Department of Internal Medicine, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina.
BMC Pulm Med. 2014 Dec 15;14:200. doi: 10.1186/1471-2466-14-200.
The prognosis of patients with suspected pulmonary embolism (PE) in whom PE has been ruled out (RPE) is unclear. We aimed to evaluate survival and diagnosis of new cancer in suspected PE patients at follow up.
A prospective cohort study nested in a prospective Institutional Registry of Venous Thromboembolic Disease was performed between 2006 and 2011. This study was designed to evaluate all consecutive, incident cases of suspected PE in adults. The study was performed at the Hospital Italiano de Buenos Aires, a tertiary level hospital, in hospitalized patients and outpatients. Suspected PE cases were collected using a computerized system that alerts whenever a physician requests pulmonary angiography, angiotomography, or ventilation-perfusion scintigraphy. PE was defined by pre-specified criteria and RPE was defined when diagnostic tests were negative for PE.
We included 1736 cases of suspected PE. The prevalence of PE was 29% (n = 504). There was no difference in the overall survival at 30 days and follow-up between PE and RPE patients. The presence of provoked or unprovoked venous thromboembolic disease in these patients did not affect survival. The main causes of death were PE in the confirmed PE group (60%), and neoplasm (42%) and sepsis (37%) in the RPE group. Survival at 90 days was 63% for PE (95% CI 58-67%) and 67% for RPE patients (95% CT 64-69%). At follow-up, there was no difference in diagnosis of new cancer between PE and RPE patients (2% vs 2%, p = 0.82), even when taking into account the unprovoked group.
Even when the main cause of death in PE patients is PE itself, the overall mortality is similar between PE and RPE patients. The reason for this finding could be because of the more frequent and severe comorbidities in RPE than in PE patients.
HomeClinicalTrial.gov: NCT01372514.
排除肺栓塞（PE）的疑似 PE 患者（RPE）的预后尚不清楚。我们旨在评估疑似 PE 患者在随访期间的生存和新发癌症的诊断情况。
这是一项于 2006 年至 2011 年期间在静脉血栓栓塞疾病机构注册处进行的前瞻性队列研究，嵌套在其中。该研究旨在评估所有成人疑似 PE 的连续病例。研究在布宜诺斯艾利斯意大利医院进行，这是一家三级医院，研究对象为住院患者和门诊患者。疑似 PE 病例是通过计算机系统收集的，每当医生要求进行肺动脉造影、血管造影或通气-灌注闪烁成像时，系统就会发出警报。PE 通过预先规定的标准定义，当诊断性检查结果为阴性时，定义为 RPE。
我们纳入了 1736 例疑似 PE 患者。PE 的患病率为 29%（n=504）。PE 患者和 RPE 患者在 30 天和随访期间的总体生存率没有差异。这些患者中存在的诱发或非诱发静脉血栓栓塞疾病并不影响生存率。确诊 PE 组的主要死亡原因是 PE（60%），RPE 组的主要死亡原因是肿瘤（42%）和脓毒症（37%）。PE 患者 90 天的生存率为 63%（95%CI 58-67%），RPE 患者为 67%（95%CI 64-69%）。在随访期间，PE 患者和 RPE 患者新发癌症的诊断率没有差异（2%比 2%，p=0.82），即使考虑到非诱发组也是如此。
即使 PE 患者的主要死亡原因是 PE 本身，PE 患者和 RPE 患者的总体死亡率也相似。造成这一发现的原因可能是 RPE 患者比 PE 患者更常患有严重的合并症。
美国国立卫生研究院临床试验注册处：NCT01372514。
