Early Risk Stratification in Acute Pulmonary Embolism using Inflammatory and Hematologic Biomarkers

Background: Accurate early risk stratification in acute pulmonary embolism (PE) remains challenging, particularly in intermediate-risk patients. Readily available hematologic and inflammatory markers may provide additional prognostic value. Objective: To evaluate the predictive role of hematologic and inflammatory markers for in-hospital adverse events in patients with acute pulmonary embolism. Methods: This retrospective study included 88 pts diagnosed with acute PE between 2023 and 2024. Clinical, echocardiographic, and laboratory data, including red blood cell distribution width (RDW), white blood cell (WBC) count, neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), and C-reactive protein (CRP), were analyzed. Adverse events were defined as hemodynamic instability, cardiac arrest, or death during hospitalization. Logistic regression identified independent predictors; ROC curves assessed discriminative performance. Results: Adverse events occurred in 13 pts (14.8%), including four deaths. Pts with adverse events had significantly higher RDW (p = 0.008), WBC (p = 0.002), NLR (p = 0.001), PLR (p = 0.001), and CRP (p = 0.028). Multivariable analysis identified RDW (OR 1.48; 95% CI 1.12-1.96; p = 0.006), WBC (OR 1.20; 95% CI 1.02-1.41; p = 0.032), and NLR (OR 1.14; 95% CI 1.02-1.27; p=0.018) as independent predictors. ROC analysis showed improved discrimination when these markers were combined (AUC 0.880). Conclusion: Red blood cell distribution width, white blood cell count, and neutrophil-to-lymphocyte ratio independently predict in-hospital adverse events in acute pulmonary embolism. Their combined use may enhance early risk stratification.