The Prognostic Value of Inflammatory Indices in Acute Pulmonary Embolism

Overview

Journal Diagnostics (Basel)

Specialty Radiology

Date 2025 Feb 13

PMID 39941242

Authors

Mihai Stefan Cristian Haba

Oana Madalina Manole

Ana Maria Buburuz

Ionut Tudorancea

Irina-Iuliana Costache-Enache

Viviana Onofrei

Affiliations

Soon will be listed here.

Abstract

Acute pulmonary embolism (PE) is a condition with increased morbidity and mortality. It is important to identify patients with high mortality risk. Inflammation and thrombosis are interconnected in the pathophysiology of PE. The aim of the study was to investigate the prognostic value of multiple blood cellular indices such as neutrophil-to-lymphocyte ratio (NLR), lymphocyte-to-monocyte ratio (LMR), platelet-to-lymphocyte ratio (PLR), neutrophil-to-lymphocyte platelet ratio (NLPR), systemic immune-inflammation index (SII), systemic inflammation response index (SIRI) and aggregate index of systemic inflammation (AISI) in acute PE. : A total of 157 patients with acute PE confirmed by chest computed tomographic angiography (CTPA) were enrolled. These patients were divided into two categories according to the simplified pulmonary embolism severity index (sPESI): high risk and low risk. : Univariate logistic regression analysis showed that right ventricle dysfunction, NLR, SII and SIRI were significantly associated with high risk of acute PE. NLR of 4.32 was associated with high-risk PE with a sensitivity of 57.4% and specificity of 65.7% (AUC = 0.635). SII of 1086.55 was associated with high-risk PE with a sensitivity of 55.7% and specificity of 71.4% (AUC = 0.614). SIRI of 2.87 was associated with high-risk PE with a sensitivity of 59% and specificity of 62.9% (AUC = 0.624). Multivariate logistic regression analysis demonstrated that right ventricle dysfunction, NLR, PLR and NLPR are independent predictors of high-risk acute PE. Secondly, NLR, NLPR, SII and SIRI were significantly correlated with in-hospital mortality of acute PE. Based on receiver-operating characteristic (ROC) curve values of 7.66 for NLR (AUC 0.911, sensitivity of 85.7% and sensibility of 83%), 0.02 for NLPR (AUC 0.871, sensitivity of 85.7% and sensibility of 70%), 1542.71 for SII (AUC 0.782, sensitivity of 71.4% and sensibility of 72%) and 5.72 for SIRI (AUC 0.788, sensitivity of 71.4% and sensibility of 73%) could predict in-hospital mortality. : The blood cellular indices (NLR, NLPR, SII and SIRI) are associated with high-risk acute PE and in-hospital mortality. Right ventricular dysfunction, NLR and NLPR are independent predictors for high-risk acute PE.

References

Muresan A, Halmaciu I, Arbanasi E, Kaller R, Arbanasi E, Budisca O . Prognostic Nutritional Index, Controlling Nutritional Status (CONUT) Score, and Inflammatory Biomarkers as Predictors of Deep Vein Thrombosis, Acute Pulmonary Embolism, and Mortality in COVID-19 Patients. Diagnostics (Basel). 2022; 12(11). PMC: 9689150. DOI: 10.3390/diagnostics12112757. View

Kaptein F, Kroft L, Hammerschlag G, Ninaber M, Bauer M, Huisman M . Pulmonary infarction in acute pulmonary embolism. Thromb Res. 2021; 202:162-169. DOI: 10.1016/j.thromres.2021.03.022. View

Bell E, Lutsey P, Basu S, Cushman M, Heckbert S, Lloyd-Jones D . Lifetime Risk of Venous Thromboembolism in Two Cohort Studies. Am J Med. 2015; 129(3):339.e19-26. PMC: 4771407. DOI: 10.1016/j.amjmed.2015.10.014. View

Marongiu F, Mameli A, Grandone E, Barcellona D . Pulmonary Thrombosis: A Clinical Pathological Entity Distinct from Pulmonary Embolism?. Semin Thromb Hemost. 2019; 45(8):778-783. DOI: 10.1055/s-0039-1696942. View

Slajus B, Brailovsky Y, Darwish I, Fareed J, Darki A . Utility of Blood Cellular Indices in the Risk Stratification of Patients Presenting with Acute Pulmonary Embolism. Clin Appl Thromb Hemost. 2021; 27:10760296211052292. PMC: 8649084. DOI: 10.1177/10760296211052292. View

Jimenez D, de Miguel-Diez J, Guijarro R, Trujillo-Santos J, Otero R, Barba R . Trends in the Management and Outcomes of Acute Pulmonary Embolism: Analysis From the RIETE Registry. J Am Coll Cardiol. 2016; 67(2):162-170. DOI: 10.1016/j.jacc.2015.10.060. View

