Predictors of 90-Day Mortality in Patients with Acute Pulmonary Embolism- a 5-Year Retrospective Cohort Study of Patients in One Canadian Health Region

BACKGROUND Acute pulmonary embolism (PE) can be fatal if not treated. PE is linked to major co-morbidities such as cancer and ischemic heart disease. Recurrence of PE may occur and is linked to high morbidity and death. Although acute PE is a common diagnosis, the incidence is still unknown in our health region. Published studies from other countries indicate an annual incidence between 0.2 and 0.8 /1000 persons, where the variation may be related to different inclusion criteria. Our knowledge about the association between concomitant diseases and PE and its outcomes is mostly based on data from clinical trials, and these patients may not fully represent real-life PE patients. This potentially limits our understanding of concomitant disorders that are associated to PE. We sought to determine 90-day survival and predictors of mortality for patients with acute PE in a real world setting.

METHODS We retrospectively analyzed a cohort of adult outpatients aged ≥18 years with objectively confirmed acute PE between 2014 and 2019. PE was identified by positive diagnostic imaging from radiology reports obtained via search of the Picture Archiving and Communication System (PACS) database in the Eastern Health Region of Newfoundland and Labrador, Canada. We defined the clinical end-point as all-cause death within 90 days of PE diagnosis at a health facility in the health region. Cox-regression analysis was used to study the impact of patient characteristics and comorbidities on 90-day survival after the episode of acute PE.

RESULTS A total of 1184 patients were identified as having acute PE between 2014 and 2019 within the Eastern Health Region. The annual incidence of PE among adults was estimated at 0.95/1000 persons. Of the total, 785 patients were diagnosed with acute PE as outpatients and were included in our study. Mean age was [SD] 63.4 ± 15.9 years, weight [SD] 92.0 ± 30.4 kilograms, and 42.3% were men. Patients were followed for 67274 person-days and 61 (7.8%) of outpatients died. Surgery ≤ 2 weeks prior to acute PE (44.6%), cancer (44.2%) and previous venous thromboembolism (15.2%) were most prevalent comorbid conditions among the patients [Table 1]. Male patients had a multivariate-adjusted hazard ratio (HR) of 5.63 (95% CI: 1.49 - 21.32); p = 0.011; 3.24 (95%CI: 1.47 - 7.14); p=0.004 and 2.48 (95% CI: 1.39-4.42); p=0.002 for 7, 30 and 90-day mortality respectively compared to females. Patients who had surgery ≤ 2 weeks prior to acute PE were associated with HR: 6.29 (95%CI: 1.31 - 30.29) p=0.0218; HR: 4.34 (95%CI: 1.79 - 10.48) p=0.001 and HR: 2.00 (95%CI: 1.18 - 3.52); p=0.010 higher risk of 7, 30 and 90 day-mortality, respectively. Having cancer was associated with increased risk of 30-day (HR: 6.13[95%CI: 1.81 - 20.72]; p=0.004) and 90-day (HR; 4.27 [95%CI: 1.87 - 9.72]; p<0.001) mortality. An increase in weight is associated with lower risk of 30 (HR; 0.95 [95%CI: 0.94 - 0.99]; p=0.007) and 90-day mortality (HR: 0.97[95%CI: 0.95 - 0.99]; p<0.001) respectively [Figure 1].

CONCLUSIONS Male sex, surgery ≤ 2 weeks prior to PE, cancer and weight are factors that predicted 90-mortality among patients with acute PE.

Bonsu:Sanofi Canada: Research Funding. Young:Bayer Canada: Research Funding; Sanofi Canada: Research Funding; Pfizer: Honoraria. Lee:Shoppers Drug Mart: Research Funding. Chitsike:Pfizer: Honoraria; Bayer Canada: Research Funding; Sanofi Canada: Research Funding.