Hemodynamically Unstable Pulmonary Embolism in the RIETE Registry: Systolic Blood Pressure or Shock Index?

¹ Dept of Pneumonology, Hospital Virgen del Rocío. Sevilla. Spain
² Dept of Internal Medicine, Hospital Santa María del Rosell, Cartagena, Murcia. Spain
³ Research Unit of Virgen del Rocío Hospital. Sevilla
⁴ Dept of Pneumonology, Hospital Virgen del Rocío. Sevilla.
⁵ Dept of Pneumonology. Complejo Hospitalario San Millán y San Pedro. La Rioja
⁶ Dept of Pneumonology. Hospital General Universitario Carlos Haya. Málaga.
⁷ Dept of Internal Medicine. Hospital Universitari Germans Trias i Pujol. Barcelona. Spain

^* To whom correspondence should be addressed. E-mail: mmonreal.germanstrias{at}gencat.net.

	Abstract

Patients with acute pulmonary embolism (PE) presenting with hemodynamic instability have the worse prognosis. But what we understand by hemodynamic instability has not been clearly defined.

RIETE is an ongoing registry of consecutive patients with symptomatic, objectively confirmed, acute deep vein thrombosis or PE. We compared the predictive value of systolic blood pressure (SBP) <100 mm Hg, SBP <90 mm Hg, or the shock index (heart rate divided by SBP) on 30-day mortality in consecutive patients with PE.

As of May 2006, 6599 patients with PE were enrolled. Of them, 417 (6.3%) died within 30 days (153 died of the initial PE, 29 of recurrent PE, 235 other). Of these, 127 (30%) had a positive shock index; 60 (14%) had SBP <100 mm Hg; 33 (7.9%) had SBP <90 mm Hg. On multivariate analysis any of the 3 parameters were independently associated with an increased mortality. The shock index had a higher sensitivity (30.5% vs. 14.4% or 7.9%, respectively), but lower specificity (86.3 vs. 93.0 or 96.6).

All 3 measures of hemodynamic instability are independent predictors of 30-day mortality. However, while the shock index had the highest sensitivity, SBP<90 mm Hg had the highest specificity.

This article has been cited by other articles:

				O. Sanchez, B. Planquette, and G. Meyer Update on acute pulmonary embolism Eur. Respir. Rev., September 1, 2009; 18(113): 137 - 147. [Full Text] [PDF]