Rapid improvement of renal function in patients with acute pulmonary embolism indicates favorable short term prognosis.
Thromb Res. 2012 Jun 15;
Authors: Kostrubiec M, Labyk A, Pedowska-W?oszek J, Pacho S, Dzikowska-Diduch O, Dul P, Ciurzy?ski M, Bienias P, Pruszczyk P
OBJECTIVE: Various clinical and biochemical parameters predict the prognosis of patients with acute pulmonary embolism(APE). Treatment of APE can improve a patient's hemodynamic status, restoring adequate peripheral organ perfusion. Therefore, we hypothesized that improvement of renal function can predict short term prognosis of APE patients. MATERIAL & METHOD: We evaluated 232 consecutive patients (94men,aged 67±18years) with APE proven by spiral computer tomography. Blood samples were collected for creatinine assays on admission and 72hours later, the glomerular filtration rate(eGFR) was estimated using the MDRD formula. RESULTS: During the first 72hours, 6 subjects died, while during the first 30days 24(10%) subjects died (APE mortality 8%). On admission eGFR<60ml/min was present in 113 patients(49%) and after 72hours in 85 patients(38%). In 26 patients(11%) eGFR on admission was <60ml/min and renal function did not improve during subsequent 72hours. In this group the 30-day all-cause and APE-related mortality rates were 27% and 23%, respectively, while serious adverse events occurred in 38% of them. 206 patients with eGFR>60ml/min showed a more favorable prognosis (8% 30-day all-cause mortality) than subjects with eGFR<60ml/min and a stable eGFR during the first 72hours (27% mortality rate, p<0.003). Persistent renal dysfunction predicted all-cause and PE-related 30-day mortality (hazard risk 2.53(CI95%:0.96-6.68),p=0.06 and 3.04(CI95%:1.28-7.26),p=0.01, respectively). CONCLUSION: Approximately 50% of patients with APE have at least a moderately impaired renal function on admission. Renal function improves within 72hours in patients with a good prognosis, while "persistent" renal dysfunction indicates an increased mortality.
PMID: 22705059 [PubMed - as supplied by publisher]