Prognostic factors in pulmonary embolus

Abstract

Risk stratification of patients with pulmonary embolism represents an important step and may help to guide initial therapeutic management. Pulmonary embolism can be stratified into several levels of risk of early death or complications based on the presence of several risk factors. High-risk pulmonary embolism is defined by shock or peripheral signs of hypoperfusion. It is a life-threatening emergency with high short-term mortality (> 25%) requiring specific therapeutic strategy with inotropic agents and fibrinolysis. In patients with normotensive pulmonary embolism, the presence of right ventricular dysfunction on echocardiography and/or myocardial injury, as attested by elevated levels of biomarkers, is associated with an intermediate risk of early death. These patients need close monitoring, while evaluation of fibrinolysis efficacy is currently underway. Patients with normotensive pulmonary embolism and without right ventricular dysfunction or myocardial injury have low risk of death. These patients may be candidates for home treatment. Several scores combining these risk factors have been described.