Skip to main content
The Egyptian Journal of Bronchology
Download PDF

Can alveolar—arterial oxygen gradient predict severity of pulmonary embolism?

Egyptian Journal of Bronchology volume 13, pages 273–279 (2019)Cite this article

Abstract

Background

The perceived risk for pulmonary embolism (PE) can be assessed by oxygenation and calculation of the alveolar–arterial (A-a) oxygen (O2) gradient. We attempt to evaluate the efficacy of A-a O2 gradient for the diagnosis of PE and if it can predict the degree of severity of PE.

Patient and methods

This study is a prospective study conducted on 70 patients presented by signs or symptoms of suspected acute PE. Arterial-blood gases including arterial partial pressure of oxygen (PaO2), partial pressure of carbon dioxide (PaCO2), and arterial oxygen saturation (SaO2) and computed tomography pulmonary angiography were done on admission.

Results

Fifty patients proved to have PE by computed tomography pulmonary angiography. The patients were divided into (a) nonhigh-risk and (b) high-risk groups. There was a significant difference between the two groups regarding pulmonary artery obstructive index. Although A-a gradients were high in all studied patients with positive PE in comparison to negative PE patients, there was no significant difference between high-risk and nonhigh-risk groups regarding PaO2 (mmHg), arterial oxygen saturation, %, A-a O2, PaCO2. In addition, no significant relationship was detected between arterial-blood gas parameters regarding PaO2 and SaO2 with pulmonary artery obstructive index; also PaCO2 and A-a O2 gradients were nonsignificant.

Conclusion

The A-a O2 gradient values are clinically important in the diagnosis of patients with PE because it is easy to perform and is a bedside test. However, it may be incapable of detection of severity of PE.

References

  1. Masotti L, Righini M, Vuilleumier N, Antonelli F, Landini G, Cappelli R, et al. Prognostic stratification of acute pulmonary embolism:Focus on clinical aspects, imaging, and biomarkers. Vasc Health Risk Manag 2009; 5:567–575.

    Article  CAS  Google Scholar 

  2. Karakayalı O, Yılmaz S, İlyas Ertok I, Çelik G, Gül Pamukcu G, Yiǧit Y, et al. Correlation of alveolar–arterial gradient with computed tomography pulmonary artery obstruction index in acute pulmonary embolism. CMJ 2016; 4:305–314.

    Article  Google Scholar 

  3. Piazza G, Goldhaber SZ. Acute pulmonary embolism, part I:epidemiology and diagnosis. Circulation 2006; 114:28–32.

    Google Scholar 

  4. Stein P, Goldhaber S, Henry J. Alveolar-arterial oxygen gradient in the assessment of acute pulmonary embolism. Chest 1995; 105:598–603.

    Google Scholar 

  5. D’Alonzo GE, Dantzker DR. Gas exchange alterations following pulmonary thromboembolism. Clin Chest Med 1984; 5:411–419.

    PubMed  Google Scholar 

  6. Remy-Jardin M, Pistolesi M, Goodman LR, Gefter WB, Gottschalk A, Mayo JR, et al. Management of suspected acute pulmonary embolism in the era of CT angiography:a statement from the Fleischner Society. Radiology 2007; 245:315–329.

    Article  Google Scholar 

  7. Quiroz R, Kucher N, Schoepf UJ, Kipfmueller F, Solomon SD, Costello P, et al. Right ventricular enlargement on chest computed tomography:prognostic role in acute pulmonary embolism. Circulation 2004; 109:2401–2404.

    Article  Google Scholar 

  8. Le Gal G, Righini M, Roy PM, Sanchez O, Aujesky D, Bounameaux H, Perrier A. Prediction of pulmonary embolism in the emergency department:the revised Geneva score. Ann Intern Med 2006; 144:165–171.

    Article  Google Scholar 

  9. Qanadli SD, El Hajjam M, Vieillard-Baron A, Joseph T, Mesurolle B, Vincent L, et al. New CT index to quantify arterial obstruction in pulmonary embolism:comparison with angiographic index and echocardiography. Am J Roentgenol 2001; 176:1415–1420.