Kose N, Yildirim T, Akin F, Yildirim S, Altun I . Prognostic role of NLR, PLR, and LMR in patients with pulmonary embolism. Bosn J Basic Med Sci. 2019; 20(2):248-253. PMC: 7202190. DOI: 10.17305/bjbms.2019.4445. View

Ghaffari S, Parvizian N, Pourafkari L, Separham A, Hajizadeh R, Nader N . Prognostic value of platelet indices in patients with acute pulmonary thromboembolism. J Cardiovasc Thorac Res. 2020; 12(1):56-62. PMC: 7080337. DOI: 10.34172/jcvtr.2020.09. View

Dziedzic E, Gasior J, Tuzimek A, Paleczny J, Junka A, Dabrowski M . Investigation of the Associations of Novel Inflammatory Biomarkers-Systemic Inflammatory Index (SII) and Systemic Inflammatory Response Index (SIRI)-With the Severity of Coronary Artery Disease and Acute Coronary Syndrome Occurrence. Int J Mol Sci. 2022; 23(17). PMC: 9455822. DOI: 10.3390/ijms23179553. View

10.

Jimenez D, Aujesky D, Moores L, Gomez V, Lobo J, Uresandi F . Simplification of the pulmonary embolism severity index for prognostication in patients with acute symptomatic pulmonary embolism. Arch Intern Med. 2010; 170(15):1383-9. DOI: 10.1001/archinternmed.2010.199. View

11.

Kasapoglu U, Olgun Yildizeli S, Arikan H, Erer A, Kabadayi F, Yalcinkaya E . Comparison of neutrophil to lymphocyte ratio with other prognostic markers affecting 30 day mortality in acute pulmonary embolism. Tuberk Toraks. 2019; 67(3):179-189. DOI: 10.5578/tt.68519. View

12.

Gok M, Kurtul A . A novel marker for predicting severity of acute pulmonary embolism: systemic immune-inflammation index. Scand Cardiovasc J. 2020; 55(2):91-96. DOI: 10.1080/14017431.2020.1846774. View

13.

Kayrak M, Erdogan H, Solak Y, Akilli H, Gul E, Yildirim O . Prognostic value of neutrophil to lymphocyte ratio in patients with acute pulmonary embolism: a restrospective study. Heart Lung Circ. 2013; 23(1):56-62. DOI: 10.1016/j.hlc.2013.06.004. View

14.

Gary T, Pichler M, Belaj K, Hafner F, Gerger A, Froehlich H . Platelet-to-lymphocyte ratio: a novel marker for critical limb ischemia in peripheral arterial occlusive disease patients. PLoS One. 2013; 8(7):e67688. PMC: 3699634. DOI: 10.1371/journal.pone.0067688. View

15.

Duffett L, Castellucci L, Forgie M . Pulmonary embolism: update on management and controversies. BMJ. 2020; 370:m2177. DOI: 10.1136/bmj.m2177. View

16.

Dong C, Wang Z, Chen S . Neutrophil to lymphocyte ratio predict mortality and major adverse cardiac events in acute coronary syndrome: A systematic review and meta-analysis. Clin Biochem. 2017; 52:131-136. DOI: 10.1016/j.clinbiochem.2017.11.008. View

17.

Jia D, Liu F, Zhang Q, Zeng G, Li X, Hou G . Rapid on-site evaluation of routine biochemical parameters to predict right ventricular dysfunction in and the prognosis of patients with acute pulmonary embolism upon admission to the emergency room. J Clin Lab Anal. 2017; 32(4):e22362. PMC: 6817223. DOI: 10.1002/jcla.22362. View

18.

Xia Y, Xia C, Wu L, Li Z, Li H, Zhang J . Systemic Immune Inflammation Index (SII), System Inflammation Response Index (SIRI) and Risk of All-Cause Mortality and Cardiovascular Mortality: A 20-Year Follow-Up Cohort Study of 42,875 US Adults. J Clin Med. 2023; 12(3). PMC: 9918056. DOI: 10.3390/jcm12031128. View

19.

Akboga M, Canpolat U, Yayla C, Ozcan F, Ozeke O, Topaloglu S . Association of Platelet to Lymphocyte Ratio With Inflammation and Severity of Coronary Atherosclerosis in Patients With Stable Coronary Artery Disease. Angiology. 2015; 67(1):89-95. DOI: 10.1177/0003319715583186. View

20.

Lutsey P, Zakai N . Epidemiology and prevention of venous thromboembolism. Nat Rev Cardiol. 2022; 20(4):248-262. PMC: 9579604. DOI: 10.1038/s41569-022-00787-6. View