Renal dysfunction improves risk stratification and may call for a change in the management of intermediate- and high-risk acute pulmonary embolism: results from a multicenter cohort study with external validation

• Published in: Critical care (London, England) England), 2021-02, Vol.25 (1), p.57-57, Article 57
• Main Authors: Chopard, Romain, Jimenez, David, Serzian, Guillaume, Ecarnot, Fiona, Falvo, Nicolas, Kalbacher, Elsa, Bonnet, Benjamin, Capellier, Gilles, Schiele, François, Bertoletti, Laurent, Monreal, Manuel, Meneveau, Nicolas
• Format: Article
• Language: English
• Subjects: All-cause death; Care and treatment; Cohort analysis; Critical care; Epidemiology; Hypotension; Kidney failure; Life Sciences; Medical prognosis; Mortality; Prognosis; Pulmonary embolism; Pulmonary embolisms; Renal dysfunction; Stratification; Ultrasonic imaging; Variables
• ISSN: 1364-8535; 1466-609X; 1364-8535; 1366-609X
• DOI: 10.1186/s13054-021-03458-z

Renal dysfunction influences outcomes after pulmonary embolism (PE). We aimed to determine the incremental value of adding renal dysfunction, defined by estimated glomerular filtration rate (eGFR), on top of the European Society of Cardiology (ESC) prognostic model, for the prediction of 30-day mortality in acute PE patients, which in turn could lead to the optimization of acute PE management. We performed a multicenter, non-interventional retrospective post hoc analysis based on a prospectively collected cohort including consecutive confirmed acute PE stratified per ESC guidelines. We first identified which of three eGFR formulae most accurately predicted death. Changes in global model fit, discrimination, calibration and reclassification parameters were evaluated with the addition of eGFR to the prognostic model. Among 1943 patients (mean age 67.3 (17.1), 50.4% women), 107 (5.5%) had died at 30 days. The 4-variable Modification of Diet in Renal Disease (eGFR ) formula predicted death most accurately. In total, 477 patients (24.5%) had eGFR