WHATÍS NEW IN OUTCOME PREDICTION FOR ACUTE PULMONARY EMBOLISM: ADMISSION GLYCEMIA

Abstract

Background: Data is lacking over the prognostic importance of admission glycaemia in acute pulmonary embolism (PE). Purpose: to assess PE prognosis stratified by the blood sugar level at admission. Population: Retrospective, longitudinal, continuous analysis of 135 patients admitted for an acute pulmonary embolism between 2000 and 2008 in a single center. The admission glycaemia was available for 113 patients. Two groups were created based on it: A (n=92) admission glycaemia ≤ 250 mg/dL; B (n=20) admission glycaemia > 250 mg/dL. The primary end-point was a composite of inhospital mortality and the need for escalation of treatment defined by one of thefollowing: catecholamine infusion, need for mechanical ventilation and cardiopulmonary resuscitation. A clinical follow up was performed targeting all-cause mortality and PE recurrence (median follow up time of 764 days). Results: The mean admission glycaemia for the population was 157.7±74.1 mg/dL. An admission glycaemia of 250mg/dL had a 33.3% sensitivity and 88% specificity for the primary outcome. The groups were significantly different regarding to mean age (60.1±18,9 vs 64.7±15.7 years; p=0.05), history of diabetes (12.4% vs 40%; p<0.01) and obesity (36% vs 65%; p=0.02) Both groups had a similar rate of cancer, venous insufficiency, deep vein thrombosis, heart failure, known thrombophilia and recent history of surgery. Groups were similar with respect to time of symptom duration, but there were differences regarding to clinical presentation (chest pain: 61.4% vs 25%; p<0.01 and acute dyspnea 69.3% vs 95%; p=0.02). The rate of cardiopulmonary arrest and CK-MB peak was higher in Group B (2.2% vs 15.0%; p=0.01 and 2.93±4.15 vs 6.10±7.8). There was no correlation admission glycaemia, arterial blood gases, troponin and C-reactive protein. Thrombolysis was performed in a similar rate for both groups (86.5% vs 85.0%; p=0.88) and there were no differences between them regarding bleeding rate (17.9% vs 15.0% p=0.8). However, the primary endpoint was significantly higher in group B patients (8.9% vs 25.0%; p<0.05). On a multivariate logistic regression analysis that included age and cardiogenic shock, admission glycaemia remained significant for the primary endpoint (OR 4.54 95% CI 1.15 17.83). Conclusion: In our population, blood sugar level at admission had prognostic value in patients with acute PE, clearly stressing the importance of metabolic variables in PE prognosis.