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中高危肺栓塞患者院内及短期死亡的预测因素

In-hospital and short-term predictors of mortality in patients with intermediate-high risk pulmonary embolism.

作者信息

Gök Gulay, Karadağ Mehmet, Çinar Tufan, Nurkalem Zekeriya, Duman Dursun

机构信息

Medipol University Faculty of Medicine, Department of Cardiology, Istanbul, Turkey.

Hatay Mustafa Kemal University Faculty of Medicine, Department of Biostatistics, Hatay, Turkey.

出版信息

J Cardiovasc Thorac Res. 2020;12(4):321-327. doi: 10.34172/jcvtr.2020.51. Epub 2020 Nov 28.

Abstract

The aim of this study was to evaluate the in-hospital and short-term predictive factors of mortality in intermediate-high risk acute pulmonary embolism (PE) patients with right ventricle (RV)dysfunction and myocardial injury. In this retrospective study, the medical records of 187 patients with a diagnosis of intermediate high risk acute PE were evaluated. A contrast-enhanced multi-detector pulmonary angiography was used to confirm diagnosis in all cases. All-cause mortality was determined by obtaining both in hospital and 30 days follow-up data of patients from medical records. During the in-hospital stay (9.5±4.72 days), 7 patients died, resulting in an acute PE related in-hospital mortality of 3.2%. Admission heart rate (HR), (Odds ratio (OR), 1.028 95% Confidence interval (CI), 0.002-1.121; = 0.048) and blood urea nitrogen (BUN) (OR, 1.028 95% CI, 0.002-1.016; = 0.044) were found to be independent predictors for in-hospital mortality in a multi variate logistic regression analysis. In total, 32 patients (20.9%) died during 30 days follow-up.The presence of congestive heart failure (OR, 0.015, 95%CI, 0.001-0.211; = 0.002) and dementia (OR, 0.029, 95%CI,0.002-0.516; = 0.016) as well as low albumin level (OR, 0.049 95%CI, 0.006-0.383; = 0.049) were associated with 30 days mortality. HR and BUN were independent predictors of in-hospital mortality and the presence of congestive heart failure, dementia, and low albumin levels were associated with higher 30 days mortality.

摘要

本研究旨在评估中高危急性肺栓塞(PE)伴右心室(RV)功能障碍及心肌损伤患者的院内及短期死亡预测因素。在这项回顾性研究中,对187例诊断为中高危急性PE的患者的病历进行了评估。所有病例均采用对比增强多排螺旋CT肺动脉造影确诊。通过获取患者病历中的住院及30天随访数据来确定全因死亡率。在住院期间(9.5±4.72天),7例患者死亡,急性PE相关的院内死亡率为3.2%。多因素逻辑回归分析发现,入院心率(HR)(比值比(OR),1.028;95%置信区间(CI),0.002 - 1.121;P = 0.048)和血尿素氮(BUN)(OR,1.028;95%CI,0.002 - 1.016;P = 0.044)是院内死亡的独立预测因素。总共32例患者(20.9%)在30天随访期间死亡。充血性心力衰竭(OR,0.015;95%CI,0.001 - 0.211;P = 0.002)、痴呆(OR,0.029;95%CI,0.002 - 0.516;P = 0.016)以及低白蛋白水平(OR,0.049;95%CI,0.006 - 0.383;P = 0.049)与30天死亡率相关。HR和BUN是院内死亡的独立预测因素,而充血性心力衰竭、痴呆和低白蛋白水平的存在与30天更高的死亡率相关。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/94dd/7828758/bae4d5574861/jcvtr-12-321-g001.jpg

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