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.
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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: firstname.lastname@example.org
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: email@example.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: firstname.lastname@example.org
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: email@example.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: firstname.lastname@example.org