engleski

Red Cell Distribution Width in Acute Pulmonary Embolism Patients Improves 30-Day Mortality Risk Stratification Based on the Pulmonary Embolism Severity Index

Purpose To validate red cell distribution width (RDW) as an improvement in 30-day mortality risk stratification based on the Pulmonary Embolism Severity Index (PESI) in acute pulmonary embolism (PE). Patients and Methods Prospective observational analysis of consecutive adult acute PE patients. Results Among 731 patients, 30-day mortality was 11.9%. With adjustment for the PESI score and number of covariates, higher RDW was associated with higher mortality (RDW continuous: OR 1.21, 95% CI 1.06– 1.38 ; Bayesian OR 1.22, 1.07–1.40 ; RDW ‘high’ [>14.5% in men >16.1% in women] vs normal: OR 3.83, 1.98–7.46 ; Bayesian OR 3.98, 2.04–7.68]. Crude mortality was 3.6% if PESI 86–105 (intermediate risk), but 1.2% if RDW normal and 7.1% if RDW high ; 11.8% if PESI 106–125 (high risk), but 3.6% if RDW normal and 18.8% if RDW high. Adjusted probabilities showed higher mortality (ORs between 3.5–5.8) if RDW was high in any PESI risk subgroup. Crude mortality rates in two random-split subsets (n=365 and n=366) again showed the same patterns. Conclusions On-admission RDW above the normal range improves 30-day mortality risk stratification based on PESI score in acute PE. Particularly, it corrects PESI- based intermediate-risk or high-risk allocation by reclassification into very low-risk (<3.5%) or very high-risk (>11.0%).

30-day mortality ; Acute pulmonary embolism ; Pulmonary Embolism Severity Index ; Red cell distribution width

nije evidentirano