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Prognostic factors for pulmonary embolism: the prep study, a prospective multicenter cohort study

Trinquart, Ludovic
Caille, Vincent
Couturaud, Francis
Pacouret, Gerard
Meneveau, Nicolas
Verschuren, Franck
Roy, Pierre-Marie
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Published in American Journal of Respiratory and Critical Care Medicine. 2010, vol. 181, no. 2, p. 168-173
Abstract RATIONALE: The short-term prognosis of pulmonary embolism (PE) depends on hemodynamic status and underlying disease. The prognostic value of right ventricular dysfunction and injury is less well established. Objectives: To evaluate prognostic factors of PE in a multicenter prospective cohort study. METHODS: Echocardiography, brain natriuretic peptide (BNP), N-terminal-proBNP and cardiac troponin I measurements were done on admission of 570 consecutive patients with an acute PE. A predictive model was based on independent predictors of 30-day adverse events defined as death, secondary cardiogenic shock, or recurrent venous thromboembolism. MEASUREMENTS AND MAIN RESULTS: At 30 days, 42 patients (7.4%; 95% confidence interval [CI], 5.5-9.8%) had adverse events. On multivariate analysis, altered mental state (odds ratio [OR] 6.8; 95% confidence interval [CI], 2.0-23.3), shock on admission (OR 2.8; 95% CI, 1.1-7.5), cancer (OR 2.9; 95% CI, 1.2-6.9), BNP (OR 1.3 for an increase of 250 ng/L; 95% CI, 1.1-1.6) and right to left ventricle diameter ratio (OR 1.2 for an increase of 0.1; 95% CI, 1.1-1.4) were associated with 30-days of adverse events. The predictive performance of the model was good (area under receiver operating characteristics curve 0.84 [95% CI, 0.78-0.90]), making it possible to develop a bedside prognostic score. CONCLUSIONS: BNP and echocardiography may be useful determinants of the short-term outcome for patients with PE, together with clinical findings. Patients with PE can be stratified according to the initial risk of adverse outcome, using a simple score based on clinical, echocardiographic, and biochemical variables.
Keywords Acute DiseaseAgedCause of DeathCohort StudiesEchocardiographyFemaleHospital MortalityHumansMaleMiddle AgedModels, StatisticalMultivariate AnalysisNatriuretic Peptide, Brain/bloodPeptide Fragments/bloodPrognosisProspective StudiesPulmonary Embolism/*genetics/*physiopathologyRecurrenceRisk AssessmentShock, Cardiogenic/mortality/physiopathologySurvival RateTroponin I/bloodVenous Thromboembolism/mortality/physiopathology
PMID: 19910608
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Research groups Groupe Perrier Arnaud (Médecine interne générale, de réhabilitation et de gériatrie) (585)
La maladie thromboembolique veineuse (808)
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SANCHEZ, Oliver Lope et al. Prognostic factors for pulmonary embolism: the prep study, a prospective multicenter cohort study. In: American Journal of Respiratory and Critical Care Medicine, 2010, vol. 181, n° 2, p. 168-173. doi: 10.1164/rccm.200906-0970OC https://archive-ouverte.unige.ch/unige:21284

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Deposited on : 2012-05-23

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