Clinical characteristics of patients with suspected and verified PE: A single-center prospective cohort study

In this prospective cohort study, we included 196 patients presenting with dyspnea and suspected pulmonary embolism (PE) at the emergency department of Uppsala University Hospital, Sweden, between June 2019 and July 2022. All patients underwent CT for PE confirmation. Blood samples were collected and stored in a biobank, allowing for comprehensive biomarker analysis.

Of the 196 patients, 89 (45.4%) were diagnosed with PE. Patients with confirmed PE showed significantly elevated levels of D-dimer (median 5.7 mg/L [IQR 2.3-14) vs. 1.0 mg/L [0.4-1.8], p=1.2E-14) and CRP (41 mg/L [16–139] vs.7.2 mg/L [1.5-47], p=1.6E-7), indicating thrombotic and inflammatory activity. Cardiac biomarkers, including Troponin I and NT-pro-BNP, were also significantly higher in the PE group, reflecting cardiac strain. Interestingly, emergency room vital parameters and comorbidities were largely similar. On the other hand, there were notable differences in management, with PE patients more likely to be hospitalized and received thrombolysis more often. Patients were risk assessed using the PE Severity Index (PESI) and according to the European Society of Cardiology 2019 guidelines for PE. Patients with PE had a substantially increased mortality that remained after adjustment for comorbidities (OR: 6.0 (95% CI 2.3-15.3).

The results highlight inflammation as a central component of PE pathophysiology, which may serve as both a precipitant and a response to embolic events. Biomarkers including D-dimer, CRP, and cardiac markers enhance diagnostic accuracy and can guide management in patients with suspected PE, aligning with clinical needs in emergency care settings. Further investigation into the interaction between inflammation and coagulation in PE is important to improve risk stratification and targeted treatment approaches as mortality remains high even after diagnosis.