Risk factors for the development of obstructive shock in patients with pulmonary embolism


E.A. Kochmareva, V.A. Kokorin, M.N. Aref'ev, V.A. Rusina, I.G. Gordeev

1 Pirogov Russian National Research Medical University, Moscow 2 Filatov Moscow City Clinical Hospital № 15, Moscow
Obstructive shock (OS) is one of the most often cause of death in patients with pulmonary embolism (PE). Aim: We aimed to investigate the clinical, anamnestic, laboratory and instrumental predictors of OS development in patients with PE; to investigate effectiveness of previously proposed ROCky score as predictor of OS in patients of intermediate risk. Methods: 121 patients with confirmed PE of high and intermediate risk were enrolled. PE was confirmed by CT angiography and/or echocardiography. In 29 patients (24%) OS developed during 30 days of observation, 92 patients (76%) had favourable course. Clinical, anamnestic, laboratory, instrumental parameters were investigated. ROCky score threshold to identify the patients with high risk of OS was ≥3,5 points. Results: Predictors of OS in PE-patients were: chronic heart failure (p=0,01), diabetes mellitus (p=0,0001), atrial fibrillation (p=0004), permanent risk factor of venous thromboembolism (VTE), (p=0,001), syncope (p=0,02), positive heart type fatty acid binding protein (hFABP) test (p=0,00001), heart rate (HR) ≥110 bpm (p=0,003), systolic blood pressure (SBP) ≤100 mmHg (p=0,00001), creatinine clearance ≤70 ml/min (p=0,0005). The ROCky score demonstrated strong effectiveness as a predictor of OS during 30 days (p<0,001, CI 95% 2,5-30, sensitivity 73%, specificity 83%). Conclusions: The risk factors of OS in PE patients are: chronic heart failure, atrial fibrillation, diabetes mellitus, permanent risk factor of VTE, syncope, positive hFABP test, tachycardia, hypotension, creatinine clearance ≤70 ml/min. In retrospective analysis, the ROCky score demonstrates strong prediction value of OS development in hemodynamically stable patients with PE and may be recommended for applying in clinical practice.

Literature


  1. Goldhaber S.Z., Visani L., De Rosa M. Acute pulmonary embolism: clinical outcomes in the International Cooperative Pulmonary Embolism Registry (ICOPER). Lancet. 1999;353:1386–9.
  2. Stein P.D., Matta F., Alrifai A. et al. Trends in case fatality rate in pulmonary embolism according to stability and treatment. Thromb Res. 2012;130:841–6.
  3. Konstantinides S.V., Torbicki A., Agnelli G. et al. ESC guidelines on the diagnosis and management of acute pulmonary embolism: The Task Force for the Diagnosis and Management of Acute Pulmonary Embolism of the European Society of Cardiology (ESC) Endorsed by the European Respiratory Society (ERS). Eur Heart J. 2014;35:3033–69.
  4. Soloff L.A., Rodman T. Acute pulmonary embolism. Am Heart J. 1967;74(6):829.
  5. Dalen J.E., Alpert J.S. Natural history of pulmonary embolism. Prog Cardiovasc Dis. 1975;17(4):259.
  6. Kearon C., Akl E.A., Ornelas J. et al. Antithrombotic therapy for VTE disease: CHEST Guideline and Expert Panel Report. Chest. 2016;149(2):315-52.
  7. Meyer G., Vieillard Baron A., Planquette B. Recent advances in the management of pulmonary embolism: focus on the critically ill patients. Ann Intensive Care. 2016;6(1):19.
  8. Кочмарева Е.А, Кокорин В.А., Волкова А.Л. и др. Предикторы краткосрочных осложнений тромбоэмболии легочной артерии высокого и промежуточного риска. Российский кардиологический журнал. 2017;9(149):7-12. [Kochmareva E.A., Kokorin V.A., Volkova A.L. et al. Predictors of short term outcomes in high and moderate risk pulmonary thromboembolism. Russian Journal of Cardiology. 2017;9(149):7-12.]
  9. Pivetti S., Aluffi E., Bonino L. et al. Obstructive shock in pulmonary embolism: thrombolytic therapy and survival. Crit Care. 1999;3 (Suppl 1):242.
  10. Sanchez O., Trinquart L., Caille V. et al. Prognostic factors for pulmonary embolism: the PREP study, a prospective multicenter cohort study. Am J Respir Crit Care Med 2010;181(2):168–73.
  11. imenez D., Kopecna D., Tapson V. et al. Оn behalf of the PROTECT Investigators. Derivation and validation of multimarker prognostication for normotensive patients with acute symptomatic pulmonary embolism. Am J Respir Crit Care Med 2014;189(6):718–26.
  12. Lankeit M., Friesen D., Schafer K. et al. A simple score for rapid risk assessment of non-high-risk pulmonary embolism. Clin Res Cardiol 2013;102(1):73–80.
  13. Bova C., Sanchez O., Prandoni P. et al. Identification of intermediate-risk patients with acute symptomatic pulmonary embolism. Eur Respir J 2014;44(3):694-703.


About the Autors


Elena A. Kochmareva, MD, senior laboratory assistant of the Hospital therapy #1 department of Pirogov Russian National Research Medical University of the Ministry of Healthcare of Russia, Moscow, cardiologist of the 9th department of anesthesiology and intensive care of «Municipal Clinical Hospital № 15 named after O.M. Filatov» of the Department of Health of Moscow, Moscow. E-mail: sangrija27@yandex.ru

Valentin A. Kokorin, MD, PhD, associate professor of the Hospital therapy #1 department of Pirogov Russian National Research Medical University of the Ministry of Healthcare of Russia, Moscow. Е -mail: valentinkokorin@yahoo.com, http://orcid.org/0000-0001-8614-6542

Mikhail N. Arefyev, MD, Head of the 9th department of anesthesiology and intensive care of «Municipal Clinical Hospital №15 named after O.M. Filatov» of the Department of Health of Moscow, Moscow. E-mail: ar839mn@yandex.ru

Vera A. Rusina, MD, PhD, cardiologist of the 9th department of anesthesiology and intensive care of «Municipal Clinical Hospital №15 named after O.M. Filatov» of the Department of Health of Moscow, Moscow. E-mail: 321var19@gmail.com

Ivan G. Gordeev, Doctor of Medicine, professor, Head of the Hospital therapy #1 department of Pirogov Russian National Research Medical University of the Ministry of Healthcare of Russia, Moscow. E-mail: cardio-15@yandex.ru


Similar Articles


Бионика Медиа