Study On Clinical Characteristics And Role Of Biomarkers In Prediction For Risk Stratification Of Acute Pulmonary Embolism

ObjectiveThe aim of this study is to analyze the clinical characteristics of hospitalized patients with acute pulmonary embolism(APE)and determine if biomarkers can play clinically significant role in the prediction for risk stratification of acute pulmonary embolism.MethodsPatients diagnosed with APE by computed tomography pulmonary arteriography(CTPA)were enrolled in the prospective,cross-section observational study.Demographic features,clinical manifestations,laboratory data,imaging features and PESI scores were collected on admission.The patients were divided into high-risk and non-high-risk groups according to 2014 European Society of Cardiology(ESC)guidelines for APE.The differences between the patients in two groups were compared and a predictive model for high risk APE was established using univariate and multivariate logistic regression analyses.The accuracy in predicting the poor outcomes of the patients with APE using these parameters was compared in a Receiver-Operating Characteristic(ROC)plot.The cut-off value of the maximum parameters of each measurements was obtained respectively.ResultsA total of 106 patients,59 males(55.7%),47 females(44.3%),age range of 20 to 87 years were included whose cohort with the high risk group of 22 cases and the non-high risk group of 74.The distribution of patients with APE at admission was as follows:37.5% of the cohort was hospitalized in the division of pulmonary and critical care medicine,15.6% in intensive care unit(ICU),17.7% in department of vascular surgery,5.2% in rehabilitation department,5.2% in general department,4.2% in department of cardiothoracic surgery,3.1% in geriatrics department and the other 11.5% in the departments such as orthopaedics,cardiology,hematology,rheumatology and endocrinology.The incidence of dyspnea was significantly higher in the patients of high-risk group than in those of the non-high-risk group(P<0.05).Underlying pulmonary disease,thrombus burden,frequency of acute exacerbation of chronic obstructive pulmonary disease,degree of dyspnea,level of systolic pressure,bilateralembolism,PESI score,ratio of neutrophils to lymphocytes(NLR),prothrombin time(PT),lactic acid dehydrogenase(LDH),C-reactive protein(CRP)and serum level of growth and differentiation factor-15(GDF-15)were independently associated with high-risk of APE in the multivariate logistic regression model(P all <0.05).The clinical characteristics and relevant parameters of the APE patients with different risk stratification.It showed that LDH(OR=1.041,95%CI:1.007~1.076)and GDF-15(OR=1.022,95%CI:1.003~1.041)were independent risk factors for high risk patients with APE after Logistic regression analysis.The cut-off values of serum levels of GDF-15 and LDH for APE patients with higher risk were 1017.4 pg/ml and 388.5 U/L and the corresponding sensitivity and specificity were 90.9%,86.5 % and 68.2%,97.3% respectively.ConclusionThe patients with APE were more likely hospitalized in division of pulmonary and critical care medicine.The occurrence of dyspnea is more common in the patients of high-risk group than those in the non-high-risk group.Higher serum levels of LDH and GDF-15 at admission increase the risk of APE leading to poor outcomes.The serum levels of LDH and GDF-15 could therefore play a significant role as predictive factors of APE in patients with high risk factors.The cut-off values of serum levels of GDF-15,LDH and combined factors of the two for APE patients with higher risk were 1017.425pg/ml,388.50 U/L and 1420.915 respectively.