Oxygen saturation and mortality for acute pulmonary embolism: multinational retrospective cohort study

David Jiménez; Roger D Yusen; Juan Manuel Velasco; Raquel Morillo; Alfonso Muriel; Luis Jara-Palomares; Laurent Bertoletti; Luis Manuel Hernández-Blasco; Aída Gil-Díaz; Farès Moustafa; Ángeles Fidalgo; Parham Sadeghipour; Khanh Quoc Pham; Behnood Bikdeli; Manuel Monreal; RIETE Investigators; Andris Skride

doi:10.1016/j.eclinm.2026.103889

Oxygen saturation and mortality for acute pulmonary embolism: multinational retrospective cohort study

David Jiménez^*
, Roger D Yusen
, Juan Manuel Velasco
, Raquel Morillo
, Alfonso Muriel
, Luis Jara-Palomares
, Laurent Bertoletti
, Luis Manuel Hernández-Blasco
, Aída Gil-Díaz
, Farès Moustafa
, Ángeles Fidalgo
, Parham Sadeghipour
, Khanh Quoc Pham
, Behnood Bikdeli
, Manuel Monreal
, RIETE Investigators
, Andris Skride (Member of the Working Group)

^*Corresponding author for this work

Research output: Contribution to journal › Article › peer-review

Abstract

BACKGROUND: Among patients with acute pulmonary embolism (PE), we aimed to evaluate for an association between oxygen saturation (SatO2 ) and 30-day post-PE mortality.

METHODS: Between January, 2001 and April, 2025, we conducted a retrospective cohort study of 38,739 non-hypotensive patients with acute PE enrolled from 18 countries in the Registro Informatizado de la Enfermedad Tromboembólica (RIETE) registry. Outcomes included 30-day all-cause and PE-specific mortality. We used hierarchical logistic regression to assess for an association between baseline SatO2 and outcomes. We aimed to identify optimal SatO2 cut-off points that maximized sensitivity and specificity in relation to mortality from receiver operating characteristic (ROC) curves. RIETE is registered with ClinicalTrials.gov, NCT02832245.

FINDINGS: Baseline SatO2 was significantly associated with mortality, where lower SatO2 had worse outcomes. Using a reference SatO2 of >96%, patients in the lower SatO2 strata had higher rates of all-cause death (odds ratio [OR] 0.96 for SatO2 94-96%; 1.23 for SatO2 90-93%; and 1.81 for SatO2 <90%) and PE-related mortality (OR 1.68 for SatO2 94-96%; 2.04 for SatO2 90-93%; and 3.95 for SatO2 <90%). The optimal cut-off point to identify patients at low-risk for short-term mortality was SatO2 of 96% (sensitivity of 86.1% and negative predictive value of 96.7%); while SatO2 of 90% (specificity of 77.2% and positive predictive value of 7.9%) identified patients at increased risk for mortality.

INTERPRETATION: Among non-hypotensive patients diagnosed with PE, we found an inverse association between baseline SatO2 and odds of all-cause and PE-associated mortality over the subsequent 30 days. A SatO2 cutoff value of 96% for the highest SatO2 group while breathing room air might help better identify patients with acute PE at low-risk for mortality. Future studies should assess the contribution of SatO2 in addition to established prognosticators to predicting the risk of death.

Original language	English
Article number	103889
Journal	EClinicalMedicine
Volume	94
DOIs	https://doi.org/10.1016/j.eclinm.2026.103889
Publication status	Published - Apr 2026
Externally published	Yes

Keywords*

Hypoxemia
Mortality
Prognosis
Pulmonary embolism

Field of Science*

3.2 Clinical medicine

Publication Type*

1.1. Scientific article indexed in Web of Science and/or Scopus database

Access to Document

10.1016/j.eclinm.2026.103889Licence: CC BY-NC-ND

Oxygen saturation and mortality for acute pulmonary embolismFinal published version, 1.65 MBLicence: CC BY-NC-ND

Cite this

Jiménez, D., Yusen, R. D., Velasco, J. M., Morillo, R., Muriel, A., Jara-Palomares, L., Bertoletti, L., Hernández-Blasco, L. M., Gil-Díaz, A., Moustafa, F., Fidalgo, Á., Sadeghipour, P., Pham, K. Q., Bikdeli, B., Monreal, M., RIETE Investigators, & Skride, A. (2026). Oxygen saturation and mortality for acute pulmonary embolism: multinational retrospective cohort study. EClinicalMedicine, 94, Article 103889. https://doi.org/10.1016/j.eclinm.2026.103889

