临床医生评估急性PE患者通常必须识别大量PE的风险,测量血流动力学不稳定性及其后果,大规模PE相关不良临床事件(PEACE)。我们在一个连续的PE队列(n=364)中调查了这些危险因素与大规模PE和PEACE的关联。
在右心劳损和收缩压≤90mg的患者中,重度PE被定义为急性中央血块(接近大叶动脉)。PEACE被定义为任何大型PE死亡或需要以下一项或多项:ACLS,辅助通气,血管加压药的使用,溶栓治疗,或者侵入性血栓切除术,在PE诊断后七天内。单变量和多变量分析评估风险因素(年龄,性别,合并症,PE引发风险,以及PE是否被认为是特发性的)和大量PE或PEACE进行。在p<0.05时确定显著性。
13%(n=48)的患者出现大面积PE,9%(n=32)有和平。在最终的多变量模型中,最近的侵入性手术(RR=7.4,p=0.007),最近住院(RR=7.3,p=0.002),特发性PE(RR=6.5,p=0.003)与大量PE相关。只有特发性PE(RR=5.7,p=0.005)与PEACE显着相关。没有合并症或其他引起PE的风险与大规模PE或PEACE有关。
作为一个带回家的信息,最近的侵入性手术,最近住院,特发性PE与大量PE有关,只有特发性PE与和平有关。同时,年龄或慢性心肺疾病等合并症似乎与大量PE或PEACE无关。
Clinicians evaluating acute PE patients often have to identify risks for massive PE, a measure of hemodynamic instability and its consequence, massive PE related adverse clinical events (PEACE). We investigated the association of these risk factors with massive PE and PEACE in a consecutive PE cohort (n = 364).
Massive PE was defined as an acute central clot (proximal to the lobar artery) in a patient with right heart strain and systolic blood pressure ≤ 90 mg. PEACE was defined as any massive PE who died or required one or more of the following: ACLS, assisted ventilation, vasopressor use, thrombolytic therapy, or invasive thrombectomy, within seven days of PE diagnosis. Univariate and multivariate analysis assessing associations between the risk factors (age, gender, comorbidities, PE provoking risks, and whether the PE was felt to be idiopathic) and massive PE or PEACE were performed. Significance was determined at p < 0.05.
Thirteen percent (n = 48) of patients presented with massive PE, and 9% (n = 32) had PEACE. In the final multivariate model, recent invasive procedure (RR = 7.4, p = 0.007), recent hospitalization (RR = 7.3, p = 0.002), and idiopathic PE (RR = 6.5, p = 0.003) were associated with massive PE. Only idiopathic PE (RR = 5.7, p = 0.005) was significantly associated with PEACE. No comorbidities or other PE provoking risks were associated with massive PE or PEACE.
As a take-home message, recent invasive procedure, recent hospitalization, and idiopathic PE were associated with massive PE, and only idiopathic PE was associated with PEACE. Simultaneously, comorbidities like age or chronic cardiopulmonary disease seem not to be associated with massive PE or PEACE.