Respiratory Department, Ramón y Cajal Hospital, 28034 Madrid, Spain.
Am J Respir Crit Care Med. 2010 May 1;181(9):983-91. doi: 10.1164/rccm.200908-1204OC. Epub 2010 Jan 28.
Concomitant deep vein thrombosis (DVT) in patients with acute pulmonary embolism (PE) has an uncertain prognostic significance.
In a cohort of patients with PE, this study compared the risk of death in those with and those without concomitant DVT.
We conducted a prospective cohort study of outpatients diagnosed with a first episode of acute symptomatic PE. Patients underwent bilateral lower extremity venous compression ultrasonography to assess for concomitant DVT.
The primary study outcome, all-cause mortality, and the secondary outcome of PE-specific mortality were assessed during the 3 months of follow-up after PE diagnosis. Multivariate Cox proportional hazards regression was done to adjust for significant covariates. Of 707 patients diagnosed with PE, 51.2% (362 of 707) had concomitant DVT and 10.9% (77 of 707) died during follow-up. Patients with concomitant DVT had an increased all-cause mortality (adjusted hazard ratio [HR], 2.05; 95% confidence interval [CI], 1.24 to 3.38; P = 0.005) and PE-specific mortality (adjusted HR, 4.25; 95% CI, 1.61 to 11.25; P = 0.04) compared with those without concomitant DVT. In an external validation cohort of 4,476 patients with acute PE enrolled in the international multicenter RIETE Registry, concomitant DVT remained a significant predictor of all-cause (adjusted HR, 1.66; 95% CI, 1.28 to 2.15; P < 0.001) and PE-specific mortality (adjusted HR, 2.01; 95% CI, 1.18 to 3.44; P = 0.01).
In patients with a first episode of acute symptomatic PE, the presence of concomitant DVT is an independent predictor of death in the ensuing 3 months after diagnosis. Assessment of the thrombotic burden should assist with risk stratification of patients with acute PE.
急性肺栓塞（PE）患者合并深静脉血栓形成（DVT）的预后意义尚不确定。
本研究旨在比较 PE 患者中合并与不合并 DVT 的患者的死亡风险。
我们进行了一项前瞻性队列研究，纳入了首次诊断为急性有症状 PE 的门诊患者。患者接受双侧下肢静脉压迫超声检查以评估是否合并 DVT。
主要研究结局为全因死亡率，次要结局为 PE 特异性死亡率，在 PE 诊断后 3 个月的随访期间进行评估。多变量 Cox 比例风险回归用于调整重要协变量。在 707 例诊断为 PE 的患者中，51.2%（362/707）合并 DVT，10.9%（77/707）在随访期间死亡。合并 DVT 的患者全因死亡率（校正后 HR，2.05；95%CI，1.24 至 3.38；P = 0.005）和 PE 特异性死亡率（校正后 HR，4.25；95%CI，1.61 至 11.25；P = 0.04）均高于无合并 DVT 的患者。在国际多中心 RIETE 注册中心纳入的 4476 例急性 PE 患者的外部验证队列中，合并 DVT 仍然是全因（校正后 HR，1.66；95%CI，1.28 至 2.15；P < 0.001）和 PE 特异性死亡率（校正后 HR，2.01；95%CI，1.18 至 3.44；P = 0.01）的显著预测因素。
在首次出现急性有症状 PE 的患者中，合并 DVT 是诊断后 3 个月内死亡的独立预测因素。血栓负担的评估应有助于对急性 PE 患者进行风险分层。
