Abstract
Objective. Acute pulmonary embolism (APE) is a life-threatening condition and represents the third most common cause of cardiovascular mortality. Computed tomography pulmonary angiography (CTPA) is considered the gold standard for the diagnosis of APE. The primary aim of this retrospective study was to investigate the association between admission laboratory markers in patients with CTPA-confirmed APE and the level of clot burden, as assessed by the modified Qanadli score (mQS), which should not be underestimated as a potential prognostic predictor.
Materials and methods. This retrospective, single-center study included 78 consecutive patients with CTPA-confirmed APE admitted to “Sv. Ekaterina” University Hospital, Sofia, Bulgaria. Demographic, clinical, laboratory, echocardiographic, and radiological data were collected. Clot burden was quantified using the mQS, classifying patients into non-massive, submassive, and massive APE. Statistical analyses were used to evaluate associations between laboratory markers and mQS.
Results. A total of 78 patients were included in the study. The mean mQS was 15.97. Right ventricular dysfunction (RV/LV >1) was strongly associated with higher clot burden severity (p = 0.0008). Glucose levels at admission were significantly higher in patients with greater clot burden (p = 0.042). In a multivariate analysis, glucose remained an independent predictor of high-severity APE (OR = 1.397, 95% CI 1.013-1.928, p = 0.042). A glucose cut-off of 6.12 mmol/L had a sensitivity of 61.1% and a specificity of 62.5% for identifying patients with high-severity APE. Other laboratory markers, including troponin and D-dimer, did not show statistically significant differences across the severity groups.
Conclusion. The mQS is a practical tool that, when combined with laboratory data, may aid risk stratification. Admission glucose levels showed moderate predictive value, suggesting stress-induced hyperglycemia as an indirect marker of disease severity, whereas other laboratory markers were not significantly associated with clot burden. Incorporating clot burden and glucose into prognostic models may facilitate early, individualized management, although glucose should not be used in isolation. The optimal laboratory marker for prognostic prediction in APE remains debated.