorithm (OR 3.45).
- Elevated CRP (> 124 mg/dL) and PCT (> 0.25 µg/L) independently predicted adverse outcomes (ORs 4.87 and 5.91, respectively).
Conclusions:
- Clinically relevant infections requiring antibiotics are frequent in acute PE and significantly elevate the risk of adverse in-hospital outcomes.
- The prognostic impact of these infections is substantial, mirroring an increased risk class within the ESC guidelines.
- Elevated CRP and PCT levels serve as independent predictors of adverse outcomes in PE patients, highlighting their potential role in risk stratification.
Related Concept Videos
01:29Pulmonary Embolism II: Diagnostic Studies and Interprofessional Care
01:27Pulmonary Embolism III: Nursing Management
01:29Pulmonary Embolism I: Introduction
01:30Pneumonia III: Complications and Assessment
01:20Blood Studies for Cardiovascular System I: Cardiac Biomarkers
The essential diagnostic tools for detecting myocardial necrosis and monitoring individuals suspected of having acute coronary syndrome (ACS) include:
Troponins
Troponins, particularly cardiac troponins I and T, are the most precise and sensitive markers of myocardial injury. They are detectable within 4-6 hours of myocardial injury and remain...
01:19Blood Studies for Cardiovascular System II: CRP, Hcy, and Cardiac Natriuretic Peptide Markers
These markers indicate stress or strain on the heart muscle:
Natriuretic Peptides (BNP)
Cardiac myocytes produce these hormones in response to ventricular stretching...