Sedhom Ramy, Beshai Rafail, Moussa Peter, Megaly Michael, Mohsen Amr, Abramov Dmitry, Stoletniy Liset, Elgendy Islam Y
Division of Cardiology, Loma Linda University Medical Center, Loma Linda, CA, USA.
Division of Internal Medicine, Jefferson Health, Washington Township, NJ, USA.
Mayo Clin Proc. 2024 Jan;99(1):81-89. doi: 10.1016/j.mayocp.2023.03.019. Epub 2023 Aug 26.
To examine the characteristics and outcomes among patients with high-risk pulmonary embolism (PE) and malignancy.
The Nationwide Readmissions Database was used to identify hospitalizations with high-risk PE from January 1, 2016, to December 31, 2019. The main outcome was the difference in all-cause in-hospital mortality.
Among 28,547 weighted hospitalizations with high-risk PE, 4,825 (16.9%) had malignancy. Admissions with malignancy had a lower prevalence of other comorbid conditions except for anemia and coagulopathy. The use of systemic thrombolysis, catheter-directed interventions, and surgical embolectomy was less common among admissions with malignancy, whereas the use of inferior vena cava filter was more common among those with malignancy. All-cause in-hospital mortality was higher among admissions with malignancy even after adjustment (adjusted odds ratio, 1.91; 95% CI, 1.72 to 2.11; P<.001). Metastatic genitourinary, gastrointestinal (other than colorectal), and lung malignancies were associated with the highest incidence of in-hospital mortality. The incidence of intracranial hemorrhage (3.9% vs 3.1%; P=.056) and the composite of non-intracranial hemorrhage bleeding (21.9% vs 20.6%; P=.185) was not different between admissions with and without malignancy. However, admissions with malignancy had higher incidence of gastrointestinal bleeding.
In this nationwide analysis of patients admitted with high-risk PE, malignancy was independently associated with an increased risk of in-hospital mortality. The risk was highest among patients with metastatic genitourinary, gastrointestinal, and lung malignancies. Advanced therapies were less frequently used among patients with malignancy.
研究高危肺栓塞（PE）合并恶性肿瘤患者的特征及预后。
利用全国再入院数据库，识别出2016年1月1日至2019年12月31日期间因高危PE住院的患者。主要结局为全因住院死亡率的差异。
在28,547例加权的高危PE住院患者中，4,825例（16.9%）合并恶性肿瘤。除贫血和凝血病外，合并恶性肿瘤的患者其他合并症的患病率较低。在合并恶性肿瘤的住院患者中，全身溶栓、导管定向干预和外科血栓切除术的使用较少见，而在下腔静脉滤器的使用在合并恶性肿瘤的患者中更常见。即使经过调整，合并恶性肿瘤的住院患者全因住院死亡率仍较高（调整后的优势比为1.91；95%可信区间为1.72至2.11；P<0.001）。转移性泌尿生殖系统、胃肠道（非结直肠癌）和肺部恶性肿瘤与住院死亡率的最高发生率相关。颅内出血的发生率（3.9%对3.1%；P=0.056）以及非颅内出血性出血的综合发生率（21.9%对20.6%；P=0.185）在合并和未合并恶性肿瘤的住院患者之间没有差异。然而，合并恶性肿瘤的住院患者胃肠道出血的发生率较高。
在这项对因高危PE入院患者的全国性分析中，恶性肿瘤与住院死亡率增加独立相关。在转移性泌尿生殖系统、胃肠道和肺部恶性肿瘤患者中风险最高。恶性肿瘤患者较少使用先进治疗方法。