    Article  CAS  Google Scholar 

  10. Mathur R, Gupta A, Prasanna R, Burdak S, Sourav K, Sumitra Choudhary S, et al. MDCT pulmonary angiography assessment of severity of acute pulmonary embolism:pulmonary artery obstruction index compared with right ventricle to left ventricular diameter ratio. J Evid Based Med Healthc 2016; 3:3482–3489.

    Article  Google Scholar 

  11. Ghuysen A, Ghaye B, Willems V, Lambermont B, Gerard P, Dondelinger RF, et al. Computed tomographic pulmonary angiography and prognostic significance in patients with acute pulmonary embolism. Thorax 2005; 60:956–961.

    Article  CAS  Google Scholar 

  12. Becattini C, Agnelli G. Acute pulmonary embolism:risk stratification in the emergency department. Intern Emerg Med 2007; 2:119–129.

    Article  CAS  Google Scholar 

  13. Goldhaber SZ. Cardiac biomarkers in pulmonary embolism. Chest 2003; 123:1782–1784.

    Article  Google Scholar 

  14. Singanayagam A, Chalmers JD, Scally C, Akram A, Al-Khairalla MZ, Leitch L, et al. Right ventricular dilation on CT pulmonary angiogram independently predicts mortality in pulmonary embolism. Respir Med 2010; 104:1057–1062.

    Article  Google Scholar 

  15. Manier G, Castaing Y, Guenard H. Determinants of hypoxemia during the acute phase of pulmonary embolism in humans. Am Rev Respir Dis 1985; 132:332–338.

    CAS  PubMed  Google Scholar 

  16. Farghaly S, El-Abdin AZ. Pulmonary fibrosis as a risk factor for thromboembolic disease. Egypt J Broncho 2015; 9:160–164.

    Article  Google Scholar 

  17. Günay E, Sarinc Ulasli S, Kacar E, Halici B, Unlu E, Tünay K. Can platelet indices predict obstruction level of pulmonary vascular bed in patients with acute pulmonary embolism? Clin Respir J 2014; 8:33–40.

    Article  Google Scholar 

  18. Cvitanic O, Marino PL. Improved use of arterial blood gas analysis in suspected pulmonary embolism. Chest 1989; 95:48–51.

    Article  CAS  Google Scholar 

  19. McFarlane MJ, Imperiale TF. Use of the alveolar-arterial oxygen gradient in the diagnosis of pulmonary embolism. Am J Med 1994; 96:57–62.

    Article  CAS  Google Scholar 

  20. Stein PD, Goldhaber SZ, Henry JW, Miller AC. Arterial blood gas analysis in the assessment of suspected acute pulmonary embolism. Chest 1996; 109:78–81.

    Article  CAS  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Chest Diseases and Tuberculosis, Department of Chest, Faculty of Medicine Minia University, Minia, Egypt

    Elham Abdelhady Abdelghany MD & Rasha Abdelraof Abdelfatah

  2. Department of Clinical Pathology, Faculty of Medicine, Minia University, Minia, Egypt

    Ashraf M. Othman & Mohammed-Elhoseany Magdy

  3. Department of Diagnostic Radiology, Faculty of Medicine, Minia University, Minia, Egypt

    Hosny S. Abd Elghany & Mahmoud M. Higazi

Authors
  1. Elham Abdelhady Abdelghany MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Ashraf M. Othman
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Rasha Abdelraof Abdelfatah
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Mohammed-Elhoseany Magdy
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Hosny S. Abd Elghany
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Mahmoud M. Higazi
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Elham Abdelhady Abdelghany MD.

Additional information

This is an open access journal, and articles are distributed under the terms of the Creative Commons Attribution-NonCommercial-ShareAlike 4.0 License, which allows others to remix, tweak, and build upon the work non-commercially, as long as appropriate credit is given and the new creations are licensed under the identical terms.

Rights and permissions

This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/.

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Abdelghany, E.A., Othman, A.M., Abdelfatah, R.A. et al. Can alveolar—arterial oxygen gradient predict severity of pulmonary embolism?. Egypt J Bronchol 13, 273–279 (2019). https://doi.org/10.4103/ejb.ejb_62_18

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.4103/ejb.ejb_62_18

Keywords