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A Radiological Nomogram to Predict 30-day Mortality in Patients with Acute Pulmonary Embolism

Published:December 22, 2021DOI:https://doi.org/10.1016/j.acra.2021.11.021

      Rationale and Objectives

      Acute pulmonary embolism (APE) is a common disease with a high mortality, especially in the short term. Computed tomographic pulmonary angiography (CTPA) is a recommended method in the diagnostic workup for APE; thus, this study aimed to establish a CTPA-based radiological nomogram to predict the 30-day mortality in patients with APE, and to further compare this model with the pulmonary embolism severity index (PESI) and simplified pulmonary embolism severity index (SPESI).

      Materials and Methods

      We retrospectively recruited 158 adults with confirmed APE who underwent CTPA from August 1, 2017, to August 1, 2020. These adults were stratified into two groups according to their 30-day mortality. CTPA-based variables were analyzed using univariate and multivariate analyses, independent risk factors for 30-day mortality were established, and a radiological nomogram was constructed. Subsequently, PESI and SPESI were calculated. The performance of the radiological nomogram model was compared to that of the PESI and SPESI using decision curve analysis and receiver-operating characteristic curve analysis.

      Results

      Thirty-three patients died within 30 days (30-day mortality rate, 20.9%). On logistic regression analysis, the right and left ventricular diameter ratio (odds ratio [OR] = 8.709, 95% confidence interval [CI]: 1.085-69.903, p = 0.042), ventricular septal bowing (OR = 8.085, 95% CI: 1.947-33.567, p = 0.004), chronic bronchitis (OR = 4.383, 95% CI: 1.025-18.740, p = 0.046), malignant lung lesions (OR = 17.530, 95% CI: 2.408-127.636, p = 0.005), and pneumonia (OR = 3.477, 95% CI: 1.123-10.766, p = 0.031) were identified as the independent predictors of 30-day mortality. The area under the curve of the radiological nomogram, PESI, and SPESI were 0.900 (95% CI: 0.828-0.971), 0.729 (95% CI: 0.642-0.815), and 0.718 (95% CI: 0.621-0.815), respectively.

      Conclusion

      The CTPA-based radiological nomogram appeared valuable for the prediction of 30-day mortality in patients with APE, and was superior to both PESI and SPESI.

      Key Words

      Abbreviations:

      APE (acute pulmonary embolism), CTPA (computed tomographic pulmonary angiography), PESI (pulmonary embolism severity index), SPESI (simplified pulmonary embolism severity index), DCA (decision curve analysis), ROC (receiver-operating characteristic), OR (odds ratio), VTE (venous thromboembolism), RV (right ventricular), LV (left ventricular), RA (right atrium), LA (left atrium), VSB (ventricular septal bowing), MPA (main pulmonary artery), LPA (left pulmonary artery), RPA (right pulmonary artery), AA (ascending aorta), MDCT (multi-detector computed tomographic), RVD (right ventricular dysfunction), COPD (chronic obstructive pulmonary disease), ECHO (Echocardiography)
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