Identifying prognostic factors for pulmonary embolism patients with hemodynamic decompensation admitted to the...

Area of Science:

• Critical Care Medicine
• Cardiology
• Pulmonary Medicine

Background:

• Pulmonary embolism (PE) with hemodynamic decompensation poses a significant mortality risk.
• Identifying prognostic indicators in intensive care unit (ICU) settings is vital for timely intervention.

Purpose of the Study:

• To determine prognostic indicators for mortality in PE patients experiencing hemodynamic decompensation upon ICU admission.
• To develop predictive models for in-hospital mortality in this vulnerable patient cohort.

Main Methods:

• Utilized the Medical Information Mart for Intensive Care IV (MIMIC-IV) database.
• Employed Least Absolute Shrinkage and Selection Operator (LASSO) for variable reduction, followed by multivariate logistic regression.
• Constructed two predictive models and analyzed nonlinear relationships using restricted cubic splines.

Main Results:

• Included 548 patients, with 187 deaths. Significantly elevated lactate, creatine-kinase MB, and troponin-T observed in the non-survivor group.
• Identified eight key risk factors for in-hospital mortality: older age, decreased hemoglobin, elevated anion gap, elevated International Standard Ratio (INR), elevated respiratory rate, decreased temperature, decreased blood oxygen saturation (SpO2), and cardiac arrest onset.
• Determined cutoff values for these indicators to predict mortality.

Conclusions:

• Age, hemoglobin, anion gap, INR, respiratory rate, temperature, SpO2, and cardiac arrest onset are significant predictors of mortality in ICU-admitted PE patients with hemodynamic decompensation.
• These factors can be integrated into clinical practice to stratify risk and guide management strategies.
• Further research can refine these prognostic models for improved patient care.