@article{c543c8a4a3bc41d09b8caf86d5288881,

title = "Oxygen saturation and mortality for acute pulmonary embolism: multinational retrospective cohort study",

abstract = "BACKGROUND: Among patients with acute pulmonary embolism (PE), we aimed to evaluate for an association between oxygen saturation (SatO2 ) and 30-day post-PE mortality.METHODS: Between January, 2001 and April, 2025, we conducted a retrospective cohort study of 38,739 non-hypotensive patients with acute PE enrolled from 18 countries in the Registro Informatizado de la Enfermedad Tromboemb{\'o}lica (RIETE) registry. Outcomes included 30-day all-cause and PE-specific mortality. We used hierarchical logistic regression to assess for an association between baseline SatO2 and outcomes. We aimed to identify optimal SatO2 cut-off points that maximized sensitivity and specificity in relation to mortality from receiver operating characteristic (ROC) curves. RIETE is registered with ClinicalTrials.gov, NCT02832245.FINDINGS: Baseline SatO2 was significantly associated with mortality, where lower SatO2 had worse outcomes. Using a reference SatO2 of >96\%, patients in the lower SatO2 strata had higher rates of all-cause death (odds ratio [OR] 0.96 for SatO2 94-96\%; 1.23 for SatO2 90-93\%; and 1.81 for SatO2 <90\%) and PE-related mortality (OR 1.68 for SatO2 94-96\%; 2.04 for SatO2 90-93\%; and 3.95 for SatO2 <90\%). The optimal cut-off point to identify patients at low-risk for short-term mortality was SatO2 of 96\% (sensitivity of 86.1\% and negative predictive value of 96.7\%); while SatO2 of 90\% (specificity of 77.2\% and positive predictive value of 7.9\%) identified patients at increased risk for mortality.INTERPRETATION: Among non-hypotensive patients diagnosed with PE, we found an inverse association between baseline SatO2 and odds of all-cause and PE-associated mortality over the subsequent 30 days. A SatO2 cutoff value of 96\% for the highest SatO2 group while breathing room air might help better identify patients with acute PE at low-risk for mortality. Future studies should assess the contribution of SatO2 in addition to established prognosticators to predicting the risk of death.",

keywords = "Hypoxemia, Mortality, Prognosis, Pulmonary embolism",

author = "David Jim{\'e}nez and Yusen, \{Roger D\} and Velasco, \{Juan Manuel\} and Raquel Morillo and Alfonso Muriel and Luis Jara-Palomares and Laurent Bertoletti and Hern{\'a}ndez-Blasco, \{Luis Manuel\} and A{\'i}da Gil-D{\'i}az and Far{\`e}s Moustafa and {\'A}ngeles Fidalgo and Parham Sadeghipour and Pham, \{Khanh Quoc\} and Behnood Bikdeli and Manuel Monreal and \{RIETE Investigators\} and Andris Skride",

note = "Publisher Copyright: {\textcopyright} 2026 The Author(s). Published by Elsevier Ltd. This is an open access article under the CC BY-NC-ND license. http://creativecommons.org/licenses/by-nc-nd/4.0/",

year = "2026",

month = apr,

doi = "10.1016/j.eclinm.2026.103889",

language = "English",

volume = "94",

journal = "EClinicalMedicine",

issn = "2589-5370",

publisher = "Elsevier Ltd.",

}

Jiménez, D, Yusen, RD, Velasco, JM, Morillo, R, Muriel, A, Jara-Palomares, L, Bertoletti, L, Hernández-Blasco, LM, Gil-Díaz, A, Moustafa, F, Fidalgo, Á, Sadeghipour, P, Pham, KQ, Bikdeli, B, Monreal, M, RIETE Investigators & Skride, A 2026, 'Oxygen saturation and mortality for acute pulmonary embolism: multinational retrospective cohort study', EClinicalMedicine, vol. 94, 103889. https://doi.org/10.1016/j.eclinm.2026.103889

