Abstract 16964: Predictive Value of Blood Cellular Indices for 30-day Mortality in Patients With Acute Pulmonary Embolism. Data From the RIETE Registry

Introduction: In patients with acute pulmonary embolism (PE), the prognostic value of cellular indices, such as neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), or systemic immune-inflammation index (SII, NLR*platelets) is uncertain. The aim of this study is to investigate the relationship between blood cellular indices (NLR, PLR and SII) and adverse outcome as 30-day mortality in a cohort of patients recruited in the RIETE registry.

Methods: In this study, the data of 10085 patients from the RIETE registry were used to estimate the association between NLR, PLR or SII with the 30-day mortality in patients with acute PE. They were randomly separated into a derivation cohort (n=6,710) and validation cohort (n=3,375). Results of the logistic regression analyses in the derivation cohort were then validated using the validation cohort.

Results: In the derivation cohort, median values of NLR were: 4.3 (IQR: 2.7-7.3), PLR 151 (IQR: 104-231), and SII: 958 (IQR: 568-1,739). During the first 30 days, 315 (4.7%) patients died, 32 (0.5%) developed VTE recurrences and 142 (2.1%) major bleeding. On multivariable analyses, patients who subsequently died more likely had NLR >5.0 (OR: 3.08; 95%CI: 2.26-4.20), PLR >160 (OR: 2.40; 95%CI. 1.75-3.29) or SII >1,000 (OR: 2.14; 95%CI: 1.60-2.86). The results were further endorsed by the validation cohort where NLR >5.0 (OR: 2.42; 95%CI: 1.57-3.74), PLR >160 (OR: 1.87; 95%CI. 1.25-2.82) or SII >1,000 (OR: 2.10; 95%CI: 1.34-3.29) predicts 30-day mortality.

Conclusions: These studies suggest that patients with elevated NLR >5, PLR >160, and SII >1000 values at baseline were determined to be at increased risk for death in 30-days.