Gatuz Marlon, Abu Fanne Rami, Abramov Dmitry, Mamas Mamas, Ebert Tanya, Barel Maguli, Roguin Ariel, Kobo Ofer
Hillel Yaffe Medical Center, Hadera, Israel
Internal Medicine, Lorma Medical Center, San Fernando, Central Luzon, Philippines.
BMJ Open. 2025 Sep 5;15(9):e100141. doi: 10.1136/bmjopen-2025-100141.
Pulmonary embolism (PE) is a life-threatening condition with significant morbidity and mortality. The relationship between psychiatric disorders and PE outcomes is complex and not well understood. This study aimed to determine the impact of psychiatric disorders on PE outcomes by comparing patients with and without these conditions.
Using the National Inpatient Sample database, we analysed 725 725 adult patients hospitalised with PE between 2016 and 2019. Patients were stratified based on the presence or absence of psychiatric disorders. Multivariable logistic regression models were used to examine associations between psychiatric disorders and in-hospital outcomes, adjusting for baseline differences.
Of the patients studied, 26.6% had psychiatric disorders. These patients were younger (59.80 vs 63.91 years, p<0.001), more likely to be female (60.7% vs 48.8%, p<0.001), and had higher rates of smoking and obesity but lower rates of diabetes and atrial fibrillation. After adjustment, patients with psychiatric disorders were less likely to undergo systemic thrombolysis (adjusted OR (aOR) 0.83, 95% CI: 0.80 to 0.85, p<0.001), catheter-directed interventions and placement of inferior vena cava filters (aOR 0.90, 95% CI: 0.88 to 0.92, p<0.001). These patients had lower odds of all-cause mortality (aOR 0.81, 95% CI: 0.78 to 0.84, p<0.001) and major adverse cardiovascular and cerebrovascular events (aOR 0.87, 95% CI: 0.85 to 0.89, p<0.001), with no significant difference in major bleeding risk (aOR 1.01, 95% CI: 0.98 to 1.05, p=0.553).
Psychiatric disorders are associated with distinct management and outcomes in PE. Recognising these unique characteristics may help optimise care for this population; further research is needed to clarify the best management strategies.
肺栓塞（PE）是一种危及生命的疾病，具有较高的发病率和死亡率。精神障碍与PE预后之间的关系复杂，尚未得到充分理解。本研究旨在通过比较患有和未患有这些疾病的患者，确定精神障碍对PE预后的影响。
使用国家住院患者样本数据库，我们分析了2016年至2019年间因PE住院的725725名成年患者。根据是否存在精神障碍对患者进行分层。使用多变量逻辑回归模型来检验精神障碍与住院结局之间的关联，并对基线差异进行调整。
在研究的患者中，26.6%患有精神障碍。这些患者更年轻（59.80岁对63.91岁，p<0.001），女性比例更高（60.7%对48.8%，p<0.001），吸烟和肥胖率更高，但糖尿病和心房颤动率更低。调整后，患有精神障碍的患者接受全身溶栓治疗的可能性较小（调整后的比值比[aOR]为0.83，95%置信区间[CI]：0.80至0.85，p<0.001），导管定向干预和下腔静脉滤器置入的可能性较小（aOR为0.90，95%CI：0.88至0.92，p<0.001）。这些患者全因死亡率（aOR为0.81，95%CI：0.78至0.84，p<0.001）和主要不良心血管和脑血管事件（aOR为0.87，95%CI：0.85至0.89，p<0.001）的几率较低，主要出血风险无显著差异（aOR为1.01，95%CI：0.98至1.05，p=0.553）。
精神障碍与PE的不同治疗和结局相关。认识到这些独特特征可能有助于优化对这一人群的护理；需要进一步研究以阐明最佳管理策略。