TY - JOUR

T1 - Oxygen saturation and mortality for acute pulmonary embolism

T2 - multinational retrospective cohort study

AU - Jiménez, David

AU - Yusen, Roger D

AU - Velasco, Juan Manuel

AU - Morillo, Raquel

AU - Muriel, Alfonso

AU - Jara-Palomares, Luis

AU - Bertoletti, Laurent

AU - Hernández-Blasco, Luis Manuel

AU - Gil-Díaz, Aída

AU - Moustafa, Farès

AU - Fidalgo, Ángeles

AU - Sadeghipour, Parham

AU - Pham, Khanh Quoc

AU - Bikdeli, Behnood

AU - Monreal, Manuel

AU - RIETE Investigators

A2 - Skride, Andris

PY - 2026/4

Y1 - 2026/4

N2 - BACKGROUND: Among patients with acute pulmonary embolism (PE), we aimed to evaluate for an association between oxygen saturation (SatO2 ) and 30-day post-PE mortality.METHODS: Between January, 2001 and April, 2025, we conducted a retrospective cohort study of 38,739 non-hypotensive patients with acute PE enrolled from 18 countries in the Registro Informatizado de la Enfermedad Tromboembólica (RIETE) registry. Outcomes included 30-day all-cause and PE-specific mortality. We used hierarchical logistic regression to assess for an association between baseline SatO2 and outcomes. We aimed to identify optimal SatO2 cut-off points that maximized sensitivity and specificity in relation to mortality from receiver operating characteristic (ROC) curves. RIETE is registered with ClinicalTrials.gov, NCT02832245.FINDINGS: Baseline SatO2 was significantly associated with mortality, where lower SatO2 had worse outcomes. Using a reference SatO2 of >96%, patients in the lower SatO2 strata had higher rates of all-cause death (odds ratio [OR] 0.96 for SatO2 94-96%; 1.23 for SatO2 90-93%; and 1.81 for SatO2 <90%) and PE-related mortality (OR 1.68 for SatO2 94-96%; 2.04 for SatO2 90-93%; and 3.95 for SatO2 <90%). The optimal cut-off point to identify patients at low-risk for short-term mortality was SatO2 of 96% (sensitivity of 86.1% and negative predictive value of 96.7%); while SatO2 of 90% (specificity of 77.2% and positive predictive value of 7.9%) identified patients at increased risk for mortality.INTERPRETATION: Among non-hypotensive patients diagnosed with PE, we found an inverse association between baseline SatO2 and odds of all-cause and PE-associated mortality over the subsequent 30 days. A SatO2 cutoff value of 96% for the highest SatO2 group while breathing room air might help better identify patients with acute PE at low-risk for mortality. Future studies should assess the contribution of SatO2 in addition to established prognosticators to predicting the risk of death.

AB - BACKGROUND: Among patients with acute pulmonary embolism (PE), we aimed to evaluate for an association between oxygen saturation (SatO2 ) and 30-day post-PE mortality.METHODS: Between January, 2001 and April, 2025, we conducted a retrospective cohort study of 38,739 non-hypotensive patients with acute PE enrolled from 18 countries in the Registro Informatizado de la Enfermedad Tromboembólica (RIETE) registry. Outcomes included 30-day all-cause and PE-specific mortality. We used hierarchical logistic regression to assess for an association between baseline SatO2 and outcomes. We aimed to identify optimal SatO2 cut-off points that maximized sensitivity and specificity in relation to mortality from receiver operating characteristic (ROC) curves. RIETE is registered with ClinicalTrials.gov, NCT02832245.FINDINGS: Baseline SatO2 was significantly associated with mortality, where lower SatO2 had worse outcomes. Using a reference SatO2 of >96%, patients in the lower SatO2 strata had higher rates of all-cause death (odds ratio [OR] 0.96 for SatO2 94-96%; 1.23 for SatO2 90-93%; and 1.81 for SatO2 <90%) and PE-related mortality (OR 1.68 for SatO2 94-96%; 2.04 for SatO2 90-93%; and 3.95 for SatO2 <90%). The optimal cut-off point to identify patients at low-risk for short-term mortality was SatO2 of 96% (sensitivity of 86.1% and negative predictive value of 96.7%); while SatO2 of 90% (specificity of 77.2% and positive predictive value of 7.9%) identified patients at increased risk for mortality.INTERPRETATION: Among non-hypotensive patients diagnosed with PE, we found an inverse association between baseline SatO2 and odds of all-cause and PE-associated mortality over the subsequent 30 days. A SatO2 cutoff value of 96% for the highest SatO2 group while breathing room air might help better identify patients with acute PE at low-risk for mortality. Future studies should assess the contribution of SatO2 in addition to established prognosticators to predicting the risk of death.

KW - Hypoxemia

KW - Mortality

KW - Prognosis

KW - Pulmonary embolism

UR - https://www-webofscience-com.db.rsu.lv/wos/alldb/full-record/WOS:001750165400001

UR - https://www.scopus.com/pages/publications/105035510449

U2 - 10.1016/j.eclinm.2026.103889

DO - 10.1016/j.eclinm.2026.103889

M3 - Article

C2 - 42077645

SN - 2589-5370

VL - 94

JO - EClinicalMedicine

JF - EClinicalMedicine

M1 - 103889

ER -

Oxygen saturation and mortality for acute pulmonary embolism: multinational retrospective cohort study

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Keywords*

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