Oxygen saturation and mortality for acute pulmonary embolism: multinational retrospective cohort study.
retrospective_cohort · Level III
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- Record sourced from PubMed, PMID 42077645.
- Also identified by DOI 10.1016/j.eclinm.2026.103889 and PMC identifier 13133531.
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Abstract
Among patients with acute pulmonary embolism (<b>PE</b>), we aimed to evaluate for an association between oxygen saturation (<b>SatO<sub>2</sub></b> ) and 30-day post-PE mortality. Between January, 2001 and April, 2025, we conducted a retrospective cohort study of 38,739 non-hypotensive patients with acute PE enrolled from 18 countries in the Registro Informatizado de la Enfermedad Tromboembólica (<b>RIETE</b>) registry. Outcomes included 30-day all-cause and PE-specific mortality. We used hierarchical logistic regression to assess for an association between baseline SatO<sub>2</sub> and outcomes. We aimed to identify optimal SatO<sub>2</sub> cut-off points that maximized sensitivity and specificity in relation to mortality from receiver operating characteristic (<b>ROC</b>) curves. RIETE is registered with ClinicalTrials.gov, NCT02832245. Baseline SatO<sub>2</sub> was significantly associated with mortality, where lower SatO<sub>2</sub> had worse outcomes. Using a reference SatO<sub>2</sub> of >96%, patients in the lower SatO<sub>2</sub> strata had higher rates of all-cause death (odds ratio [<b>OR</b>] 0.96 for SatO<sub>2</sub> 94-96%; 1.23 for SatO<sub>2</sub> 90-93%; and 1.81 for SatO<sub>2</sub> <90%) and PE-related mortality (OR 1.68 for SatO<sub>2</sub> 94-96%; 2.04 for SatO<sub>2</sub> 90-93%; and 3.95 for SatO<sub>2</sub> <90%). The optimal cut-off point to identify patients at low-risk for short-term mortality was SatO<sub>2</sub> of 96% (sensitivity of 86.1% and negative predictive value of 96.7%); while SatO<sub>2</sub> of 90% (specificity of 77.2% and positive predictive value of 7.9%) identified patients at increased risk for mortality. Among non-hypotensive patients diagnosed with PE, we found an inverse association between baseline SatO<sub>2</sub> and odds of all-cause and PE-associated mortality over the subsequent 30 days. A SatO<sub>2</sub> cutoff value of 96% for the highest SatO<sub>2</sub> group while breathing room air might help better identify patients with acute PE at low-risk for mortality. Future studies should assess the contribution of SatO2 in addition to established prognosticators to predicting the risk of death. ROVI.