Kabrhel et al identified risk factors for clinical deterioration after a pulmonary embolism. These can help to identify a patient who may require more aggressive management. The authors are from Massachusetts General Hospital, Mater Misericordiae University (Dublin), and Inova Fairfax Hospital (Falls Church, Virginia.
Patient selection: >= 18 years old, diagnosed with pulmonary embolism within 24 hours of presentation
Outcome: clinical deterioration within 5 days and 30-day mortality. Deterioration may include need for cardiac life support, new arrhythmia, hypoxemia or respiratory failure, need for vasopressors.
Risk factors for clinical deterioration:
(1) hypotension (systolic blood pressure < 90 mm Hg)
(2) hypoxia
(3) coronary artery disease
(4) residual deep vein thrombosis (DVT)
(5) right heart strain on echocardiogram
Risk factors for severe clinical deterioration:
(1) hypotension (systolic blood pressure < 90 mm Hg)
(2) elevated serum NT-proBNP
(3) right heart strain on echocardiogram
Risk factors for 30-day mortality:
(1) active malignancy
(2) congestive heart failure (CHF)
