Prognostic Risk Factors of 30-Day Death in Traumatic Lower Limb Fracture Patients with Acute Pulmonary Embolism: A Single-Center Retrospective Study.

IF 2.1 4区 医学 Q3 RESPIRATORY SYSTEM Canadian respiratory journal Pub Date : 2023-01-01 DOI:10.1155/2023/8246730
Huanhuan Li, Yijun Yu, Yuting Wang, Qian Zhang, Ye Gu
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Abstract

Background: To explore the prognostic risk factors of 30-day death in patients with traumatic lower limb fracture (TLLF) complicated with acute pulmonary embolism (APE).

Methods: 295 consecutive TLLF patients diagnosed as APE according to pulmonary artery CT angiography, hospitalized in our hospital from January 2017 to December 2021, were included in this study. Patients were divided into nonsurvival group and survival group according to 30-day follow-up results. After adjusting age, sex, and all the clinical variables with P values of <0.2 with backward stepwise method (likelihood ratio), multivariate Cox regression analysis was used to analyze risk factors of 30 days all-cause death in TLLF patients with APE. The area under curve (AUC) calculated by receiver operating characteristic curve (ROC) and the incremental model were used to determine the prognostic potential of identified risk factors.

Results: 29 patients died during 30-day follow-up. Simplified pulmonary embolism severity index (sPESI) score ≥1 (P < 0.05), Wells score ≥7 (P < 0.01), and pulmonary hypertension (P < 0.01) were associated with higher risk, while anticoagulant therapy (P < 0.01) was associated with lower risk of all-cause death during 30 days follow-up in APE patients. Compared with sPESI score, Wells score plus pulmonary hypertension produced better predictive efficacy. Prognostic value of sPESI score could be enhanced by adding Wells score, pulmonary hypertension, and anticoagulant therapy to the predicting models.

Conclusions: Wells score ≥7 and pulmonary hypertension are independent predictive risk factors of 30-day all-cause death in TLLF patients with APE.

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创伤性下肢骨折合并急性肺栓塞患者30天死亡的预后危险因素:一项单中心回顾性研究
背景:探讨外伤性下肢骨折(TLLF)并发急性肺栓塞(APE)患者30天死亡的预后危险因素。方法:选取2017年1月至2021年12月在我院住院的经肺动脉CT血管造影诊断为APE的连续295例TLLF患者。根据30 d随访结果将患者分为非生存组和生存组。在调整年龄、性别及所有临床变量P值后,结果:29例患者在随访30天死亡。简化肺栓塞严重程度指数(sPESI)评分≥1 (P < 0.05)、Wells评分≥7 (P < 0.01)和肺动脉高压(P < 0.01)与APE患者30 d随访期间全因死亡风险增高相关,抗凝治疗(P < 0.01)与全因死亡风险降低相关。与sPESI评分相比,Wells评分加肺动脉高压的预测效果更好。在预测模型中加入Wells评分、肺动脉高压、抗凝治疗等因素可提高sPESI评分的预测价值。结论:Wells评分≥7和肺动脉高压是TLLF合并APE患者30天全因死亡的独立预测危险因素。
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来源期刊
Canadian respiratory journal
Canadian respiratory journal 医学-呼吸系统
CiteScore
4.20
自引率
0.00%
发文量
61
审稿时长
6-12 weeks
期刊介绍: Canadian Respiratory Journal is a peer-reviewed, Open Access journal that aims to provide a multidisciplinary forum for research in all areas of respiratory medicine. The journal publishes original research articles, review articles, and clinical studies related to asthma, allergy, COPD, non-invasive ventilation, therapeutic intervention, lung cancer, airway and lung infections, as well as any other respiratory diseases.
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