Association of SII, LAR, and D-Dimer with In-Hospital Adverse Outcomes in Acute Pulmonary Embolism
- 1School of Medicine, Nantong University, Nantong, Jiangsu, China
- 2Department of Respiratory Medicine, Affiliated Hospital of Nantong University, Nantong, Jiangsu, China
Abstract
Objectives: To investigate the prognostic value of the systemic immune-inflammation index (SII), lactate-to-albumin ratio (LAR), and D-dimer for in-hospital adverse outcomes in patients with acute pulmonary embolism (APE).
Methods: This single-center retrospective cohort study screened 248 patients with computed tomography pulmonary angiography-confirmed APE between June 2022 and February 2026; 151 patients were included after 97 exclusions. Predictors were defined using the first measurements obtained within 24 hours after admission and before anticoagulation, thrombolysis, vasopressor therapy, or any related adverse event. The primary outcome was an in-hospital composite of intensive care unit transfer, shock or vasopressor use, cardiopulmonary resuscitation, catheter-based therapy or thrombolysis, and fatal outcome (in-hospital death or withdrawal of life-sustaining treatment after irreversible deterioration). Multiple imputation and logistic regression were used to construct and compare an sPESI model, a biomarker model, and a combined model. Performance was assessed using receiver operating characteristic curves, calibration analysis, bootstrap internal validation, and decision curve analysis.
Results: Among 151 patients, 37 (24.5%) experienced the composite outcome and 114 did not. SII, LAR, and D-dimer remained associated with the outcome after adjustment for sPESI. Model 2 had an AUC of 0.891, compared with 0.637 for model 1 and 0.661 for ESC risk classification. Adding sPESI or ESC classification to model 2 increased the AUC to 0.912 and 0.900, respectively, without a significant further improvement in discrimination (P=.221 and P=.409). The bootstrap-corrected AUC for model 2 was 0.885, the Brier score was 0.091, and internal decision-curve analysis showed potential net benefit.
Conclusions: Admission SII, LAR, and D-dimer were associated with in-hospital adverse outcomes and remained associated after adjustment for sPESI. The exploratory three-biomarker model may complement sPESI and ESC risk classification, but multicenter external validation is required before clinical application.
Related
- Frailty Impact on In-Hospital Outcomes Among Patients Hospitalized with Acute Pulmonary Embolism: A National Inpatient Sample Analysis
- Prehospital Detection of Acute Pulmonary Embolism and Its Association with Clinical Outcomes: A Retrospective Cohort Study
- Sex-Based Differences in Clinical Characteristics and Outcomes in Patients with Acute Pulmonary Embolism. An Analysis of 1000 Pulmonary Embolism Response Team Activations
- Atrioventricular Nodal Blocking Agents and Adverse Outcomes Following Cardioversion at a Rural Hospital
- Long-Term Outcomes of Mortality and CTEPH in Patients With Massive/Submassive Pulmonary Embolism Treated With Thrombolytics: Retro-Prospective Analysis
BibTeX
@article{chen2026association,
title = {{Association of SII, LAR, and D-Dimer with In-Hospital Adverse Outcomes in Acute Pulmonary Embolism}},
author = {Zixuan Chen and Sijia Huang and Yuxiao Song and Wanwei Gong and Lu Zhang and Wenqin Ding and Jun Li},
journal = {Clinical and Applied Thrombosis/Hemostasis},
year = {2026},
month = sep,
doi = {10.1177/10760296261488578},
url = {https://doi.org/10.1177/10760296261488578},
note = {CC BY-NC 4.0},
}
RIS
TY - JOUR
TI - Association of SII, LAR, and D-Dimer with In-Hospital Adverse Outcomes in Acute Pulmonary Embolism
AU - Zixuan Chen
AU - Sijia Huang
AU - Yuxiao Song
AU - Wanwei Gong
AU - Lu Zhang
AU - Wenqin Ding
AU - Jun Li
PY - 2026
DA - 2026/09/18
JO - Clinical and Applied Thrombosis/Hemostasis
DO - 10.1177/10760296261488578
UR - https://doi.org/10.1177/10760296261488578
AB - Objectives: To investigate the prognostic value of the systemic immune-inflammation index (SII), lactate-to-albumin ratio (LAR), and D-dimer for in-hospital adverse outcomes in patients with acute pulmonary embolism (APE). Methods: This single-center retrospective cohort study screened 248 patients with computed tomography pulmonary angiography-confirmed APE between June 2022 and February 2026; 151 patients were included after 97 exclusions. Predictors were defined using the first measurements obtained within 24 hours after admission and before anticoagulation, thrombolysis, vasopressor therapy, or any related adverse event. The primary outcome was an in-hospital composite of intensive care unit transfer, shock or vasopressor use, cardiopulmonary resuscitation, catheter-based therapy or thrombolysis, and fatal outcome (in-hospital death or withdrawal of life-sustaining treatment after irreversible deterioration). Multiple imputation and logistic regression were used to construct and compare an sPESI model, a biomarker model, and a combined model. Performance was assessed using receiver operating characteristic curves, calibration analysis, bootstrap internal validation, and decision curve analysis. Results: Among 151 patients, 37 (24.5%) experienced the composite outcome and 114 did not. SII, LAR, and D-dimer remained associated with the outcome after adjustment for sPESI. Model 2 had an AUC of 0.891, compared with 0.637 for model 1 and 0.661 for ESC risk classification. Adding sPESI or ESC classification to model 2 increased the AUC to 0.912 and 0.900, respectively, without a significant further improvement in discrimination (P=.221 and P=.409). The bootstrap-corrected AUC for model 2 was 0.885, the Brier score was 0.091, and internal decision-curve analysis showed potential net benefit. Conclusions: Admission SII, LAR, and D-dimer were associated with in-hospital adverse outcomes and remained associated after adjustment for sPESI. The exploratory three-biomarker model may complement sPESI and ESC risk classification, but multicenter external validation is required before clinical application.
SN - 1076-0296
SN - 1938-2723
ER -