RISK STRATIFICATION OF IN-HOSPITAL MORTALITY IN PATIENTS WITH HIGH-RISK PULMONARY EMBOLISM

Objective. To identify factors associated with in-hospi­tal mortality and to develop and validate a formula for additional risk of early mortality in patients (pts) with high-risk pulmonary embolism (PE). Materials and Methods. The study consisted of two pha­ses. In Phase I, a retrospective analysis was conducted on the medical records of 113 pts with high-risk PE who were consecutively hospitalized at Kharkiv City Clini­cal Hospital No. 8 from 01.01. 2017 to 01.01.2023. The mean age of pts was 65.14±14.13 years, with 45 (38.8%) males and 68 (60.2%) females. Based on the course of the disease, the pts were divided into two groups: Group 1 – 63 pts (55.8%) who improved and were discharged, and Group 2 – 50 pts (44.2%) who died during hospi­talization. Phase II of the study involved a multicenter cohort (9 centers in Ukraine that provided data on pts with high-risk pulmonary embolism hospitalized from January 2023 to December 2023). This phase included 75 pts with high-risk PE, with mean age of 60.60±13.40 ye­ars; 38 (50.7%) were male, and 37 (49.3%) were female. Group I consisted of 65 patients (80%) discharged with improvement, Group II comprised 15 patients (20%) who died during hospitalization. Clinical and anamnestic and laboratory-instrumental data were analyzed, statistical analysis of the resulting figures was performed. Results and Discussion. In Phase I of the study, a formula for additional risk stratification of early mortality in pts with high-risk PE was developed. Using ROC analysis, the sensitivity of the resulting prognostic formula was found to be 64.0%, and the specificity was 92.1%. Ba­sed on this formula, we proposed a simplified scale cal­led SBAFS (S – saturation, B – bifurcation, A – arterial hypotension, F – fraction of ejection, S – female sex). In Phase II of the study, the sensitivity and specificity of the obtained formula were validated using ROC analy­sis: the sensitivity was 93.3%, and the specificity was 74.6%, confirming the results of Phase I. When evalua­ting the proposed simplified SBAFS scale, it was also found that in patients of Group II, the mean score on the scale was (2.53±0.83) and was higher than that in Group I: (1.57±0.96), p=0.0006. Conclusions. The main factors associated with the risk of in-hospital mortality in pts with high-risk PE are de­creased oxygen saturation, thrombus localization in the bifurcation of the pulmonary artery as determined by СТPA angiography, arterial hypotension, female sex, and decreased left ventricular ejection fraction as assessed by echocardiography. The previously proposed SBAFS formula confirmed its significance upon validation in­volving data on PE pts from 9 regions of Ukraine, with a sensitivity of 93% and specificity of 75%.