双侧胸腔积液对急性肺栓塞患者的临床意义。

Clinical relevance of bilateral pleural effusion in patients with acute pulmonary embolism.

机构信息

Internal Medicine B, Assaf Harofeh Medical Center, Zerifin, Israel.

Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel.

出版信息

Intern Med J. 2020 Aug;50(8):938-944. doi: 10.1111/imj.14671.

DOI:10.1111/imj.14671

PMID:31661186

Abstract

BACKGROUND

The clinical relevance of bilateral pleural effusion (BPE) in patients with acute pulmonary embolism (PE) is unclear.

AIMS

To describe characteristics of patients with acute PE that present with BPE.

METHODS

Patients with acute PE were retrospectively analysed and divided into three groups: without pleural effusion, unilateral pleural effusion and bilateral effusion. Clinical, laboratory and radiological characteristics were compared between the three groups.

RESULTS

The study population (n = 343) consisted of unilateral effusion group (n = 83), BPE group (n = 94) and without effusion group (n = 166). Several variables were noted in higher proportion (%), in the BPE group in comparison to both the unilateral effusion and without effusion groups: heart failure (17.0 vs 7.2 vs 6.7, P = 0.017), hypoalbuminaemia (59.3 vs 39.5 vs 25.6, P ˂ 0.001), PE occurrence in-hospital setting (51 vs 25.6 vs 15.1, P ˂ 0.001), major operation (31 vs 19.2 vs 15.2, P = 0.01) and mechanical ventilation (13.0 vs 4.9 vs 4.2, P = 0.019). Norton scale scores were found to be lower among patients with BPE in comparison to both patients with unilateral and without pleural effusion (15.55 vs 16.92 vs 17.36, P = 0.006). After adjusting confounding variables, patients with BPE have lower probability for in-hospital survival in comparison to both patients with unilateral pleural effusion (odds ratio = 0.30, 95% confidence interval 0.12-0.79), and patients without pleural effusion (odds ratio = 0.26, 95% confidence interval 0.11-0.61).

CONCLUSIONS

BPE in patients with acute PE may have significant clinical implications. It may signify serious underlying comorbidities which contribute to higher in-hospital mortality in comparison to both patients with unilateral pleural effusion and patients without pleural effusion.

摘要

背景

急性肺栓塞（PE）患者双侧胸腔积液（BPE）的临床意义尚不清楚。

目的

描述急性 PE 患者出现 BPE 的特征。

方法

回顾性分析急性 PE 患者，将其分为无胸腔积液组、单侧胸腔积液组和双侧胸腔积液组。比较三组患者的临床、实验室和影像学特征。

结果

研究人群（n=343）包括单侧胸腔积液组（n=83）、BPE 组（n=94）和无胸腔积液组（n=166）。与单侧胸腔积液组和无胸腔积液组相比，BPE 组中以下变量的比例更高（%）：心力衰竭（17.0%比 7.2%比 6.7%，P=0.017）、低白蛋白血症（59.3%比 39.5%比 25.6%，P＜0.001）、PE 院内发病（51%比 25.6%比 15.1%，P＜0.001）、大手术（31%比 19.2%比 15.2%，P=0.01）和机械通气（13.0%比 4.9%比 4.2%，P=0.019）。与单侧胸腔积液和无胸腔积液患者相比，BPE 患者的诺顿量表评分较低（15.55 比 16.92 比 17.36，P=0.006）。调整混杂因素后，与单侧胸腔积液患者相比，BPE 患者住院期间生存率较低（比值比=0.30，95%置信区间 0.12-0.79），与无胸腔积液患者相比（比值比=0.26，95%置信区间 0.11-0.61）。