Renal dysfunction in patients with acute pulmonary embolism: how to improve prognosis and management tactics?
P.F. Klimkin, Z.D. Mikhailova, A.Yu. Ekimovskih, N.P. Fukina, T.A. Dementieva
1) City Clinical Hospital No 5, Nizhny Novgorod, Russia;
2) City Clinical Hospital No 38, Nizhny Novgorod, Russia
Objective. Evaluation of the frequency and severity of renal dysfunction in patients with pulmonary embolism (PE) and its impact on the outcome of the disease.
Material and methods. A retrospective analysis of 109 case histories of patients (men – 45%, women – 55%) who were diagnosed with pulmonary embolism during hospitalization was carried out. The median age of patients was 67 (58; 75) years, 14 (12.8%) patients died in the hospital.
Results. The proportion of PE patients with kidney dysfunction (eGFR<60 ml/min/1.73 m2) was 63.3%. Acute kidney injury (AKI) was diagnosed by the value of serum creatinine (sCr) in 59.6% of patients with PE, incl. according to the initial sCr level (n=54) and sCr level in dynamics (n=11). The presence of AKI in patients with PE was associated with the severity of respiratory failure, coagulation profile parameters, and parameters of right ventricular dysfunction. A prognostic model was obtained, which consisted of 3 indicators (PESI index score, blood sodium level less than 135 mmol/l, and the initial sCr), which made it possible to assess the probability of a lethal outcome in patients with PE.
Conclusion. Thus, in the clinical practice of a doctor, when assessing the risk of developing adverse outcomes for patients with PE, it is advisable to take into account the renal function. Patients with AKI should be given special attention because of its negative predictive value for in-hospital mortality in PE.
About the Autors
Pavel F. Klimkin – Cand. Sci. (Med.), Consultant, City Clinical Hospital № 5, Nizhny Novgorod; e-mail: firstname.lastname@example.org ORCID: https://orcid.org/0000-0002-0231-5909
Zinaida D. Mikhailova – Dr. Sci. (Med.), Associate Professor, Consultant, City Clinical Hospital №. 38, Nizhny Novgorod; e-mail: email@example.com ORCID: https://orcid.org/0000-0002-0926-6038
Anton Yu. Ekimovskikh – Cand.Sci. (Med.), Consultant, City Clinical Hospital № 5, Nizhny Novgorod; e-mail: firstname.lastname@example.org
Natalya P. Fukina – Head of the Therapeutic Department, City Clinical Hospital №. 5, Nizhny Novgorod; e-mail: email@example.com
Tatyana A. Dementieva – Doctor at the Therapeutic Department, City Clinical Hospital № 5, Nizhny Novgorod; e-mail: Lomakin_@88mail.ru