Stewart Lauren K, Kline Jeffrey A
Department of Emergency Medicine, Indiana University School of Medicine, Indianapolis, Indiana.
Ann Am Thorac Soc. 2020 Jul;17(7):821-828. doi: 10.1513/AnnalsATS.201907-518OC.
Metabolic syndrome (MetS), the clinical clustering of hypertension, dyslipidemia, insulin resistance, and abdominal obesity, has been associated with a prothrombotic and hypofibrinolytic state, although data linking MetS with venous thromboembolism (VTE) remain limited. The aim of this study was to measure the prevalence of MetS in patients with pulmonary embolism (PE) across a large population and to examine its impact on VTE recurrence. This was a retrospective, population-based analysis using deidentified information from a large statewide database, the Indiana Network for Patient Care. All patients with an -defined diagnosis of PE from 2004 to 2017 were included. We measured the frequency with which patients with PE carried a comorbid diagnosis of each MetS component. Multiple logistic regression analysis was performed with VTE recurrence as the dependent variable to test the independent effect of MetS diagnosis, with a statistical model using a directed acyclic graph to account for potential confounders and mediators. Kaplan-Meier curves were constructed to compare rates of VTE recurrence over time based on the presence or absence of MetS and its individual components. A total of 72,936 patients were included in this analysis. The most common MetS component was hypertension with a prevalence of 59%, followed by hyperlipidemia (41%), diabetes mellitus (24%), and obesity (22%). Of these patients, 69% had at least one comorbid component of MetS. The overall incidence of VTE recurrence was 17%, increasing stepwise with each additional MetS component and ranging from 6% in patients with zero components to 37% in those with all four. Logistic regression analysis yielded an adjusted odds ratio of 3.03 (95% CI, 2.90-3.16) for the effect of composite diagnosis requiring at least three of the four components of MetS diagnosis on VTE recurrence. The presence of comorbid MetS in patients with PE is associated with significantly higher rates of VTE recurrence, supporting the importance of recognizing these risk factors and initiating appropriate therapies to reduce recurrence risk.
代谢综合征（MetS）是高血压、血脂异常、胰岛素抵抗和腹型肥胖的临床聚集状态，尽管将MetS与静脉血栓栓塞（VTE）联系起来的数据仍然有限，但它与血栓前状态和纤溶功能低下有关。本研究的目的是在大量人群中测量肺栓塞（PE）患者中MetS的患病率，并研究其对VTE复发的影响。这是一项基于人群的回顾性分析，使用来自全州范围的大型数据库——印第安纳州患者护理网络中去识别化的信息。纳入了2004年至2017年所有明确诊断为PE的患者。我们测量了PE患者合并每种MetS成分诊断的频率。以VTE复发作为因变量进行多因素logistic回归分析，以检验MetS诊断的独立效应，使用有向无环图的统计模型来考虑潜在的混杂因素和中介因素。构建Kaplan-Meier曲线以比较基于是否存在MetS及其各个成分的VTE复发率随时间的变化。本分析共纳入72936例患者。最常见的MetS成分是高血压，患病率为59%，其次是高脂血症（41%）、糖尿病（24%）和肥胖（22%）。在这些患者中，69%至少有一种MetS合并成分。VTE复发的总体发生率为17%，随着MetS成分的增加而逐步上升，从无成分患者的6%到有所有四种成分患者的37%不等。logistic回归分析得出，对于需要MetS诊断的四个成分中至少三个的综合诊断对VTE复发的影响，调整后的优势比为3.03（95%CI，2.90-3.16）。PE患者合并MetS与显著更高的VTE复发率相关，这支持了识别这些危险因素并启动适当治疗以降低复发风险的重要性。
