Risk stratification of patients with pulmonary embolism based on pulse rate and D-dimer concentration

Mariette J. Agterof; Esther R. van Bladel; Roger E. G. Schutgens; Repke J. Snijder; Ellen A. M. Tromp; Martin H. Prins; Douwe H. Biesma

doi:10.1160/TH09-04-0229

Thrombosis and Haemostasis, Table of Contents

Thromb Haemost 2009; 102(04): 683-687
DOI: 10.1160/TH09-04-0229

Blood Coagulation, Fibrinolysis and Cellular Haemostasis

Schattauer GmbH

Risk stratification of patients with pulmonary embolism based on pulse rate and D-dimer concentration

Authors

Mariette J. Agterof

¹Department of Internal Medicine, University Medical Center Utrecht, Utrecht, The Netherlands
Esther R. van Bladel

²Department of Clinical Chemistry and Haematology, University Medical Center Utrecht, Utrecht, The Netherlands
Roger E. G. Schutgens

³Department of Hematology/ Van Creveldkliniek, University Medical Center Utrecht, Utrecht, The Netherlands
Repke J. Snijder

⁴Department of Pulmonary Disease, St. Antonius Hospital, Nieuwegein, The Netherlands
Ellen A. M. Tromp

⁵Department of Statistics, St. Antonius Hospital, Nieuwegein, The Netherlands
Martin H. Prins

⁶Department of Clinical Epidemiology and Technology Assessment, University of Maastricht, The Netherlands
Douwe H. Biesma

¹Department of Internal Medicine, University Medical Center Utrecht, Utrecht, The Netherlands

Abstract

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Summary

To enable outpatient treatment of a selected group of patients with pulmonary embolism (PE), insight in the determinants of adverse clinical outcome is warranted. We have identified risk factors for serious adverse events (SAE) within the first 10 days of acute PE. We have retrospectively analysed data of 440 consecutive patients with acute PE. Collected data included age, gender, medical history, blood pressure, pulse rate and D-dimer concentration. The variables associated with SAE in the first 10 days in univariate analysis (p<0.15) have been included in a multivariate logistic regression model (backward conditional, p out>0.10). In 440 patients with acute PE, 20 SAEs occurred in a 10-day follow-up period. Pulse rate ≥100 beats per minute (bpm) (OR, 6.85; 95%CI 1.43–32.81) and D-dimer concentration ≥3,000 µg/ml (OR, 5.51; 95%CI 0.68–44.64) were significantly related to the SAEs. All SAEs were predicted by a pulse rate ≥100 bpm and/or a D-dimer concentration ≥3,000 µg/ml. Older age, gender, history of venous thromboembolism (VTE), heart failure, chronic obstructive pulmonary disease, cancer or a systolic blood pressure < 90 mm Hg had no significant influence on short term SAEs. Pulse rate and D-dimer concentration can be used to identify patients with acute PE, who are at risk for adverse clinical outcome during the first 10 days of hospitalisation. Outpatient treatment of PE-patients with a pulse rate ≥100 bpm and/or a D-dimer concentration ≥3,000 µg/ml has to be discouraged.

Keywords

Pulmonary embolism - serious adverse events - risk - prediction model - outcome

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References

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