Predictors of Mortality and Escalation of Care in Acute Submassive Pulmonary Embolism

Purpose: To compare catheter-directed thrombolytic therapy (CDT) with anticoagulation alone for treatment of acute submassive pulmonary embolism (PE). To develop a risk stratification model to predict mortality for these patients to help guide management.

Materials and Methods: A total of 199 patients diagnosed with acute submassive PE on admission were retrospectively analyzed. Logistic regression was applied to clinical, laboratory, and imaging data to determine which factors were significant correlates for 30-day mortality and escalation of care. Rates of mortality and escalation of care were compared with a closely matched cohort of 71 patients treated with CDT.

Results: In the CDT cohort versus the anticoagulation-alone cohort, the rate of in-hospital mortality was 0% versus 6.0%, escalation of care was 2.8% versus 13.6%, and bleeding complications was 7.0% versus 2.5%, respectively. Three factors were identified as significant predictors of mortality: history of heart failure, elevated NLR, and elevated RV/LR ratio. Five factors were identified as significant predictors of escalation of care: history of heart failure, elevated NLR, elevated RV/LR ratio, elevated troponins, and decreased oxygen saturation.

Conclusions: CDT demonstrated a decreased mortality rate and escalation of care compared with anticoagulation alone for acute submassive PE. In addition, risk factors that predicted escalation of care and mortality were identified in patients presenting with acute submassive PE. Based on the risk factors for mortality, a prognostication tool was developed in an attempt to stratify patients with submassive PE and potentially direct early intervention.