P276 BLOOD GAS ANALYSIS AND D–DIMER IN CASES OF ORGAN DAMAGE FROM PULMONARY EMBOLISM IN ELDERLY: POOR CORRELATION IN REAL LIFE IN THE EMERGENCY ROOM. (18th May 2022)

• Record Type: Journal Article
• Authors: Savioli, G; Ceresa, I; Mugellini, A; Martignoni, A; Fumoso, F; Lapia, F; Brattoli, M; Preda, L; Bressan, M
• Is Part Of: European heart journal supplements. Volume 24(2022)Supplement C
• Publication Date: 2022-05-18
• Subjects: Cardiology -- Periodicals; Cardiology -- Europe -- Periodicals; 616.12005
• DOI: 10.1093/eurheartj/suac012.267
• Languages: English
• ISSNs: 1520-765X

Abstract

Abstract: Premise: Pulmonary embolism is a pathology still characterized by high mortality and severe sequelae, greater in cases of organ damage. Raising suspicion and early recognition of this condition is therefore important to avoid delays in undertaking the right diagnostic and therapeutic process. Purpose: Evaluate which vital parameters and shock parameters derived from them, in the real life of an Emergency Department, correlate with the presence of organ damage from pulmonary embolism to see which ones may be of help in raising the suspicion of this condition early. Methods: Single–center retrospective observational study, on all geriatric patients (>75) who were diagnosed with acute PE. Enrollment began in 2016 and ended in 2019. We collected data from medical history, physical examination, laboratory tests, imaging; we calculated the characteristic scores from the diagnostic / therapeutic algorithm, both for the risk of PE (Wells, Geneva and Years), and for the presentation of the risk of mortality at 30 days (sPESI). We analyzed all the blood gas analyzes performed upon access to the emergency room. We then had all chest CTs retested by an experienced radiologist. We went to see the correlation of vital parameters and shock indexes from these derivatives with the presence of organ damage from pulmonary embolism. We considered right ventricular dilation, pulmonary artery dilation and the presence of pulmonary infarction organ damage. Results: We enrolled 247 patients, with a mean age of 83 years and female prevalence (F = 63%). Of these, 79 (32%) have organ damage from pulmonary embolism. The lactate values do not correlate with the presence of organ damage (p > 0.05). The pCO2 values correlate inversely with the presence of organ damage reaching statistical significance (P < 0.05). Instead, the reduction in pO2 values and the increase in pH values do not have any correlation with the presence of organ damage (p > 0.05). The D–Dimer in turn shows a fair association with the values of organ damage from pulmonary embolism (p < 0.01). Conclusions: The study suggests a reduced significance of blood gas analysis in the early identification of patients with organ damage in the event of pulmonary embolism. A fair correlation is given only by the reduction in pCO2 values and by the increase in D–Dimer values.