Objective To investigate the correlation of serum levels of soluble programmed death ligand 1(sPD-L1),tumor necrosis factor-associated apoptosis-inducing ligand(TRAIL)and fibroblast growth factor 23(FGF-23)with risk stratification and death in patients with acute pulmonary embolism(APE).Methods A total of 113 pa-tients with APE admitted to the hospital from January 2022 to January 2024 were selected as APE group,and 50 healthy subjects were selected as control group.The 113 patients with APE were divided into high risk group(39 cases),medium risk group(45 cases)and low risk group(29 cases)by risk stratification.Accord-ing to the death of APE patients,they were divided into survival group(83 cases)and death group(30 cases).The levels of serum sPD-L1,TRAIL and FGF-23 were measured by enzyme-linked immunosorbent assay(ELISA).Multiple Logistic regression was used to analyze the risk factors affecting death of APE patients.Receiver operating characteristic(ROC)curve was drawn to analyze the value of serum sPD-L1,TRAIL and FGF-23 levels in evaluating mortality in APE patients.Pearson correlation analysis was used to investigate the correlation between serum sPD-L1,TRAIL and FGF-23 levels and cardiac function indicators in APE patients.Results The levels of serum sPD-L1,TRAILand FGF-23 in the APE group were significantly higher than those in the control group(P＜0.001).The serum sPD-L1,TRAIL and FGF-23 levels in the death group were significantly higher than those in the survival group(P＜0.001).The levels of serum sPD-L1,TRAIL and FGF-23 in the high-risk group were higher than those in the medium and low-risk groups,and the medium risk group was higher than the low-risk group,and the differences were statistically significant(P＜0.001).Multiple Logistic regression analysis showed that elevated levels of cardiac troponin Ⅰ(cTnⅠ),B type brain na-triuretic peptide(BNP),sPD-L1,TRAIL and FGF-23 were risk factors for mortality in APE patients(P＜0.05).ROC curve analysis showed that the combination of sPD-L1,TRAIL and FGF-23 had the largest area under curve for predicting death in APE patients,which was 0.924(95％CI:0.861-0.986),with a sensitivity of 96.8％and a specificity of 81.2％.Correlation analysis showed that the levels of serum sPD-L1,TRAIL and FGF-23 were positively correlated with cTnⅠ and BNP in APE patients(P＜0.001).Conclusion The lev-els of serum sPD-L1,TRAIL and FGF-23 are significantly elevated in APE patients,and their high expression is associated with high-risk stratification and mortality.The combination of these three indexes has good eval-uation value for APE patient mortality.