Background: Acute pulmonary embolism (PE) can contribute to acute kidney injury (AKI) in one in three patients, due to haemodynamic compromise. The potential of AKI assessment on the prognostic stratification of PE, remains unknown.
Aims: We aimed to determine the incremental value of adding AKI assessment according to Kidney Disease: Improving Global Outcomes (KDIGO) in the improvement of risk stratification made based on the hemodynamic status, and simplified Pulmonary Embolism Severity Index (sPESI) in patients with acute PE.
Methods: We identified patients with acute PE enrolled in the multicenter international RIETE (Registro Informatizado Enfermedad TromboEmbolica) registry between March 2001 and February 2020. Hemodynamically unstable patients were considered at high-risk. Hemodynamically stable patients were stratified according to the sPESI score (low-risk: sPESI=0; intermediate-risk: sPESI>0). We identified all patients with AKI in each subgroup. The primary outcome was all-cause 30-day mortality. Secondary outcomes were major bleeding and VTE recurrences during the same period.
Results: Among 30,532 patients with acute PE, 3.6% were classified to be at high-risk, 34.6% at low-risk, and the remaining 61.8%at intermediate-risk of 30-days mortality. At baseline, 26% had AKI. The presence of AKI was associated with an increased 30-day mortality in low-risk, intermediate-risk, and high-risk PE patients, from 0.46% to 3%, from 5.4% to 10%, and from 9.4% to 18%, respectively (P<0.001 for each comparison, Figure 1). The presence of AKI was associated with increased rates of major bleeding in patients at low-risk (1.7 vs 0.72%), and also in those at intermediate-risk (3.3 vs 1.8%) compared to patients without AKI (p < 0,001, Table 1).
| Normotensive PE patients | High-risk PE | |||||
| Low-risk PE (sPESI=0) |
Intermediate-risk PE (sPESI≥1) |
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| AKI + | No AKI | AKI + | No AKI | AKI + | No AKI | |
| Patients, N | 1,513 | 9,064 | 5,834 | 13,013 | 532 | 576 |
| All cause death | 45 (3.0%) | 42 (0.46%)‡ | 611 (10%) | 697 (5.4%)‡ | 94 (18%) | 54 (9.4%)‡ |
| Major bleeding | 25 (1.7%) | 65 (0.72%)‡ | 192 (3.3%) | 231 (1.8%)‡ | 33 (6.2%) | 25 (4.3%) |
| VTE recurrences | 6 (0.40%) | 42 (0.46%) | 55 (0.94%) | 113 (0.87%) | 8 (1.5%) | 3 (0.52%) |
| Comparisons between subgroups (reference: AKI+): ‡ P<.001. AKI: Acute kidney injury; AKI + : presence of AKI; AKI- : absence of AKI; sPESI: simplified Pulmonary Embolism Severity Index |
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Value adding AKI in sPESI risk at admission for predicting 30-day survival
Clinical outcomes during the first 30 days, according to the presence or absence of AKI.
Conclusions: AKI status in patients with acute PE allows to better predict the 30-day mortality and bleeding rates in the three subgroups of risk stratification.
To cite this abstract in AMA style:
Bertoletti L, Murgier M, Bikdeli B, Jimenez D, Trujillo-Santos J, Merah A, de Ancos C, Fidalgo Á, Aibar J, Monreal M. Prognostic Impact of Acute Kidney Injury in Patients with Acute Pulmonary Embolism. Data from the RIETE Registry [abstract]. Res Pract Thromb Haemost. 2021; 5 (Suppl 2). https://abstracts.isth.org/abstract/prognostic-impact-of-acute-kidney-injury-in-patients-with-acute-pulmonary-embolism-data-from-the-riete-registry/. Accessed October 2, 2023.« Back to ISTH 2021 Congress
ISTH Congress Abstracts - https://abstracts.isth.org/abstract/prognostic-impact-of-acute-kidney-injury-in-patients-with-acute-pulmonary-embolism-data-from-the-riete-registry/