Prognostic value of systemic inflammatory markers in patients with malignancy-associated pulmonary thromboembolism: A retrospective observational study.
Arslan Aksu E, Özdemir L, Gegin S, Özdemir B • Medicine • 2026
Neutrophil count, NLR, and lactate levels were associated with in-hospital mortality in patients with malignancy-associated PTE, and neutrophil count and SIRI were also associated with ESC clinical risk classification.
Key Findings
Results
In-hospital mortality among patients with malignancy-associated pulmonary thromboembolism was 20%.
The study included 75 adult patients diagnosed with both malignancy and PTE at a tertiary chest diseases center between February 2018 and June 2025.
Mean age was 69.5 ± 11.8 years and 56% of patients were male.
The most common malignancies were lung (24%), colorectal (13.3%), and breast (9.3%) cancers.
Primary outcome was in-hospital mortality; secondary outcome was association between inflammatory markers and ESC PTE clinical risk classification.
Results
Neutrophil count, NLR, and lactate were significantly higher in patients who died during hospitalization compared to survivors.
Neutrophil count was significantly higher in non-survivors (P = .026).
NLR was significantly higher in non-survivors (P = .032).
Lactate was significantly higher in non-survivors (P = .027).
PLR, LMR, LCRPR, SII, and SIRI were not reported as significantly associated with in-hospital mortality.
Results
ROC analysis identified an NLR cutoff value of 4.95 for predicting in-hospital mortality, with a sensitivity of 86.7% and a specificity of 51.7%.
The NLR cutoff of 4.95 was derived from ROC curve analysis.
Sensitivity for predicting in-hospital mortality at this cutoff was 86.7%.
Specificity at this cutoff was 51.7%.
NLR is calculated from blood samples obtained at diagnosis.
Results
Neutrophil count and SIRI were significantly higher in the intermediate-risk ESC PTE clinical risk group.
Neutrophil count was significantly higher in the intermediate-risk group (P = .036).
SIRI was significantly higher in the intermediate-risk group (P = .049).
Troponin was highest in the high-risk group (P < .001).
ESC PTE clinical risk classification was used as the secondary outcome measure.
Methods
Six systemic inflammatory indices were calculated and evaluated for their prognostic value in malignancy-associated PTE.
Indices calculated included neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), lymphocyte-to-monocyte ratio (LMR), lymphocyte-to-CRP ratio (LCRPR), systemic immune-inflammation index (SII), and systemic inflammation response index (SIRI).
All indices were derived from blood samples obtained at the time of PTE diagnosis.
The study design was retrospective and observational.
Demographic characteristics, cancer types, laboratory values, treatment details, and clinical outcomes were all recorded.
Conclusions
The authors characterized their findings as exploratory and stated they require validation in larger prospective studies.
The study was limited to 75 patients at a single tertiary chest diseases center.
The retrospective design limits causal inference.
The authors explicitly noted: 'These findings should be considered exploratory and require validation in larger prospective studies.'
The study period spanned February 2018 to June 2025.
What This Means
This research examined whether blood markers of inflammation could predict which cancer patients hospitalized with a blood clot in the lungs (pulmonary thromboembolism, or PTE) were most likely to die during their hospital stay. The study looked at 75 patients who had both cancer and PTE, and found that one in five patients (20%) died in the hospital. Patients who died had significantly higher levels of neutrophils (a type of white blood cell), a ratio called the neutrophil-to-lymphocyte ratio (NLR), and lactate (a marker of tissue stress) when they were first diagnosed. An NLR above 4.95 identified patients at higher risk of death with a sensitivity of about 87%, meaning it correctly flagged most patients who ultimately died.
The study also found that two inflammatory markers — neutrophil count and the systemic inflammation response index (SIRI) — were higher in patients classified as intermediate-risk by standard European Society of Cardiology guidelines, while troponin (a heart injury marker) was highest in the high-risk group. This suggests these simple blood tests, which are routinely available, may help clinicians identify cancer patients with PTE who need closer monitoring or more aggressive treatment.
This research suggests that measuring inflammatory markers at the time of PTE diagnosis in cancer patients could add useful prognostic information beyond standard risk tools. However, because this was a small, single-center retrospective study, the authors caution that these findings are preliminary and need to be confirmed in larger, prospective studies before they can reliably guide clinical decisions.
Arslan Aksu E, Özdemir L, Gegin S, Özdemir B. (2026). Prognostic value of systemic inflammatory markers in patients with malignancy-associated pulmonary thromboembolism: A retrospective observational study.. Medicine. https://doi.org/10.1097/MD.0000000000051137