Opportunistic CT bone mineral density as a prognostic marker in acute pulmonary embolism

Computed tomography (CT)-defined bone mineral density (BMD) is a promising quantitative imaging marker that reflects the overall condition of patients, which was demonstrated in several diseases.

The present multicentric study aimed to demonstrate the prognostic role of BMD in patients with acute PE.

The investigated patient sampled was comprised of 829 patients (355 female, 42.8%) with a mean age of 64.1 ± 15.8 years. The primary endpoint of this study was 30-day mortality. The simplified pulmonary embolism index (sPESI) was calculated as a clinical prognostic score. Logistic binary regression analyses were used to test the associations between BMD and 30-day mortality. A total of 94 patients (11.3%) died within the 30-day observation period. A weak inverse association was identified between BMD and sPESI score (r = -0.21, p <0.0001). Low BMD showed an association with 30-day mortality with an odds ratio (OR) of 2.26 (95% confidence interval [CI], 1.24 - 4.10; p = 0.008 in univariable analysis) and 2.39 (95% CI, 1.24 -4.44; p = 0.007) in multivariable analysis.

Using the threshold value of 75 HU, bone mineral density is a prognostic factor in patients with acute pulmonary embolism. However, this threshold value is lower than the values previously proposed for diagnosing osteoporosis.