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Article

Prognostic Value of Initial Inflammatory Biomarkers, ECG Findings, and Computed Tomography in the Assessment of Acute Pulmonary Embolism Severity

by
Bojana Uzelac
1,*,
Vladimir Jakovljević
2,3,4,
Vladimir Živković
2,3,5,
Jelena Janković
6,
Katarina Lazarević
7,
Danilo Marković
7,
Marija Laban-Lazović
6,
Andrija Jovanović
1,
Marina Đikić
1,
Dušica Gujaničić
1,
Ivana Milićević-Nešić
1 and
Sanja Stanković
8,9
1
Emergency Center, University Clinical Center of Serbia, 11000 Belgrade, Serbia
2
Department of Physiology, Faculty of Medical Sciences, University of Kragujevac, 34000 Kragujevac, Serbia
3
Center of Excellence for Redox Balance Research in Cardiovascular and Metabolic Disorders, 34000 Kragujevac, Serbia
4
Department of Human Pathology, First Moscow State Medical University I.M. Sechenov, 119146 Moscow, Russia
5
Department of Pharmacology, First Moscow State Medical University I.M. Sechenov, 119146 Moscow, Russia
6
Clinic for Pulmonology, University Clinical Center of Serbia, 11000 Belgrade, Serbia
7
Center for Radiology and Magnetic Resonance, University Clinical Center of Serbia, 11000 Belgrade, Serbia
8
Center for Medical Biochemistry, University Clinical Center of Serbia, 11000 Belgrade, Serbia
9
Department of Biochemistry, Faculty of Medical Sciences University of Kragujevac, 34000 Kragujevac, Serbia
*
Author to whom correspondence should be addressed.
Medicina 2025, 61(10), 1830; https://doi.org/10.3390/medicina61101830
Submission received: 29 August 2025 / Revised: 8 October 2025 / Accepted: 10 October 2025 / Published: 13 October 2025
(This article belongs to the Section Cardiology)
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Abstract

Background and Objectives: Acute pulmonary thromboembolism (PTE) is one of the leading causes of cardiovascular mortality. Recent insights into PTE pathophysiology emphasize the complex interplay of multiple mechanisms, particularly the roles of thrombosis and inflammation. Materials and Methods: This retrospective, single-center observational study included 138 participants: 69 adult patients diagnosed with PTE via computed tomography pulmonary angiography (CTPA) and 69 matched healthy controls. Upon admission, a standard 12-lead electrocardiogram (ECG) was performed, and Daniel’s score was calculated. Peripheral blood samples were collected to assess inflammatory biomarkers and hemogram-derived ratios (SII, NLR, dNLR, NPR, PLR, LMR). CTPA scans were analyzed not only for diagnostic purposes and PTE localization but also for inflammatory changes. PTE severity was classified according to the 2019 ESC guidelines. Results: Patients with PTE had significantly higher Daniel’s ECG scores, initial values of inflammatory biomarkers (WBC, neutrophils, IL-6, CRP) and hemogram-derived ratios (SII, NLR, dNLR, NPR) compared to controls. In multivariate analysis, older age (OR = 1.05; p = 0.038), higher Daniel’s ECG score (OR = 1.24; p < 0.001), and higher dNLR (OR = 1.40; p = 0.001) were found as an independent predictors of PTE severity. Ground-glass opacity (GGO) was the most common parenchymal and pleural inflammatory finding relating to CTPA (48.4%), but these findings did not show significant predictive value for PTE severity. Conclusions: Daniel’s ECG score and dNLR, both readily available and cost-effective biomarkers demonstrated independent predictive value for assessing PTE severity.
Keywords: acute pulmonary thromboembolism; Daniel’s ECG score; hemogram-derived ratios acute pulmonary thromboembolism; Daniel’s ECG score; hemogram-derived ratios
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MDPI and ACS Style

Uzelac, B.; Jakovljević, V.; Živković, V.; Janković, J.; Lazarević, K.; Marković, D.; Laban-Lazović, M.; Jovanović, A.; Đikić, M.; Gujaničić, D.; et al. Prognostic Value of Initial Inflammatory Biomarkers, ECG Findings, and Computed Tomography in the Assessment of Acute Pulmonary Embolism Severity. Medicina 2025, 61, 1830. https://doi.org/10.3390/medicina61101830

AMA Style

Uzelac B, Jakovljević V, Živković V, Janković J, Lazarević K, Marković D, Laban-Lazović M, Jovanović A, Đikić M, Gujaničić D, et al. Prognostic Value of Initial Inflammatory Biomarkers, ECG Findings, and Computed Tomography in the Assessment of Acute Pulmonary Embolism Severity. Medicina. 2025; 61(10):1830. https://doi.org/10.3390/medicina61101830

Chicago/Turabian Style

Uzelac, Bojana, Vladimir Jakovljević, Vladimir Živković, Jelena Janković, Katarina Lazarević, Danilo Marković, Marija Laban-Lazović, Andrija Jovanović, Marina Đikić, Dušica Gujaničić, and et al. 2025. "Prognostic Value of Initial Inflammatory Biomarkers, ECG Findings, and Computed Tomography in the Assessment of Acute Pulmonary Embolism Severity" Medicina 61, no. 10: 1830. https://doi.org/10.3390/medicina61101830

APA Style

Uzelac, B., Jakovljević, V., Živković, V., Janković, J., Lazarević, K., Marković, D., Laban-Lazović, M., Jovanović, A., Đikić, M., Gujaničić, D., Milićević-Nešić, I., & Stanković, S. (2025). Prognostic Value of Initial Inflammatory Biomarkers, ECG Findings, and Computed Tomography in the Assessment of Acute Pulmonary Embolism Severity. Medicina, 61(10), 1830. https://doi.org/10.3390/medicina61101830

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