Keller Karsten, Beule Johannes, Balzer Jörn Oliver, Dippold Wolfgang
Department of Medicine II, University Medical Center Mainz, Johannes Gutenberg-University Mainz, Mainz, Germany; Center for Thrombosis and Hemostasis, University Medical Center Mainz, Johannes Gutenberg-University Mainz, Mainz, Germany.
Department of Internal Medicine, St. Vincenz and Elisabeth Hospital Mainz (KKM), Mainz, Germany.
Am J Emerg Med. 2015 Nov;33(11):1617-21. doi: 10.1016/j.ajem.2015.07.009. Epub 2015 Jul 17.
Risk stratification of patients with acute pulmonary embolism (PE) is crucial in deciding appropriate therapy management. Blood pressure (BP) is rapidly available and a reliable parameter. We aimed to investigate BP for short-term outcome in acute PE.
Data of 182 patients with acute PE were analyzed retrospectively. Logistic regression models were calculated to investigate associations between BP and in-hospital-death as well as myocardial necrosis. Moreover, receiver operating characteristic (ROC) curves and cutoff values for systolic and diastolic BPs predicting in-hospital death and myocardial necrosis were computed.
A total of 182 patients (61.5% female; mean age, 68.5 ± 15.3 years) with acute PE event were included in the study. Five patients (2.7%) died in the hospital. Logistic regression models showed a significant association between in-hospital death and systolic BP ≤ 120 mm Hg (odds ratio [OR], 22.222; 95% confidence interval [CI], 2.370-200.00; P = .00660), systolic BP ≤ 110 mm Hg (OR, 22.727; 95% CI, 3.378-142.857; P = .00130), systolic BP ≤ 100 mm Hg (OR, 16.129; 95% CI, 2.304-111.111; P = .00513), systolic BP ≤ 90 mm Hg (OR, 22.727; 95% CI, 3.086-166.667'; P = .00220), and diastolic BP ≤65 mm Hg (OR, 14.706; 95% CI, 1.572-142.857; P = .0184), respectively. Association between myocardial necrosis and systolic BP0 >100 mm Hg (OR, 5.444; 95% CI, 1.052-28.173; P = .0433) was also significant. Receiver operating characteristic analysis for systolic BP predicting in-hospital death revealed an area under the curve of 0.831 with a cutoff value of 119.5 mm Hg. Receiver operating characteristic analysis for diastolic BP predicting in-hospital death showed an area under the curve of 0.903 with a cutoff value of 66.5 mm Hg.
Systolic and diastolic BPs are excellent prognosis predictors of patients with acute PE. Systolic BP of 120 mm Hg or less and diastolic BP of 65 mm Hg or less at admission are connected with elevated risk of in-hospital death.
急性肺栓塞（PE）患者的风险分层对于决定合适的治疗管理至关重要。血压（BP）易于快速获取且是一个可靠的参数。我们旨在研究血压对急性PE短期预后的影响。
回顾性分析182例急性PE患者的数据。计算逻辑回归模型以研究血压与院内死亡以及心肌坏死之间的关联。此外，计算预测院内死亡和心肌坏死的收缩压和舒张压的受试者工作特征（ROC）曲线及临界值。
本研究共纳入182例急性PE事件患者（女性占61.5%；平均年龄68.5±15.3岁）。5例患者（2.7%）在医院死亡。逻辑回归模型显示，院内死亡与收缩压≤120 mmHg（比值比[OR]，22.222；95%置信区间[CI]，2.370 - 200.00；P = 0.00660）、收缩压≤110 mmHg（OR，22.727；95% CI，3.378 - 142.857；P = 0.00130）、收缩压≤100 mmHg（OR，16.129；95% CI，2.304 - 111.111；P = 0.00513）、收缩压≤90 mmHg（OR，22.727；95% CI，3.086 - 166.667；P = 0.00220）以及舒张压≤65 mmHg（OR，14.706；95% CI，1.572 - 142.857；P = 0.0184）分别显著相关。心肌坏死与收缩压>100 mmHg（OR，5.444；95% CI，1.052 - 28.173；P = 0.0433）之间的关联也显著。预测院内死亡的收缩压的受试者工作特征分析显示曲线下面积为0.831，临界值为119.5 mmHg。预测院内死亡的舒张压的受试者工作特征分析显示曲线下面积为0.903，临界值为66.5 mmHg。
收缩压和舒张压是急性PE患者预后的优秀预测指标。入院时收缩压≤120 mmHg和舒张压≤65 mmHg与院内死亡风险升高相关。
