EXPRESS: A prognostic prediction model for acute pulmonary embolism.

Abstract

Acute pulmonary embolism (APE) is a very common and important medical emergency in intensive care units with unfavorable prognosis. This study aims to explore the prognostic factors of APE and to construct a prognostic prediction model. A retrospective analysis was conducted on 252 APE patients in the Emergency Department of our hospital from January 2020 to March 2024. The initial observation endpoint was set as the mortality status of patients within 30 days of admission. Cox multivariate regression analysis were used to identify independent risk factors for prognosis. Based on these factors, a nomogram predictive model was constructed and evaluated using R software. Within 30 days of admission, 42 patients died with an overall mortality rate of 16.6% (42/252). Binary Cox multivariate regression analysis indicated that age ≥ 62.5 (HR: 2.64, 95%CI: 1.23-5.63, P = 0.012), right ventricular dysfunction (RVD) (HR: 4.58, 95%CI: 1.76-11.96, P = 0.002), white blood cell count (WBC) ≥ 13.1 (HR: 2.35, 95%CI: 1.20-4.60, P = 0.013), albumin/fibrinogen ratio (AFR) < 9.15 (HR: 3.36, 95%CI: 1.76-6.42, P < 0.001), Prognostic Nutritional Index (PNI) < 50.3 (HR: 4.35, 95%CI: 1.62-11.71, P = 0.004), and Systemic Inflammation Response Index (SIRI) ≥ 1.05 (HR: 7.21, 95%CI: 3.38-15.37, P < 0.001) were independent risk factors for mortality. The nomogram model based on these factors demonstrated a good predictive value for 30-day mortality, with an AUC of 0.908. The nomogram model based on age, RVD, WBC, AFR, PNI, and SIRI has a well prognostic value for APE patients.