Loyola University Medical Center, Stritch School of Medicine, Maywood, IL, USA.
Advanced Heart Failure, Mechanical Circulatory Support, Heart Transplant, Jefferson Heart Institute, Sidney Kimmel School of Medicine, Thomas Jefferson University, Philadelphia, PA, USA.
Clin Appl Thromb Hemost. 2021 Jan-Dec;27:10760296211052292. doi: 10.1177/10760296211052292.
Pulmonary embolism (PE) clinical manifestations vary widely, and that scope is not fully captured by current all-cause mortality risk models. PE is associated with inflammatory, coagulation, and hemostatic imbalances so blood cellular indices may be prognostically useful. Complete blood count (CBC) data may improve current risk models like the simplified pulmonary embolism severity index (sPESI) for all-cause mortality, offering greater accuracy and analytic ability. Acute PE patients (n = 228) with confirmatory diagnostic imaging were followed for all-cause mortality. Blood cellular indices were assessed for association to all-cause mortality and were supplemented into sPESI using multivariate logistic regression. Multiple blood cellular indices were found to be significantly associated with all-cause mortality in acute PE. sPESI including red cell distribution width, hematocrit and neutrophil-lymphocyte ratio had better predictive ability as compared to sPESI alone (AUC: 0.852 vs 0.754). Blood cellular indices contribute an inflammatory and hemodynamic perspective not currently included in sPESI. CBC with differential is a widely used, low-cost test that can augment current risk stratification tools for all-cause mortality in acute PE patients.
肺栓塞（PE）的临床表现差异很大，而目前的全因死亡率风险模型并不能完全捕捉到这一范围。PE 与炎症、凝血和止血失衡有关，因此血液细胞指标可能具有预后意义。全血细胞计数（CBC）数据可能会改善当前的风险模型，如简化的肺栓塞严重指数（sPESI），以预测全因死亡率，从而提供更高的准确性和分析能力。对接受明确诊断性影像学检查的急性 PE 患者（n=228）进行全因死亡率随访。评估血液细胞指标与全因死亡率的相关性，并通过多变量逻辑回归将其补充到 sPESI 中。多项血液细胞指标与急性 PE 的全因死亡率显著相关。与单独的 sPESI 相比，包含红细胞分布宽度、血细胞比容和中性粒细胞-淋巴细胞比值的 sPESI 具有更好的预测能力（AUC：0.852 比 0.754）。血液细胞指标提供了目前在 sPESI 中未包含的炎症和血液动力学视角。CBC 加分类是一种广泛使用的、低成本的检测方法，可以增强急性 PE 患者全因死亡率的当前风险分层工具。
