Correlation between inflammatory hematological indices with severity of pulmonary thromboembolism
Introduction
Pulmonary thromboembolism (PTE) is a major cardiovascular emergency associated with significant mortality. Systemic inflammation contributes to the pathogenesis of thrombosis and to disease severity, and hematological indices derived from the complete blood count, such as the neutrophil-to-lymphocyte ratio (NLR) and the platelet-to-lymphocyte ratio (PLR), have been proposed as prognostic predictors.
Materials and methods
A prospective observational study was conducted on a cohort of 182 consecutively investigated patients at Holy Trinity Municipal Clinical Hospital and the Institute of Cardiology. The diagnosis of PTE was confirmed by CT pulmonary angiography. Clinical data, inflammatory hematological indices, echocardiographic parameters, and severity scores were analyzed during the course of inpatient care. The prognostic value of NLR and PLR was assessed using ROC curve analysis.
Results
Pulmonary thromboembolism was confirmed in 153 patients (84.1%, 95% CI [78.7, 89.4]). Elevated NLR was identified in 82 patients (45.1%; 95% CI [37.8, 52.3]), and elevated PLR in 89 patients (48.9%; 95% CI [41.6, 56.2]). Overall mortality was 17.0% (95% CI [11.6, 22.5]) (31 patients). Elevated NLR was present in 26 (14.3; 95% CI [9.2, 19.4]) of deceased patients (p<0.00001), while elevated PLR was present in 22 (12.1%; 95% CI [7.4, 16.8]) of deceased patients (p = 0.012). ROC analysis demonstrated that NLR has a very good predictive ability for mortality (AUC = 0.799), whereas PLR has good predictive ability (AUC = 0.715). Additionally, NLR was significantly correlated with severity according to the PESI score (AUC = 0.614; p = 0.0048). Echocardiography revealed right ventricular dysfunction in 80.2% (95% CI [74.4, 86.0]) of patients and reduced TAPSE in 57.7% (95% CI [50.5, 64.9]) of patients.
Conclusions
The neutrophil-to-lymphocyte ratio is an important prognostic marker of severity and mortality in pulmonary thromboembolism, with a predictive value superior to that of the platelet-to-lymphocyte ratio. Integrating inflammatory hematological indices with clinical scores and imaging assessment may improve risk stratification and the management of patients with pulmonary thromboembolism.
Electrocardiographic changes in patients with acute pulmonary embolism
Introduction
Pulmonary embolism is a life-threatening condition requiring prompt diagnosis. While contrast-enhanced computed tomography is the gold standard, its limited availability and associated risks necessitate complementary diagnostic tools. Recent studies suggest that combining multiple electrocardiographic abnormalities into a composite score may enhance diagnostic performance.
Material and methods
We conducted a prospective, cross-sectional study involving 200 patients with suspected pulmonary embolism admitted to two hospitals in the Republic of Moldova between 2022 and 2025. Among them, 168 had confirmed pulmonary embolism based on computed tomography pulmonary angiography, while 32 patients with similar symptoms but negative imaging served as the control group. All participants underwent a standard 12-lead electrocardiogram upon admission. A composite electrocardiographic score was applied, incorporating 10 criteria (e.g., sinus tachycardia, S1Q3T3 pattern, negative T waves in V1-V4, right bundle branch block, and right axis deviation), with a total score ranging from 0 to 12. Diagnostic thresholds were defined as follows: 0-3 low risk, 4-6 intermediate risk, and ≥7 high risk.
Results
Electrocardiographic abnormalities such as negative T waves in V1–V4 (42.9% vs. 6.2%), atrial fibrillation (28.0% vs. 6.2%), and S1Q3T3 pattern (21.4% vs. 3.1%) were significantly more frequent in pulmonary embolism patients. A composite electrocardiographic score of ≥5 demonstrated excellent diagnostic performance: sensitivity 89.9%, specificity 93.8%, positive predictive value 98.7%, and overall accuracy 90.5%. The area under the ROC curve was 0.92, indicating strong discriminative ability. Among combinations of electrocardiographic findings, the pairing of S1Q3T3 with negative T waves in V1-V4 showed a statistically significant association with confirmed pulmonary embolism.
Conclusions
Our study confirms that a composite electrocardiographic score ≥5 is a highly effective, rapid, and noninvasive tool for identifying pulmonary embolism, improving early triage, particularly in emergency settings where imaging may be delayed. The model significantly outperforms isolated electrocardiographic findings and should be interpreted within a broader clinical context, including symptomatology and imaging when available.