Predicting Deterioration in Patients With Normotensive Acute Pulmonary Embolism Using Clinical-Imaging Features: A Multicenter Prospective Cohort Study

Abstract

Background: Prioritization of management strategies in patients with normotensive acute pulmonary embolism is based on the identification of individuals at risk for early deterioration. This study aims to develop and validate a novel score for deterioration prediction using clinical-imaging features.

Methods: This is multicenter, prospective observational cohort study (AOAPECT [Adverse Outcomes in Acute Pulmonary Embolism patients using Computed Tomography pulmonary angiography] cohort, NCT05098769). Registered-enrolled patients with normotensive acute pulmonary embolism were collected consecutively from 5 centers across China. Derivation set was established from 2 centers, while local and nonlocal external validation sets were derived from the remaining 3 centers. The end point was pulmonary embolism-related deterioration within 30 days after admission. Deterioration-related candidate predictors consisted of clinical, laboratory and computed tomography pulmonary angiography parameters were screened and then split into dichotomous values. The predictive score was conducted by a multivariable logistics regression and validated. Score performances were quantified using the area under the receiver operating characteristic curve.

Results: Of 3310 enrolled patients including 1 derivation (n=2061) and 2 validation sets (n=969 and 280), 272 patients (8.2%) experienced deterioration. In the derivation set, an increased risk of deterioration was observed with right to left ventricle diameter ratio ≥1.2, appearance of pulmonary vein sign on computed tomography pulmonary angiography, and heart rate ≥110 beats/min. When at least 2 out of 3 items were positive, patients were assigned to the high-risk deterioration group. This PE-RPH score revealed good discrimination to deterioration in derivation and validation sets (area under the receiver operating characteristic curve, 0.82, 0.82, and 0.80).

Conclusions: This PE-RPH score incorporating 2 computed tomography pulmonary angiography parameters and heart rate may help predict the deterioration risk in patients with normotensive acute pulmonary embolism. REGISTRATION: https://clinicaltrials.gov; identifier: NCT05098769.

Keywords: clinical deterioration; heart rate; heart ventricles; pulmonary embolism; pulmonary vein.