Abstract Body (Do not enter title and authors here): Introduction: Venous thromboembolism (VTE) including deep vein thrombosis (DVT) and pulmonary embolism (PE) is the leading cause of cardiovascular death. The pathophysiology of PE is complex and multifactorial. This study was designed to understand the relationship of thrombo-inflammatory biomarkers including endothelial dysregulation, platelet and coagulation activation, fibrinolysis, and inflammation along with blood cellular indices for 30-day mortality outcome in PE patients.

Materials and Method: Citrated blood samples from 500 patients with the confirmed diagnosis of PE were collected from Loyola University Medical Center. Biomarkers including vWF, E-Selectin, P-Selectin, FVII, FIX, FX, FXIIIa, D-Dimer, PAI-1a, tPA, TAFIa, CRP, IL-6 and TNF-α were analyzed by Sandwich ELISA method. Blood cellular indices as neutrophil to lymphocyte ratio (NLR), platelet to lymphocyte ratio (PLR), and systemic immune-inflammation index (SII; NLR* platelets) were calculated from complete blood count. Thirty-day mortality data was obtained from chart review. Receiver operating curve (ROC) analysis to determine the optimal cutoff values, while for degree of association univariate chi-square and multivariate logistic regression analysis were performed for 30-day morality.

Results: The study cohort includes 500 patients with equivalent distribution of male (52.1%) and female (47.9%) with the median age of 64-years. In first 30-day, 48 (9.7%) of the patients died. At baseline, patients who subsequently died had higher levels of vWF, P-selectin, tPA, PAI-1a, D-dimer, CRP, IL-6, TNF-α, NLR, PLR, and SII. Following ROC and univariate analysis, all the significant markers and indices were included in the multivariate logistic regression model. Of note, vWF >140 (OR: 2.68; 95%CI: 1.04-6.92), F-X <65 (OR: 4.55; 95%CI: 1.33-15.6), F-XIIIa <58 (OR: 2.70; 95%CI: 1.13-6.47), D-Dimer >13688 (OR: 3.51; 95%CI: 1.32-9.35), CRP >12 (OR: 5.31; 95%CI: 1.01-28.0), TNF-α >2 (OR: 2.65; 95%CI: 1.13-6.19), and NLR >7 (OR: 4.44; 95%CI: 1.76-11.19) predicted risk of 30-day mortality in PE patients (Figure 1).

Conclusion: This study suggests that patients with vWF >140, FX <65, FXIIIa <58, D-Dimer >13688, CRP >12, TNF-α >2, and NLR >7 at baseline were at increased risk of death in 30-days. Study also suggests the integrated role of thrombo-inflammatory biomarkers and blood cellular indices for the risk stratification and prediction of the adverse outcomes.