A novel prognostic indicator for in-hospital and 4-year outcomes in patients with pulmonary embolism: TIMI risk index

• Published in: Journal of critical care 2017-10, Vol.41, p.183-190
• Main Authors: Keskin, Muhammed, MD, Güvenç, Tolga Sinan, MD, Hayıroğlu, Mert İlker, MD, Kaya, Adnan, MD, Tatlısu, Mustafa Adem, MD, Avşar, Şahin, MD, Öz, Ahmet, MD, Keskin, Taha, MD, Uzun, Ahmet Okan, MD, Kozan, Ömer, MD
• Format: Article
• Language: English
• Subjects: Acute coronary syndromes; Age; Aged; Aged, 80 and over; Analysis of Variance; Cardiovascular disease; Critical Care; Embolisms; Female; Fibrinolytic Agents - therapeutic use; Health risk assessment; Heart attacks; Heart rate; Hospital Mortality; Humans; Hypertension; Kidney diseases; Laboratories; Male; Medical databases; Medical imaging; Medical prognosis; Middle Aged; Mortality; Multivariate Analysis; Myocardial Infarction - complications; Myocardial Infarction - drug therapy; Myocardial Infarction - mortality; Predictive Value of Tests; Prognosis; Pulmonary arteries; Pulmonary embolism; Pulmonary Embolism - complications; Pulmonary Embolism - drug therapy; Pulmonary Embolism - mortality; Pulmonary embolisms; Retrospective Studies; Risk Assessment - methods; Risk stratification; Thromboembolism; Thrombolytic Therapy - statistics & numerical data; TIMI risk index
• ISSN: 0883-9441; 1557-8615
• DOI: 10.1016/j.jcrc.2017.05.018

Abstract Background Thrombolysis in Myocardial Infarction (TIMI) risk index (TRI) was recently evaluated in patients with acute myocardial infarction and found as an important prognostic index. In the current study, we evaluated the prognostic value of TRI in patients with moderate-high and high risk pulmonary embolism (PE) who were treated with thrombolytic agents. Methods We retrospectively evaluated the in-hospital and long-term (4-year) prognostic impact of TRI in a total number of 456 patients with moderate-high and high risk PE. Patients were stratified by quartiles (Q) of admission TRI. Results In-hospital analysis revealed significantly higher rates of in-hospital death for patients with TRI in Q4. After adjustment for confounding baseline variables, TRI in Q4 was associated with 2.8-fold hazard of in-hospital death. Upon multivariate analysis, admission TRI in Q4 vs. Q1–3 was associated with 3.1 fold hazard of 4-year mortality rate. Conclusion TRI in Q4, as compared to Q1–3, was significantly predictive of short term and long-term outcomes in PE patients who treated with thrombolytic agents. Our data suggest TRI to be an independent, feasible, and cost-effective tool for rapid risk stratification in moderate-high and high risk PE patients who treated with thrombolytic agents.