Pulmonary vascular disease & thromboembolism
Mean arterial pressure predicts 48 h clinical deterioration in intermediate-high risk patients with acute pulmonary embolism
Primary result · Clinical deterioration within 48 h; prognostic performance of MAPResult — go to the resultHazard ratio 3.25 95% CI 1.89–5.21Authors' conclusion
The mean arterial pressure appears to be a useful, bedside, and non-invasive prognostic tool potentially capable of promptly identifying intermediate-high risk PE patients at higher risk of 48 h clinical deterioration.
Study context
- Population
- Intermediate-high risk pulmonary embolism (PE) patients (Italian Pulmonary Embolism Registry)intermediate-high risk PE
- Participants
- 450 patients
- Comparison
- Mean arterial pressure (MAP) ≤81.5 mmHg vs >81.5 mmHg at admission
- Primary endpoint
- Clinical deterioration (worsening from stable to unstable haemodynamic condition, need of catecholamine infusion, endotracheal intubation, or cardiopulmonary resuscitation)
- Follow-up
- 48 h from admission
Primary result
As reported in the abstract
Clinical deterioration within 48 h; prognostic performance of MAP
Hazard ratio
3.25
95% CI 1.89–5.21
P < 0.0001
By group
MAP ≤81.5 mmHg
- AUC
- 0.77 ± 0.3
- Sensitivity
- 77.5%
- Specificity
- 95.0%
- PPV
- 63.2%
- NPV
- 97.7%
MAP ≤81.5 mmHg
AUC0.77 ± 0.3
Sensitivity77.5%
Specificity95.0%
PPV63.2%
NPV97.7%
MAP ≤81.5 mmHgvs >81.5 mmHg at admission
HR 3.25 (95% CI 1.89–5.21); P < 0.0001
- Clinical deterioration within 48 h
- 40 (8.8%)
Further findings
Other independent risk factors for 48 h clinical deterioration
| HR (95% CI) | P value | ||
|---|---|---|---|
| AgeMultivariate Cox regression | 1.26 (1.19–1.28) | P < 0.0001 | |
| History of HFMultivariate Cox regression | 1.76 (1.72–1.81) | P < 0.0001 | |
| Simplified PE Severity IndexMultivariate Cox regression | 1.52 (1.49–1.58) | P = 0.001 | |
| Systemic thrombolysisMultivariate Cox regression | 0.54 (0.30–0.65) | P < 0.0001 | |
| 0.20.5125Hazard ratio (log scale) |
| Outcome | HR (95% CI) | P value | |
|---|---|---|---|
| 30-day mortality, deterioratingvs non-deteriorating | 2.61 (2.54–2.66) | P < 0.0001 | |
| 0.20.5125Hazard ratio (log scale) |
Original publication
Mean arterial pressure predicts 48 h clinical deterioration in intermediate-high risk patients with acute pulmonary embolism. Eur Heart J Acute Cardiovasc Care. Published 29 December 2022. doi:10.
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