Respiratory Department, Ramón y Cajal Hospital and Instituto Ramón y Cajal de Investigación Sanitaria IRYCIS Respiratory Department, Gregorio Marañón Hospital, Madrid, Spain.
J Thromb Haemost. 2011 Nov;9(11):2201-7. doi: 10.1111/j.1538-7836.2011.04490.x.
Although previous studies have provided evidence that the majority of deaths following an acute pulmonary embolism (PE) directly relate to the PE, more recent registries and cohort studies suggest otherwise.
We assessed the cause of death during the first 30 days after the diagnosis of acute symptomatic PE in a consecutive series of patients. We also assessed the prognostic characteristics of the simplified Pulmonary Embolism Severity Index (sPESI) and cardiac troponin I (cTnI) obtained at the time of PE diagnosis.
During the first 30 days after diagnosis, 127 of the 1291 patients died (9.8%; 95% confidence interval [CI], 8.2-11.5). Sixty patients (4.6%; 95% CI, 3.5-5.8) died from definite or possible PE, and 67 (5.2%; 95% CI, 4.0-6.4) died from other causes (cancer 25, infection 18, hemorrhage 7, heart failure 7, chronic obstructive pulmonary disease 5, renal failure 1, seizures 1, unknown 3). The sPESI predicted all-cause (odds ratio [OR], 5.97; 95% CI, 1.74-20.54; P < 0.01) and PE-associated mortality (OR, 8.79; 95% CI, 1.12-68.79; P = 0.04). cTnI only predicted PE-associated mortality (adjusted OR, 2.39; 95% CI, 1.25-4.57; P < 0.01). For all-cause mortality, the sPESI low-risk strata had a negative predictive value of 98.8% (95% CI, 97.4-100) in comparison with 91.3% (95% CI, 88.9-93.6) for the cTnI.
Within the first 30 days after the diagnosis of acute symptomatic PE, death due to PE and death due to other causes occur in a similar proportion of patients. As cTnI only predicted PE-associated mortality, low-risk sPESI had a higher negative predictive value for all-cause mortality compared with cTnI.
尽管先前的研究已经证明，大多数急性肺栓塞（PE）死亡直接与 PE 有关，但最近的登记处和队列研究表明并非如此。
我们评估了连续系列急性有症状 PE 患者在诊断后 30 天内的死亡原因。我们还评估了简化的肺栓塞严重程度指数（sPESI）和在 PE 诊断时获得的心脏肌钙蛋白 I（cTnI）的预后特征。
在诊断后 30 天内，1291 例患者中有 127 例死亡（9.8%；95%置信区间[CI]，8.2-11.5）。60 例（4.6%；95%CI，3.5-5.8）死于明确或可能的 PE，67 例（5.2%；95%CI，4.0-6.4）死于其他原因（癌症 25 例，感染 18 例，出血 7 例，心力衰竭 7 例，慢性阻塞性肺疾病 5 例，肾衰竭 1 例，癫痫发作 1 例，原因不明 3 例）。sPESI 预测全因（优势比[OR]，5.97；95%CI，1.74-20.54；P<0.01）和 PE 相关死亡率（OR，8.79；95%CI，1.12-68.79；P=0.04）。cTnI 仅预测 PE 相关死亡率（调整 OR，2.39；95%CI，1.25-4.57；P<0.01）。对于全因死亡率，sPESI 低危分层的阴性预测值为 98.8%（95%CI，97.4-100），而 cTnI 的阴性预测值为 91.3%（95%CI，88.9-93.6）。
在急性有症状 PE 诊断后 30 天内，死于 PE 和死于其他原因的患者比例相似。由于 cTnI 仅预测 PE 相关死亡率，因此低危 sPESI 对全因死亡率的阴性预测值高于 cTnI。
