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. 2023 Sep 28;12(19):6269.
doi: 10.3390/jcm12196269.

Association of Blood Leukocytes and Hemoglobin with Hospital Mortality in Acute Pulmonary Embolism

Slobodan Obradovic  1   2 , Boris Dzudovic  2   3 , Bojana Subotic  1 , Sonja Salinger  4   5 , Jovan Matijasevic  6   7 , Marija Benic  6 , Tamara Kovacevic  8   9 , Ana Kovacevic-Kuzmanovic  10 , Irena Mitevska  11 , Vladimir Miloradovic  12   13 , Ema Jevtic  12 , Aleksandar Neskovic  14   15
Affiliations

Association of Blood Leukocytes and Hemoglobin with Hospital Mortality in Acute Pulmonary Embolism

Slobodan Obradovic et al. J Clin Med. .

Abstract

This study aimed to assess the prognostic significance of total leukocyte count (TLC) and hemoglobin (Hb) levels upon admission for patients with acute pulmonary embolism (PE), considering the European Society of Cardiology (ESC) model for mortality risk. 1622 patients from a regional PE registry were included. Decision tree statistics were employed to evaluate the prognostic value of TLC and Hb, both independently and in conjunction with the ESC model. The results indicated all-cause and PE-related in-hospital mortality rates of 10.7% and 6.5%, respectively. Subgrouping patients based on TLC cut-off values (≤11.2, 11.2-16.84, >16.84 × 109/L) revealed increasing all-cause mortality risks (7.0%, 11.8%, 30.2%). Incorporating Hb levels (≤126 g/L or above) further stratified the lowest risk group into two strata with all-cause mortality rates of 10.1% and 4.7%. Similar trends were observed for PE-related mortality. Notably, TLC improved risk assessment for intermediate-high-risk patients within the ESC model, while Hb levels enhanced mortality risk stratification for lower-risk PE patients in the ESC model for all-cause mortality. In conclusion, TLC and Hb levels upon admission can refine the ESC model's mortality risk classification for patients with acute PE, providing valuable insights for improved patient management.

Keywords: hemoglobin; mortality; pulmonary embolism; total leukocyte counts.

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Conflict of interest statement

The authors declare no conflict of interest.

Figures

Figure 1
Figure 1
Decision tree for all-cause hospital death in acute PE using blood total leukocyte count and Hb concentration at admission.
Figure 2
Figure 2
Decision tree for PE-related hospital death in acute PE using blood total leukocyte count and Hb concentration at admission.
Figure 3
Figure 3
Decision tree for all-cause death in acute PE using blood total leukocyte count and Hb concentration and ESC mortality risk stratification at admission.
Figure 4
Figure 4
Decision tree for PE-related death in acute PE using blood total leukocyte count and Hb concentration and ESC mortality risk stratification at admission.
Figure 5
Figure 5
(A,B). Kaplan–Meier estimates of hospital survival with respect to the TLC quartiles (×109/L) in the whole group of patients (A) and in subgroups who were treated with thrombolysis (B). For both KM, log-rank p is <0.001.
Figure 5
Figure 5
(A,B). Kaplan–Meier estimates of hospital survival with respect to the TLC quartiles (×109/L) in the whole group of patients (A) and in subgroups who were treated with thrombolysis (B). For both KM, log-rank p is <0.001.
Figure 6
Figure 6
(A,B). Kaplan–Meier estimates of hospital survival with respect to the Hb level quartiles in the whole group of patients (A) and in subgroups who were treated with thrombolysis (B). For the whole group the log-rank p value is 0.001, and for the Kaplan–Meier analysis of survival in patients treated with thrombolysis p = 0.042.
Figure 6
Figure 6
(A,B). Kaplan–Meier estimates of hospital survival with respect to the Hb level quartiles in the whole group of patients (A) and in subgroups who were treated with thrombolysis (B). For the whole group the log-rank p value is 0.001, and for the Kaplan–Meier analysis of survival in patients treated with thrombolysis p = 0.042.
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