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J Clin Lab Anal. 2018 Jan;32(1). doi: 10.1002/jcla.22164. Epub 2017 Feb 18.

The relation between international normalized ratio and mortality in acute pulmonary embolism: A retrospective study.

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Department of Cardiology, Ataturk Training and Research Hospital, Izmir Katip Celebi University, Izmir, Turkey.
Department of Cardiology, Dr. Siyami Ersek Thoracic and Cardiovascular Surgery Center Training Research Hospital, Istanbul, Turkey.
Department of Cardiology, Haseki Training and Research Hospital, Istanbul, Turkey.
Department of Cardiology, Medical School, Ataturk Training and Research Hospital, Izmir Katip Celebi University, Izmir, Turkey.



Acute pulmonary embolism (PE) is a serious clinical disease characterized by a high mortality rate. The aim of this study was to assess the prognostic value of international normalized ratio (INR) in acute PE patients not on anticoagulant therapy.


The study included 244 hospitalized acute PE patients who were not receiving previous anticoagulant therapy. Based on their 30-day mortality, patients were categorized as survivors or non-survivors. INR was measured during the patients' admission, on the same day as the diagnosis of PE but before anticoagulation started.


Thirty-day mortality occurred in 39 patients (16%). INR was higher in non-survivors than in survivors (1.3±0.4 vs 1.1±0.3, P=.003). In multivariate analysis, INR (HR: 3.303, 95% CI: 1.210-9.016, P=.020) was independently associated with 30-day mortality from PE. Inclusion of INR in a model with simplified pulmonary embolism severity index (sPESI) score improved the area under the receiver operating characteristics (ROC) curve from 0.736 (95% CI: 0.659-0.814) to 0.775 (95% CI: 0.701-0.849) (P=.028). Also, the addition of INR to sPESI score enhanced the net reclassification improvement (NRI=8.8%, P<.001) and integrated discrimination improvement (IDI=0.043, P=.027).


Elevated INR may have prognostic value for 30-day mortality in acute PE patients not on anticoagulation. Combining INR with sPESI score improved the predictive value for all-cause mortality. However, further large-scale studies are needed to confirm it's prognostic role.


coagulation; international normalized ratio; mortality; pulmonary embolism

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