Risk factors for the development of obstructive shock in patients with pulmonary embolism

Obstructive shock (OS) is one of the most often cause of death in patients with pulmonary embolism (PE). Aim: We aimed to investigate the clinical, anamnestic, laboratory and instrumental predictors of OS development in patients with PE; to investigate effectiveness of previously proposed ROCky score as predictor of OS in patients of intermediate risk. Methods: 121 patients with confirmed PE of high and intermediate risk were enrolled. PE was confirmed by CT angiography and/or echocardiography. In 29 patients (24%) OS developed during 30 days of observation, 92 patients (76%) had favourable course. Clinical, anamnestic, laboratory, instrumental parameters were investigated. ROCky score threshold to identify the patients with high risk of OS was s3,5 points. Results: Predictors of OS in PE-patients were: chronic heart failure (p=0,01), diabetes mellitus (p=0,0001 ), atrial fibrillation (p=0004), permanent risk factor of venous thromboembolism (VTE), (p=0,001), syncope (p=0,02), positive heart type fatty acid binding protein (hFABP) test (p=0,00001), heart rate (HR) И 10 bpm (p=0,003), systolic blood pressure (SBP) ≤100 mmHg (p=0,00001), creatinine clearance ≤70 ml/min (p=0,0005). The ROCky score demonstrated strong effectiveness as a predictor of OS during 30 days (p<0,001, CI 95% 2,5-30, sensitivity 73%, specificity 83%). Conclusions: The risk factors of OS in Pe patients are: chronic heart failure, atrial fibrillation, diabetes mellitus, permanent risk factor of VTE, syncope, positive hFABP test, tachycardia, hypotension, creatinine clearance ≤70 ml/min. In retrospective analysis, the ROCky score demonstrates strong prediction value of OS development in hemodynamically stable patients with PE and may be recommended for applying in clinical practice.

pulmonary embolism, obstructive shock, predictors of poor outcome, heart type fatty acid binding protein