Prognostic Factors for Pulmonary Embolism: The PREP Study, A Prospective Multicenter Cohort Study.

Abstract : RATIONALE: The short-term prognosis of pulmonary embolism (PE) depends on hemodynamic status and underlying disease. The prognostic value of right ventricular dysfunction and injury is less well established. OBJECTIVES: To evaluate prognostic factors of PE in a multicenter prospective cohort study. METHODS: Echocardiography, brain natriuretic peptide (BNP), N-terminal-proBNP and cardiac troponin I measurements were done on admission of 570 consecutive patients with an acute PE. A predictive model was based on independent predictors of thirty-day adverse events defined as death, secondary cardiogenic shock or recurrent venous thromboembolism. MEASUREMENTS AND MAIN RESULTS: At 30 days, 42 patients (7.4%; 95% confidence interval (CI), 5.5% to 9.8%) had adverse events. On multivariate analysis, altered mental state (OR 6.8; 95% CI, 2.0 to 23.3), shock on admission (OR 2.8; 95% CI, 1.1 to 7.5), cancer (OR 2.9; 95% CI, 1.2 to 6.9), BNP (OR 1.3 for an increase of 250 ng/L; 95% CI, 1.1 to 1.6) and right to left ventricle diameter ratio (OR 1.2 for an increase of 0.1; 95% CI, 1.1 to 1.4) were associated with 30-day adverse events. The predictive performance of the model was good (area under receiver operating characteristics curve 0.84 (95% CI, 0.78 to 0.90)), making it possible to develop a bedside prognostic score. CONCLUSION: BNP and echocardiography may be useful determinants of the short-term outcome for patients with PE, together with clinical findings. PE patients can be stratified according to the initial risk of adverse outcome, using a simple score based on clinical, echocardiographic and biochemical variables.
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Submitted on : Wednesday, December 9, 2009 - 11:55:56 AM
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Olivier Sanchez, Ludovic Trinquart, Vincent Caille, Francis Couturaud, Gérard Pacouret, et al.. Prognostic Factors for Pulmonary Embolism: The PREP Study, A Prospective Multicenter Cohort Study.. American Journal of Respiratory and Critical Care Medicine, American Thoracic Society, 2009, epub ahead of print. ⟨10.1164/rccm.200906-0970OC⟩. ⟨ujm-00440075⟩



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