DVT and PE

Q: Which of the following in Pulmonary Embolism (PE) with coexisting Deep vein thrombosis (DVT) is an indicator of increased risk for death? - select one

A) Hypernatremia

B) Hyponatremia 

Answer: B

PE patients without DVT usually do better than patients with coexisting DVT. There are a few clinical and laboratory signs that predict high mortality in patients with PE and a coexisting DVT, either in the upper or lower extremities. These include:

• Hyponatremia
• Indicators of kidney dysfunction 
• Serum lactate (>2 mmol/L)
• Leucocytosis (>12.6 x 109/L) 
• Charlson comorbidity index ≥1
• Residual pulmonary vascular obstruction 
• Age ≥65 years 
• Tachycardia

#hematology

#pulmonary

#electrolytes

References:

1. Scherz N, Labarère J, Méan M, et al. Prognostic importance of hyponatremia in patients with acute pulmonary embolism. Am J Respir Crit Care Med 2010; 182:1178.

2. Jiménez D, Aujesky D, Díaz G, et al. Prognostic significance of deep vein thrombosis in patients presenting with acute symptomatic pulmonary embolism. Am J Respir Crit Care Med 2010; 181:983.

3. Venetz C, Labarère J, Jiménez D, Aujesky D. White blood cell count and mortality in patients with acute pulmonary embolism. Am J Hematol 2013; 88:677.

4. Jaureguízar A, Jiménez D, Bikdeli B, et al. Heart Rate and Mortality in Patients With Acute Symptomatic Pulmonary Embolism. Chest 2022; 161:524.

5. Murgier M, Bertoletti L, Darmon M, et al. Frequency and prognostic impact of acute kidney injury in patients with acute pulmonary embolism. Data from the RIETE registry. Int J Cardiol 2019; 291:121.