A novel marker for predicting severity of acute pulmonary embolism: systemic immune-inflammation index

Figures & data

Table 1. The association of the variables with the acute pulmonary embolism severity.

Variable	Acute pulmonary embolism severity			p-Value
	Massive (n = 114)	Submassive (n = 211)	Nonmassive (n = 117)
Age (years)	67 ± 15	66 ± 16	58 ± 18	<.001
Women, n (%)	60 (52.6)	110 (52.1)	70 (59.8)	.374
Diabetes Mellitus, n (%)	19 (16.7)	17 (8.1)	18 (15.4)	.037
Current smoker, n (%)	42 (36.8)	71 (33.6)	33 (28.2)	.365
Dyspnea, n (%)	109 (95.6)	179 (84.8)	93 (79.5)	.001
Hemoptysis, n (%)	11 (9.6)	30 (14.2)	10 (8.5)	.234
Chest pain, n (%)	59 (51.8)	120 (56.9)	76 (65.0)	.120
Prior cardiac disease, n (%)	58 (50.9)	92 (43.6)	33 (28.2)	.001
Prior DVT, n (%)	6 (5.3)	14 (6.6)	8 (6.8)	.860
Prior APE, n (%)	6 (5.3)	7 (3.3)	8 (6.8)	.341
Systolic BP (mmHg)	108 ± 18	120 ± 14	118 ± 15	<.001
Diastolic BP (mmHg)	66 ± 12	76 ± 10	73 ± 10	<.001
WBC count (x10^9/L)	14.10 ± 4.12	8.97 ± 3.28	8.91 ± 3.06	<.001
Cardiac troponin (ng/mL)	2.83 (0.25–36.30)	1.48 (0.07–13.45)	0.90 (0.02–4.0)	.006
Lymphocyte count (x10^9/L)	1.8 ± 1.3	2.1 ± 1.2	2.3 ± 1.1	.006
Neutrophil count (x10^9/L)	11.4 ± 3.7	6.2 ± 3.1	5.9 ± 2.5	<.001
Platelet count (x10^9/L)	294 ± 74	226 ± 60	244 ± 76	<.001
Wells score	5.5 ± 2.1	5.3 ± 2.1	4.2 ± 2.4	<.001
In-hospital mortality, n (%)	22 (19.3)	12 (5.7)	4 (3.4)	<.001
D-dimer (ng/mL)	5500 (3645–8701)	4180 (2514–7084)	3052 (1617–5157)	<.001
C-reactive protein (mg/L)	18.2 (6.2–46.6)	15.7 (6.8–40.8)	10.3 (3.2–34.5)	.125
NT-proBNP (pg/dL)	1846 (454–5547)	935 (282–3114)	88 (60–150)	<.001
SII	1863 (1447–2762)	604 (481–906)	698 (427–928)	<.001
PAPs (mmHg)	59 ± 16	50 ± 15	41 ± 14	<.001

DVT: deep venous thrombosis; APE: acute pulmonary embolism; BP: blood pressure; WBC: white blood cell; NT-proBNP: N-terminal pro–B-type natriuretic peptide; SII: systemic immune-inflammation index; PAPs: pulmonary artery systolic pressure.

Table 2. The relationship between in-hospital mortality and clinical and laboratory variables.

Variable	In-hospital all-cause mortality		p-Value
	Yes (n = 38)	No (n = 404)
Age (years)	73 ± 11	63 ± 16	<.001
Women, n (%)	17 (44.7)	223 (55.2)	.216
Acute pulmonary embolism severity, n (%)			.001
Massive	22 (57.9 )	92 (22.8 )
Submassive	12 (31.6)	199 (49.3 )
Nonmassive	4 (10.5 )	13 (28.0 )
Diabetes Mellitus, n (%)	9 (23.7 )	45 (11.1 )	.024
Current smoker, n (%)	7 (18.4)	139 (34.4)	.045
Dyspnea, n (%)	35 (92.1)	346 (85.6)	.270
Hemoptysis, n (%)	1 (2.6)	50 (12.4)	.072
Chest pain, n (%)	14 (36.8)	241 (59.7)	.007
History of cardiac disease, n (%)	29 (76.3)	154 (38.1)	<.001
History of pulmonary embolism, n (%)	2 (5.3 )	19 (4.7 )	.877
Prior deep venous thrombosis, n (%)	1 (2.6 )	27 (6.7 )	.327
Right ventricle overload, n (%)	34 (89.5)	247 (61.1)	.001
D-dimer (ng/mL)	5225 (2009–8650)	4211 (2453–6950)	.426
C-reactive protein (mg/L)	28.7 (12.2–46.9)	12 (4.75–41)	.004
NT-proBNP (pg/dL)	2113 (1041–7850)	869 (118–3168)	.007
Cardiac troponin (ng/mL)	2.46 (0.26–31.5)	1.35 (0.14–9.70)	<.001
SII	1635 (917–3182)	767 (498–1256)	<.001
PAPs (mmHg)	58 ± 14	49 ± 16	.001
Simplified PESI			<.001
0	16 (42.1)	311 (77.0)
≥1	22 (57.9 )	93 (23.0)

NT-proBNP: N-Terminal-Pro-brain natriuretic peptide; SII: systemic immune-inflammation index; PAPs: pulmonary artery systolic pressure; PESI: pulmonary embolism severity index.

Table 3. Logistic regression analyses showing independent predictors of massive acute pulmonary embolism.

Variable	Univariate analysis		Multivariate analysis
	OR (95% CI)	p-Value	OR (95% CI)	p-Value
Age	1.014 (1.000–1.017)	.050	1.039 (0.988–1.093)	.137
Diabetes mellitus	1.674 (0.915–3.065)	.095	3.175 (0.043–235.9)	.599
Cardiac troponin	1.005 (1.000–1.010)	.048	1.012 (1.001–1.023)	.029
D-dimer	1.129 (1.022–1.139)	<.001	1.010 (0.932–1.027)	.214
NT-proBNP	1.290 (1.019–1.319)	.001	1.005 (0.989–1.012)	.918
WBC count	2.440 (1.672–3.561)	<.001	1.957 (0.754–2.231)	.376
C-reactive protein	1.007 (0.999–1.016)	.088	1.034 (1.002–1.066)	.038
SII	1.005 (1.004–1.005)	<.001	1.005 (1.003–1.007)	.001
Wells score	1.112 (1.012–1.222)	.028	1.048 (0.738–1.488)	.792

OR: odds ratio; CI: confidence interval; WBC: white blood cell; NT-proBNP: N-terminal pro–B-type natriuretic peptide; SII: systemic immune-inflammation index.

Figure 1. The receiver operating characteristic (ROC) curves of systemic immune-inflammation index (SII), neutrophil count, and platelet count in predicting massive acute pulmonary embolism. AUC: area under the curve.