Can Systemic Inflammatory Markers Be Used in Pulmonary Embolism Risk Assessment in Patients with Acute Pulmonary Thromboembolism?

Levent Özdemir,1 Burcu Özdemir,2 Savaş Gegin,2 Esra Arslan Aksu,1 Ahmet Cemal Pazarlı3 1Department of Chest Diseases, Samsun University Faculty of Medicine, Samsun, Turkey; 2Department of Chest Diseases, Samsun Training and Research Hospital, Samsun, Turkey; 3Department of Pulmonary Diseases, Tokat Gaziosmanpaşa University Faculty of Medicine, Tokat, TurkeyCorrespondence: Ahmet Cemal Pazarlı, Email [email protected]: Understanding the effect of systemic inflammation on the pathophysiology of thromboembolism may provide an approach to determine the course and prognosis of the disease. The aim of this study was to investigate the usability of systemic inflammatory markers in the risk stratification of pulmonary embolism in patients with acute pulmonary thromboembolism (PTE).Methods: The data of 234 patients diagnosed with pulmonary embolism by computed tomography pulmonary angiography (CTPA) or ventilation perfusion scintigraphy were evaluated retrospectively. Demographic data, co-morbid conditions, and laboratory parameters of the patients were obtained from the hospital data system. Pulmonary embolism risk classification was performed according to the 2019 ESC guidelines as low, intermediate (intermediate-low, intermediate-high), and high risk. Neutrophil - lymphocyte ratio (NLR), platelets-to-lymphocyte ratio (PLR), lymphocyte - monocyte ratio (LMR), lymphocyte / CRP ratio (LCRPR), systemic inflammatory response index (SIRI) (Neutrophil×Platelet/Lymphocyte) and systemic immune-inflammation index (SII) (Neutrophil×Monocyte/Lymphocyte) were calculated using the patients’ hemogram (White blood count (WBC), hemoglobin, hematocrit, platelet, neutrophil, lymphocyte, monocyte), C-reactive protein (CRP), lactate, troponin, and d-dimer values at the time of diagnosis.Results: In our study, WBC, neutrophils, NLR, PLR, SIRI, SII and CRP levels were significantly lower in low risk, while lymphocyte count and LCRPR were significantly higher. Platelet counts were significantly lower in high risk. D-dimer levels were significantly higher in intermediate-high and high risk. Lactate levels were significantly higher in high risk. Troponin levels were significantly higher in intermediate-high risk and high risk. WBC, neutrophils, D-dimer, troponin, lactate levels and NLR, SII, indices were found to be significant biomarkers in predicting high-risk embolism.Conclusion: Our findings suggest that systemic inflammatory markers may be a clinically important risk determinant in patients with acute pulmonary thromboembolism.Keywords: pulmonary embolism (PE), systemic inflammation, inflammatory markers, neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), systemic immune-inflammation index (SII)