Outcomes of hospitalized patients with acute pulmonary embolism: a focus on mortality risk

Abstract Acute pulmonary embolism (APE) is a severe pulmonary vascular disease with a significant mortality rate. Due to its potentially fatal nature, more knowledge is still needed to facilitate a physician management plan. Identifying the predictors of worse outcomes is the main goal. A prospective cohort study was conducted in the Chest Department and Respiratory ICU at Assiut University Hospital during the period from April 2022 to December 2023. The study was approved by the university ethical committee, number: 17101855, and clinical trial number: NCT05469724; consecutive patients with APE admitted to the Chest Department ward or respiratory intensive care were included in our study. Patient’s clinical, laboratory, and imaging characteristics were recorded in addition to their final outcomes. All these data were analyzed to identify outcome characteristics and predictors. One-hundred fifty(150) patients with APE were enrolled in this work. The mean age was 51.88 years, and 66.7% of them were females. A total of 32 (21.3%) patients died (non-survivors), and 118 (78.7%) patients improved and were discharged (survivors). At admission, non-survivors had significantly higher levels of leukocytes, lymphocytes, neutrophils, creatinine, urea, troponin, and D-dimer in comparison to survivors. Non-survivors had a higher frequency of positive troponin levels at admission (98.3% vs. 38.1%) and desaturated patients (90.6% vs. 35.6%). Non-survivors had significantly more frequent involvement of the main pulmonary artery (87.5% vs. 41.5%). It was found that non-survivors were more likely to receive higher frequency thrombolytic therapy (87.5% vs. 22.9%) and bleeding (43.8% vs. 11%). Predictors for mortality among the studied APE patients were main artery pulmonary embolism, desaturation, and shock. Significant hypoxemia, hemodynamic instability, and proximal pulmonary artery embolization with APE are vulnerable to poor prognosis. Proper identification of these patients for specialized care may improve the prognosis.