Vol 6, No 4 (2021)
Original article
Published online: 2021-12-30

open access

Page views 5579
Article views/downloads 332
Get Citation

Connect on Social Media

Connect on Social Media

The risk factors for all-cause in-hospital death in patients with acute pulmonary embolism

Oleh Matskiv1, Agnieszka Kusiak23, Beata Zwierko3, Marta Dura34, Jacek Budzyński1
Medical Research Journal 2021;6(4):322-329.


Introduction: Patient risk stratification is important in managing individuals with suspected acute pulmonary embolism (APE). The aim of this study was to determine risk factors for in-hospital mortality among real-world patients who had undergone computed tomography pulmonary angiography (CTPA) due to suspected APE.
Material and methods: Retrospective analysis of clinical data extracted from the medical documentation of 700 consecutive patients in whom CTPA was performed due to APE suspicion.
Results: APE was confirmed in 22.7% of the patients in the sample. In-hospital death was recorded in 10.1% and 12.4% of patients with and without APE confirmed in CTPA, respectively. APE-related death was diagnosed in 37.5% of the APE patients who died during hospitalization. Compared to patients who were discharged from hospital, those who died during hospitalization had a greater prevalence of comorbidities (e.g., neoplasm) and higher values of laboratory determinations and prognostic rule scores. An age-adjusted high-sensitivity troponin I (hs-TNI) cut-off and Pulmonary Embolism Severity Index (PESI) score were found to be independent risk factors of in-hospital death, but only in the whole study group and in patients without APE confirmed in CTPA. The area-under-the-curve value for all the parameters studied was lower than 0.6.
Conclusions: Age-adjusted hs-TNI cut-off and PESI score were independent risk factors for in-hospital death in patients with APE suspicion. The predictive power of standard stratifying tools is insufficient in real-world patients with suspected APE. Patients with suspected APE require careful diagnosis and management of comorbidities because these may affect the in-hospital mortality rate.

Article available in PDF format

View PDF Download PDF file


  1. Al-Hakim R, Li N, Nonas S, et al. Evaluation and Management of Intermediate and High-Risk Pulmonary Embolism. AJR Am J Roentgenol. 2020; 214(3): 671–678.
  2. Konstantinides S, Torbicki A, Agnelli G, et al. 2014 ESC Guidelines on the diagnosis and management of acute pulmonary embolism. Kardiologia Polska. 2014; 72(11): 997–1053.
  3. Konstantinides S, Meyer G, Becattini C, et al. 2019 ESC Guidelines for the diagnosis and management of acute pulmonary embolism developed in collaboration with the European Respiratory Society (ERS). European Respiratory Journal. 2019; 54(3): 1901647.
  4. Duffett L, Castellucci LA, Forgie MA. Pulmonary embolism: update on management and controversies. BMJ. 2020; 370: m2177.
  5. Quezada CA, Bikdeli B, Barrios D, et al. PROTECT investigators, Investigators of the PROTECT study. Assessment of coexisting deep vein thrombosis for risk stratification of acute pulmonary embolism. Thromb Res. 2018; 164: 40–44.
  6. Kong WF, Wang YT, Yin LL, et al. Clinical risk stratification of acute pulmonary embolism: comparing the usefulness of CTA obstruction score and pulmonary perfusion defect score with dual-energy CT. Int J Cardiovasc Imaging. 2017; 33(12): 2039–2047.
  7. Jen WY, Jeon YS, Kojodjojo P, et al. A New Model for Risk Stratification of Patients With Acute Pulmonary Embolism. Clin Appl Thromb Hemost. 2018; 24(9_suppl): 277S–284S.
  8. Jia D, Li XL, Zhang Q, et al. A decision tree built with parameters obtained by computed tomographic pulmonary angiography is useful for predicting adverse outcomes in non-high-risk acute pulmonary embolism patients. Respir Res. 2019; 20(1): 187.
  9. Kozlowska M, Plywaczewska M, Koc M, et al. d-Dimer Assessment Improves the Simplified Pulmonary Embolism Severity Index for In-Hospital Risk Stratification in Acute Pulmonary Embolism. Clin Appl Thromb Hemost. 2018; 24(8): 1340–1346.
  10. Klingenberg R, Schlager O, Limacher A, et al. Risk stratification of elderly patients with acute pulmonary embolism. Eur J Clin Invest. 2019; 49(9): e13154.
  11. Barnes GD, Muzikansky A, Cameron S, et al. Comparison of 4 Acute Pulmonary Embolism Mortality Risk Scores in Patients Evaluated by Pulmonary Embolism Response Teams. JAMA Netw Open. 2020; 3(8): e2010779.
  12. Teng F, Chen YX, He XH, et al. Contribution of Quick Sequential Organ Failure Assessment Score Combined with Electrocardiography in Risk Stratification of Patients with Acute Pulmonary Embolism. Chin Med J (Engl). 2018; 131(20): 2395–2401.
  13. Barco S, Mahmoudpour SH, Planquette B, et al. Prognostic value of right ventricular dysfunction or elevated cardiac biomarkers in patients with low-risk pulmonary embolism: a systematic review and meta-analysis. Eur Heart J. 2019; 40(11): 902–910.
  14. Elias A, Mallett S, Daoud-Elias M, et al. Prognostic models in acute pulmonary embolism: a systematic review and meta-analysis. BMJ Open. 2016; 6(4): e010324.
  15. Darwish OS, Mahayni A, Patel M, et al. Cardiac Troponins in Low-Risk Pulmonary Embolism Patients: A Systematic Review and Meta-Analysis. J Hosp Med. 2018; 13(10): 706–712.
  16. Hobohm L, Hellenkamp K, Hasenfuß G, et al. Comparison of risk assessment strategies for not-high-risk pulmonary embolism. Eur Respir J. 2016; 47(4): 1170–1178.
  17. Gupta R, Ammari Z, Dasa O, et al. Long-term mortality after massive, submassive, and low-risk pulmonary embolism. Vasc Med. 2020; 25(2): 141–149.
  18. Yamashita Y, Morimoto T, Amano H, et al. COMMAND VTE Registry Investigators. Usefulness of Simplified Pulmonary Embolism Severity Index Score for Identification of Patients With Low-Risk Pulmonary Embolism and Active Cancer: From the COMMAND VTE Registry. Chest. 2020; 157(3): 636–644.
  19. Ebner M, Kresoja KP, Keller K, et al. Temporal trends in management and outcome of pulmonary embolism: a single-centre experience. Clin Res Cardiol. 2020; 109(1): 67–77.
  20. Soriano Ld, Castro TT, Vilalva K, et al. Validation of the Pulmonary Embolism Severity Index for risk stratification after acute pulmonary embolism in a cohort of patients in Brazil. J Bras Pneumol. 2019; 45(1): e20170251.
  21. Vamsidhar A, Rajasekhar D, Vanajakshamma V, et al. Comparison of PESI, echocardiogram, CTPA, and NT-proBNP as risk stratification tools in patients with acute pulmonary embolism. Indian Heart J. 2017; 69(1): 68–74.
  22. Perera M, Aggarwal L, Scott IA, et al. Underuse of risk assessment and overuse of computed tomography pulmonary angiography in patients with suspected pulmonary thromboembolism. Intern Med J. 2017; 47(10): 1154–1160.