Predictors of Mortality in Acute Pulmonary Embolism: A Prospective Observational Study

Abstract

Background: Acute pulmonary embolism (PE) is a life-threatening cardiovascular emergency with reported in-hospital mortality ranging from 1% to over 30%, depending on haemodynamic status and underlying comorbidities. Aim: To identify independent clinical, laboratory, echocardiographic, and imaging predictors of inhospital mortality in patients with confirmed acute PE.

Methods: This prospective observational study enrolled 250 consecutive patients with computed tomography pulmonary angiography (CTPA)-confirmed acute PE admitted to Patna Medical College and Hospital, Patna, India, between January 2021 and December 2022. Demographic, clinical, haemodynamic, laboratory, echocardiographic, and imaging data were systematically collected. Pulmonary Embolism Severity Index (PESI) was calculated for all patients. Univariate and multivariate logistic regression analyses were performed to identify independent predictors of in-hospital mortality. Receiver operating characteristic (ROC) curve analysis was used to determine the diagnostic performance of significant predictors.

Results: The in-hospital mortality rate was 14.4% (n=36). On multivariate analysis, independent predictors of mortality included cardiogenic shock (OR 6.14; 95% CI 3.07– 12.28; p<0.001), systolic blood pressure <90 mmHg (OR 5.47; 95% CI 2.74–10.94; p<0.001), right ventricular-to-left ventricular (RV/LV) diameter ratio ≥0.9 on echocardiography (OR 4.82; 95% CI 2.41–9.64; p<0.001), elevated troponin I (OR 4.35; 95% CI 2.18–8.70; p<0.001), elevated NT-proBNP (OR 3.91; 95% CI 1.96–7.82; p<0.001), PaO₂/FiO₂ ratio <200 (OR 3.22; 95% CI 1.61–6.44; p<0.001), bilateral deep vein thrombosis (OR 2.78; 95% CI 1.39–5.56; p=0.004), and age >65 years (OR 2.14; 95% CI 1.07–4.28; p=0.031). The PESI score demonstrated the highest discriminatory ability (AUC 0.92), while a combined model incorporating PESI, troponin I, and RV/LV ratio achieved an AUC of 0.95.