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.

Keywords: heart type fatty acid binding protein, predictors of poor outcome, obstructive shock, pulmonary embolism