Clinical and radiological characteristics of acute pulmonary embolus in relation to 28-day and 6-month mortality

Norton, Lindsey and Cooper, Gordon and Sheerins, Owen and Mac a’ Bháird, Killian and Roditi, Giles and Adamson, Michael and Young, David and Dolan, Ross and Church, Colin and Brady, Adrian and Tait, Campbell and McKenzie, Graham and McFadyen, Alasdair and Zelic, Matthew and Maguire, Donogh (2021) Clinical and radiological characteristics of acute pulmonary embolus in relation to 28-day and 6-month mortality. PLoS ONE, 16 (12). e0258843. ISSN 1932-6203 (

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Background: Patients with acute pulmonary embolism (PE) exhibit a wide spectrum of clinical and laboratory features when presenting to hospital and pathophysiologic mechanisms differentiating low-risk and high-risk PE are poorly understood. Objectives: To investigate the prognostic value of clinical, laboratory and radiological information that is available within routine tests undertaken for patients with acute PE. Methods: Electronic patient records (EPR) of patients who underwent Computed Tomography Pulmonary Angiogram (CTPA) scan for the investigation of acute PE during 6-month period (01.01.2016–30.06.2016) were examined. Data was gathered from EPR for patients that met inclusion criteria and all CTPA scans were re-evaluated. Biochemical thresholds of low-grade and high-grade inflammation, serum CRP >10mg/L and >150mg/L and serum albumin concentrations 100, poGPS≥1, NLR ≥3 and CAC score ≥6 were associated with 28-day and 6-month mortality. PESI score ≥100, poGPS≥1 and NLR ≥3 remained independently associated with 28-day mortality. PESI score ≥100 and CAC score ≥6 remained independently associated with 6-month mortality. When patients with underlying cancer were excluded from the analysis, GPS≥1 remained independently associated with 6-month mortality. The role of the systemic inflammatory response (SIR) in determining treatment and prognosis requires further study. Routine reporting of CAC scores in CTPA scans for acute PE may have a role in aiding clinical decision-making regarding treatment and prognosis.