Department of Internal Medicine, St. Joseph Mercy Oakland, Pontiac, MI, USA.
Clin Appl Thromb Hemost. 2011 Nov-Dec;17(6):656-8. doi: 10.1177/1076029611405033. Epub 2011 May 17.
Predictors of in-hospital mortality from massive pulmonary embolism (PE) were retrospectively assessed in 78 patients who received thrombolytic therapy. Mortality from PE was 19% (15 of 78). Mortality from PE was higher in those with shock, 36% (12 of 33) versus no shock, 7% (3 of 45; P = .001), 21% (7 of 34) with right ventricle (RV) hypokinesis, and 20% (13 of 64) with RV enlargement. Mortality was 14% (2 of 14) with normal cardiac troponin I (cTnI), 19% (4 of 21) with intermediate cTnI, and 22% (8 of 36) with high cTnI (comparisons between groups nonsignificant [NS]). Trends with combinations of risk factors showed the highest mortality with shock plus high cTnI plus RV hypokinesis (57%) or shock plus high cTnI plus RV enlargement (54%). In conclusion, among the single risk factors, shock was associated with the highest in-hospital mortality from PE and combinations with high cTnI and RV enlargement were associated with higher mortalities.
回顾性评估了 78 例接受溶栓治疗的大面积肺栓塞（PE）患者的院内死亡率预测因素。PE 的死亡率为 19%（78 例中有 15 例）。有休克的患者死亡率更高，36%（33 例中有 12 例），而非休克患者的死亡率为 7%（45 例中有 3 例；P =.001），右心室（RV）运动功能减退的患者死亡率为 21%（34 例中有 7 例），RV 扩大的患者死亡率为 20%（64 例中有 13 例）。心肌肌钙蛋白 I（cTnI）正常的患者死亡率为 14%（14 例中有 2 例），中间 cTnI 的患者死亡率为 19%（21 例中有 4 例），高 cTnI 的患者死亡率为 22%（36 例中有 8 例）（组间比较无统计学意义[NS]）。危险因素组合的趋势显示，休克加高 cTnI 加 RV 运动功能减退（57%）或休克加高 cTnI 加 RV 扩大（54%）的死亡率最高。总之，在单一危险因素中，休克与 PE 的院内死亡率最高相关，而与高 cTnI 和 RV 扩大相关的组合与更高的死亡率相关。
