Casazza Franco, Becattini Cecilia, Rulli Eliana, Pacchetti Ilaria, Floriani Irene, Biancardi Marco, Scardovi Angela Beatrice, Enea Iolanda, Bongarzoni Amedeo, Pignataro Luigi, Agnelli Giancarlo
Cardiology Division, Ospedale San Carlo Borromeo, Milan, Italy.
Internal and Cardiovascular Medicine-Stroke Unit, University of Perugia, Via G Dottori 1, Perugia, Italy.
Intern Emerg Med. 2016 Sep;11(6):817-24. doi: 10.1007/s11739-016-1431-9. Epub 2016 Mar 29.
Cancer is one of the most common risk factors for acute pulmonary embolism (PE), but only few studies report on the short-term outcome of patients with PE and a history of cancer. The aim of the study was to assess whether a cancer diagnosis affects the clinical presentation and short-term outcome in patients hospitalized for PE who were included in the Italian Pulmonary Embolism Registry. All-cause and PE-related in-hospital deaths were also analyzed. Out of 1702 patients, 451 (26.5 %) of patients had a diagnosis of cancer: cancer was known at presentation in 365, or diagnosed during the hospital stay for PE in 86 (19 % of cancer patients). Patients with and without cancer were similar concerning clinical status at presentation. Patients with cancer less commonly received thrombolytic therapy, and more often had an inferior vena cava filter inserted. Major or intracranial bleeding was not different between groups. In-hospital all-cause death occurred in 8.4 and 5.9 % of patients with and without cancer, respectively. At multivariate analysis, cancer (OR 2.24, 95 % CI 1.27-3.98; P = 0.006) was an independent predictor of in-hospital death. Clinical instability, PE recurrence, age ≥75 years, recent bed rest ≥3 days, but not cancer, were independent predictors of in-hospital death due to PE. Cancer seems a weaker predictor of all-cause in-hospital death compared to other factors; the mere presence of cancer, without other risk factors, leads to a probability of early death of 2 %. In patients with acute PE, cancer increases the probability of in-hospital all-cause death, but does not seem to affect the clinical presentation or the risk of in-hospital PE-related death.
癌症是急性肺栓塞（PE）最常见的危险因素之一，但仅有少数研究报道了有PE病史且患癌症患者的短期预后。本研究旨在评估癌症诊断是否会影响纳入意大利肺栓塞登记处的因PE住院患者的临床表现和短期预后。同时还分析了全因和与PE相关的住院死亡情况。在1702例患者中，451例（26.5%）被诊断患有癌症：365例在就诊时已知患有癌症，86例（占癌症患者的19%）在因PE住院期间被诊断出癌症。有癌症和无癌症患者在就诊时的临床状况相似。癌症患者较少接受溶栓治疗，且更常植入下腔静脉滤器。两组之间严重或颅内出血情况无差异。有癌症和无癌症患者的住院全因死亡率分别为8.4%和5.9%。多因素分析显示，癌症（比值比2.24，95%可信区间1.27 - 3.98；P = 0.006）是住院死亡的独立预测因素。临床不稳定、PE复发、年龄≥75岁、近期卧床休息≥3天，但癌症不是因PE导致住院死亡的独立预测因素。与其他因素相比，癌症似乎是全因住院死亡的较弱预测因素；仅患有癌症而无其他危险因素时，早期死亡概率为2%。在急性PE患者中，癌症会增加住院全因死亡的概率，但似乎不影响临床表现或住院PE相关死亡的风险。
