Impaired kidney function predicts acute PE mortality
MedWire News: Impaired kidney function independently predicts all-cause mortality in patients with acute pulmonary embolism (APE), Polish researchers report.
“Current risk stratification in APE includes assessment of clinical status, right ventricular overload, and plasma troponin concentrations,” explain Maciej Kostrubiec (The Medical University of Warsaw) and colleagues.
As impaired renal function is an important predictor of mortality in cardiovascular diseases, Kostrubiec and team hypothesized that it could also independently predict early mortality in patients with APE.
To test this hypothesis, the researchers observed 220 consecutive patients (39% women) with APE proven by spiral computed tomography. On admission, patients underwent echocardiography and had their troponin and creatinine levels measured.
As reported in the Journal of Thrombosis and Haemostasis, clinically high-risk APE was diagnosed in eight (4%) patients, low-risk APE was found in 81 (37%) patients, and the remaining 131 (59%) patients formed a subgroup with moderate-risk APE.
Glomerular filtration rate (GFR) differed significantly among the patients with low-, moderate-, and high-risk APE. GFR was significantly higher in the group with low-risk APE, at 71 ml/minute, compared with patients with moderate- or high-risk APE, at 55 and 41 ml/minute, respectively.
Of note, 104 (47%) patients had a GFR below 60 ml/minute on admission, indicating at least intermediate renal impairment, the researchers remark.
During the 30-day observation period, 23 (10%) patients died, and GFR was significantly lower among these patients that it was among survivors (35 vs 63 ml/minute).
Multivariate analysis revealed that GFR, troponin, heart rate, and history of chronic heart failure independently predicted mortality.
In a Kaplan–Meier analysis of 212 patients who were normotensive on admission, the team found that troponin-positive patients with a GFR of 35 ml/minute or lower had 48% (10/21) 30-day all-cause mortality, whereas troponin-positive patients with a GFR above 35 ml/minute had 11% mortality, and troponin-negative patients with a GFR above 35 ml/minute only had 1% mortality, indicating an additive prognostic value of renal dysfunction.
Kostrubiec and co-authors conclude that the results of their study suggest joint analysis of GFR and cardiac troponin can improve the positive predictive value of risk stratification for APE.
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By Laura Dean