Department of Vascular Medicine, Amsterdam Cardiovascular Sciences, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands; Amsterdam Cardiovascular Sciences, Pulmonary hypertension & Thrombosis, Amsterdam, the Netherlands; Department of Internal Medicine, Tergooi MC, Hilversum, the Netherlands.
Department of Medicine - Thrombosis and Hemostasis, Leiden University Medical Center, Leiden, the Netherlands.
Thromb Res. 2024 Jan;233:181-188. doi: 10.1016/j.thromres.2023.12.003. Epub 2023 Dec 13.
It is unclear how often cancer patients with acute pulmonary embolism (PE) are discharged from the emergency department (ED) or outpatient clinic and whether direct discharge is safe. We assessed treatment setting and early safety outcomes in cancer patients with acute symptomatic and incidental PE.
Cancer patients diagnosed with PE at the ED or outpatient clinic between August 2017 and May 2021 were included in Four Cities VTE Cancer, a Dutch multicenter retrospective cohort study. The main outcome was direct discharge versus hospitalization. Safety outcomes were cumulative 14-day mortality and PE-related readmission incidences.
We included 602 patients (median age 71 years; 49.5 % female) of whom 285 (47.3 %) were discharged directly and 317 (52.7 %) were hospitalized. The cumulative 14-day mortality incidence was 0.7 % (95 % CI, 0.1-2.4 %) in patients discharged directly and 9.0 % (95 % CI, 6.2-12.5 %) in those hospitalized. The cumulative 14-day PE-related readmission incidence was 1.8 % (95 % CI, 0.7-3.9 %) and 1.4 % (95 % CI, 0.5-3.3 %) in directly discharged and hospitalized patients, respectively. Of the 220 patients with incidental PE, 180 (81.8 %) were discharged directly compared to 105 of 382 (27.5 %) patients with symptomatic PE (P < 0.001). Mortality and readmission incidences in symptomatic and incidental PE were consistent with the main analysis.
About 28 % and 82 % of cancer patients with symptomatic or incidental PE, respectively, were discharged directly, with low 14-day mortality and PE-related readmission incidences. These data underline the need for PE risk stratification in oncological populations and suggest that clinicians successfully identify a proportion of patients in whom direct discharge is safe.
目前尚不清楚有多少伴有急性肺栓塞（PE）的癌症患者从急诊部（ED）或门诊出院，以及直接出院是否安全。我们评估了伴有急性症状性和偶发性 PE 的癌症患者的治疗场所和早期安全性结局。
本研究纳入了 2017 年 8 月至 2021 年 5 月期间在 ED 或门诊被诊断为 PE 的癌症患者，这是一项荷兰多中心回顾性队列研究。主要结局为直接出院与住院。安全性结局为 14 天内累计死亡率和与 PE 相关的再入院发生率。
共纳入 602 例患者（中位年龄 71 岁；49.5%为女性），其中 285 例（47.3%）直接出院，317 例（52.7%）住院。直接出院患者的 14 天内累计死亡率为 0.7%（95%CI，0.1-2.4%），住院患者为 9.0%（95%CI，6.2-12.5%）。直接出院患者的 14 天内与 PE 相关的再入院发生率为 1.8%（95%CI，0.7-3.9%），住院患者为 1.4%（95%CI，0.5-3.3%）。在 220 例偶发性 PE 患者中，180 例（81.8%）直接出院，而在 382 例症状性 PE 患者中，仅有 105 例（27.5%）直接出院（P<0.001）。症状性和偶发性 PE 的死亡率和再入院率与主要分析一致。
分别有 28%和 82%的伴有症状性或偶发性 PE 的癌症患者直接出院，其 14 天死亡率和与 PE 相关的再入院率较低。这些数据强调了在肿瘤人群中进行 PE 风险分层的必要性，并表明临床医生成功识别出了一部分直接出院安全的患者。
