Zhang Wanling, Paudel Dhirendra, Shi Rui, Yang Junwei, Liu Jingwen, Jia Yanbin
Department of Psychiatry, First Affiliated Hospital of Jinan University, Guangzhou, Guangdong, China.
Department of Psychiatry, Sleep Medicine Center, Nanfang Hospital, Southern Medical University, Guangzhou, Guangdong, China.
Front Psychiatry. 2024 Aug 16;15:1449963. doi: 10.3389/fpsyt.2024.1449963. eCollection 2024.
Pulmonary embolism (PE) is a serious and potentially life-threatening condition that requires prompt diagnosis and treatment. Identifying risk factors and diagnostic markers can aid in the early detection and management of this condition.
This case-control study examined 10,077 patients admitted to Shenzhen Kangning Hospital's psychiatry facility in 2020. Among these, 65 patients were diagnosed with PE, including 50 new cases. After survival sampling for controls and age-and-gender matching, the study included 41 new PE cases and 41 age-and-gender-matched controls. Data on demographics, comorbidities, and medication use were extracted from electronic records. Conditional logistic regression analyses were performed to determine the association between each predictor and PE risk. Additionally, the sensitivity and specificity of the d-dimer diagnostic tool were assessed.
In univariable conditional logistic regression, active alcoholism was associated with a higher PE risk (OR=3.675, 95% CI 1.02-13.14, P=0.046). A history of physical restraint (OR=4.33, 95% CI 1.24-15.21, P=0.022) and chemical restraint (OR 4.67, 95% CI 1.34-16.24, p=0.015) also increased PE risk, as did benzodiazepine use (OR=3.33, 95% CI 1.34-8.30, P=0.010). Conversely, psychotropic medication before admission was associated with a lower risk of PE (OR=0.07, 95% CI 0.01-0.59, P=0.013). Stepwise multivariable forward conditional regression identified two subsets of psychiatric patients at higher risk of PE: new psychiatric cases without medication at admission who were chemically restrained, and cases without medication at admission who were started on antipsychotics and benzodiazepines. The d-dimer diagnostic tool, with an optimal threshold of 570 ng/ml determined by the Youden index (J statistic of 0.6098), showed a sensitivity of 73.17% and specificity of 87.80% for detecting PE, with an AUC of 0.833 (95% CI: 0.735-0.906).
Our findings suggest that a history of restraint, alcoholism, and the use of antipsychotics and benzodiazepines are important predictors of PE in psychiatric inpatients. Conversely, psychotropic medications at admission may be linked to a lower PE risk. The d-dimer diagnostic tool shows good value for screening PE in psychiatric inpatients. These predictors and diagnostic markers could help clinicians identify high-risk patients and implement appropriate prevention strategies.
肺栓塞（PE）是一种严重且可能危及生命的疾病，需要及时诊断和治疗。识别风险因素和诊断标志物有助于早期发现和管理这种疾病。
本病例对照研究对2020年入住深圳康宁医院精神科的10077例患者进行了检查。其中，65例患者被诊断为肺栓塞，包括50例新发病例。在对对照组进行生存抽样并进行年龄和性别匹配后，该研究纳入了41例新的肺栓塞病例和41例年龄和性别匹配的对照组。从电子记录中提取了人口统计学、合并症和用药情况的数据。进行条件逻辑回归分析以确定每个预测因素与肺栓塞风险之间的关联。此外，还评估了D-二聚体诊断工具的敏感性和特异性。
在单变量条件逻辑回归中，酗酒与较高的肺栓塞风险相关（OR = 3.675，95% CI 1.02 - 13.14，P = 0.046）。身体约束史（OR = 4.33，95% CI 1.24 - 15.21，P = 0.022）和化学约束史（OR = 4.67，95% CI 1.34 - 16.24，P = 0.015）也增加了肺栓塞风险，使用苯二氮䓬类药物同样如此（OR = 3.33，95% CI 1.34 - 8.30，P = 0.010）。相反，入院前使用精神药物与较低的肺栓塞风险相关（OR = 0.07，95% CI 0.01 - 0.59，P = 0.013）。逐步多变量向前条件回归确定了两组肺栓塞风险较高的精神科患者：入院时未用药且接受化学约束的新精神科病例，以及入院时未用药且开始使用抗精神病药物和苯二氮䓬类药物的病例。通过约登指数（J统计量为0.6098）确定的最佳阈值为570 ng/ml的D-二聚体诊断工具，检测肺栓塞的敏感性为73.17%，特异性为87.80%，AUC为0.833（95% CI：0.735 - 0.906）。
我们的研究结果表明，约束史、酗酒以及使用抗精神病药物和苯二氮䓬类药物是精神科住院患者肺栓塞的重要预测因素。相反，入院时使用精神药物可能与较低的肺栓塞风险相关。D-二聚体诊断工具在筛查精神科住院患者的肺栓塞方面具有良好价值。这些预测因素和诊断标志物可以帮助临床医生识别高危患者并实施适当的预防策略。
