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

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. 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.