Prognostic factors for pulmonary embolism: the prep study, a prospective multicenter cohort study

Am J Respir Crit Care Med. 2010 Jan 15;181(2):168-73. doi: 10.1164/rccm.200906-0970OC. Epub 2009 Nov 12.


Rationale: The short-term prognosis of pulmonary embolism (PE) depends on hemodynamic status and underlying disease. The prognostic value of right ventricular dysfunction and injury is less well established.

Objectives: To evaluate prognostic factors of PE in a multicenter prospective cohort study.

Methods: Echocardiography, brain natriuretic peptide (BNP), N-terminal-proBNP and cardiac troponin I measurements were done on admission of 570 consecutive patients with an acute PE. A predictive model was based on independent predictors of 30-day adverse events defined as death, secondary cardiogenic shock, or recurrent venous thromboembolism.

Measurements and main results: At 30 days, 42 patients (7.4%; 95% confidence interval [CI], 5.5-9.8%) had adverse events. On multivariate analysis, altered mental state (odds ratio [OR] 6.8; 95% confidence interval [CI], 2.0-23.3), shock on admission (OR 2.8; 95% CI, 1.1-7.5), cancer (OR 2.9; 95% CI, 1.2-6.9), BNP (OR 1.3 for an increase of 250 ng/L; 95% CI, 1.1-1.6) and right to left ventricle diameter ratio (OR 1.2 for an increase of 0.1; 95% CI, 1.1-1.4) were associated with 30-days of adverse events. The predictive performance of the model was good (area under receiver operating characteristics curve 0.84 [95% CI, 0.78-0.90]), making it possible to develop a bedside prognostic score.

Conclusions: BNP and echocardiography may be useful determinants of the short-term outcome for patients with PE, together with clinical findings. Patients with PE can be stratified according to the initial risk of adverse outcome, using a simple score based on clinical, echocardiographic, and biochemical variables.

Publication types

  • Multicenter Study
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Acute Disease
  • Aged
  • Cause of Death
  • Cohort Studies
  • Echocardiography
  • Female
  • Hospital Mortality
  • Humans
  • Male
  • Middle Aged
  • Models, Statistical
  • Multivariate Analysis
  • Natriuretic Peptide, Brain / blood
  • Peptide Fragments / blood
  • Prognosis
  • Prospective Studies
  • Pulmonary Embolism / genetics*
  • Pulmonary Embolism / physiopathology*
  • Recurrence
  • Risk Assessment
  • Shock, Cardiogenic / mortality
  • Shock, Cardiogenic / physiopathology
  • Survival Rate
  • Troponin I / blood
  • Venous Thromboembolism / mortality
  • Venous Thromboembolism / physiopathology


  • Peptide Fragments
  • Troponin I
  • pro-brain natriuretic peptide (1-76)
  • Natriuretic Peptide, Brain