Predictors of In-Hospital Mortality in Acute Pulmonary Embolism: A Retrospective Cohort Study

Abstract

Background & Objective: We focused on uncovering independent mortality predictors in acute PE, specifically examining how BMI and D-dimer levels relate to each other during hospitalization. Methodology: Our retrospective cohort enrolled adults who had acute PE verified by CTPA upon admission from June 2023 to March 2026. We gathered clinical, lab, ECG, echo, and imaging findings from charts. For comparisons, we applied t-tests or Mann-Whitney U to continuous data and chi-square or Fisher's exact tests to categorical variables. Univariate and multivariate logistic regression identified independent mortality predictors, and ROC analysis assessed discriminative performance. Results: Among 300 patients, in-hospital mortality was 10.0% (n=30). Non-survivors were older (57.0 vs. 46.6 years) and predominantly female (70.0% of deaths). Independent predictors of mortality included older age (aOR=1.052, p=0.001), lower systolic blood pressure (aOR=0.842, p=0.026), higher heart rate (aOR=1.036, p=0.020), and right ventricular enlargement on echocardiography (aOR=4.072, p=0.020). Systolic blood pressure showed the best discriminative performance (AUC=0.795). A strong positive correlation was found between BMI and D-dimer (r=0.73, p<0.001). Conclusion: Age, hemodynamic instability, and right ventricular enlargement independently predict in-hospital mortality in acute PE, while the BMI–D-dimer correlation suggests an adiposity-linked hypercoagulable state warranting further investigation. Key Words: Pulmonary Embolism, In-Hospital Mortality.