Kobayashi Soichiro, Ogihara Yoshito, Yamashita Yugo, Morimoto Takeshi, Chatani Ryuki, Kaneda Kazuhisa, Nishimoto Yuji, Ikeda Nobutaka, Kobayashi Yohei, Ikeda Satoshi, Kim Kitae, Inoko Moriaki, Takase Toru, Tsuji Shuhei, Oi Maki, Takada Takuma, Otsui Kazunori, Sakamoto Jiro, Inoue Takeshi, Usami Shunsuke, Chen Po-Min, Togi Kiyonori, Koitabashi Norimichi, Hiramori Seiichi, Doi Kosuke, Mabuchi Hiroshi, Tsuyuki Yoshiaki, Murata Koichiro, Takabayashi Kensuke, Nakai Hisato, Sueta Daisuke, Shioyama Wataru, Dohke Tomohiro, Sato Toru, Nishikawa Ryusuke, Kimura Takeshi, Dohi Kaoru
Department of Cardiology and Nephrology, Mie University Graduate School of Medicine, Tsu, Japan.
Department of Cardiovascular Medicine, Graduate School of Medicine, Kyoto University, Kyoto, Japan.
Res Pract Thromb Haemost. 2025 Jul 3;9(5):102965. doi: 10.1016/j.rpth.2025.102965. eCollection 2025 Jul.
Accurate risk prediction of early mortality, particularly pulmonary embolism (PE)-related death, in patients with acute PE has become more important for selecting optimal management strategies.
To evaluate the cumulative 30-day incidence of and risk factors for all-cause and PE-related death within 30 days.
In the COMMAND VTE Registry-2, which enrolled symptomatic patients with venous thromboembolism at 31 centers in Japan, we analyzed 2035 patients with acute PE.
The cumulative 30-day incidence of all-cause and PE-related death was 6.4% and 3.4%, respectively. Independent risk factors for all-cause and PE-related death were age >80 years (hazard ratio [HR], 2.43; 95% CI, 1.45-4.08; < .001), hypoxemia (HR, 3.36; 95% CI, 1.07-10.5; = .04), tachycardia (HR, 3.78; 95% CI, 2.20-6.50; < .001), hypotension (HR, 5.43; 95% CI, 3.17-9.29; < .001), an abnormal leukocyte count (HR, 1.78; 95% CI, 1.08-2.93; = .02), and the absence of proximal deep vein thrombosis (HR, 2.58; 95% CI, 1.51-4.39; < .001). Active cancer (HR, 2.59; 95% CI, 1.75-3.82; < .001) and male sex (HR, 1.56; 95% CI, 1.07-2.28; = .02) were independent risk factors for all-cause death, but not PE-related death. Chronic heart or lung disease (HR, 1.72; 95% CI, 1.02-2.90; = .04) and right ventricular dysfunction (HR, 2.61; 95% CI, 1.02-6.70; = .046) were independent risk factors for PE-related death, but not all-cause death.
We identified several independent risk factors for PE-related death within 30 days, which differed from those of all-cause death. Risk factors specifically for PE-related death may be useful in decision-making for optimal treatment strategies for acute PE.
准确预测急性肺栓塞（PE）患者的早期死亡率，尤其是与PE相关的死亡，对于选择最佳治疗策略变得更加重要。
评估30天内全因死亡和PE相关死亡的累积发生率及危险因素。
在COMMAND VTE注册研究-2中，该研究纳入了日本31个中心有症状的静脉血栓栓塞患者，我们分析了2035例急性PE患者。
全因死亡和PE相关死亡的30天累积发生率分别为6.4%和3.4%。全因死亡和PE相关死亡的独立危险因素为年龄>80岁（风险比[HR]，2.43；95%置信区间[CI]，1.45-4.08；P<0.001）、低氧血症（HR，3.36；95%CI，1.07-10.5；P = 0.04）、心动过速（HR，3.78；95%CI，2.20-6.50；P<0.001）、低血压（HR，5.43；95%CI，3.17-9.29；P<0.001）、白细胞计数异常（HR，1.78；95%CI，1.08-2.93；P = 0.02）以及无近端深静脉血栓形成（HR，2.58；95%CI，1.51-4.39；P<0.001）。活动性癌症（HR，2.59；95%CI，1.75-3.82；P<0.001）和男性（HR，1.56；95%CI，1.07-2.28；P = 0.02）是全因死亡的独立危险因素，但不是PE相关死亡的危险因素。慢性心肺疾病（HR，1.72；95%CI，1.02-2.90；P = 0.04）和右心室功能障碍（HR，2.61；95%CI，1.02-6.70；P = 0.046）是PE相关死亡的独立危险因素，但不是全因死亡的危险因素。
我们确定了30天内与PE相关死亡的几个独立危险因素，这些因素与全因死亡的危险因素不同。专门针对PE相关死亡的危险因素可能有助于为急性PE的最佳治疗策略决策提供参考。
