非高风险肺栓塞患者不良预后的风险因素

V. Tseluyko, R. Askerov
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摘要

目的--确定影响非高风险肺栓塞(PE)患者住院死亡率的因素。我们分析了 2017 年 1 月 1 日至 2023 年 1 月 1 日期间在哈尔科夫市第八临床医院住院的 635 名诊断为 "肺栓塞(PE)"的患者(pts)的医疗卡。纳入标准为经肺动脉多螺旋计算机断层扫描(CTPA)和/或尸检证实的 "肺栓塞 "诊断。在 635 例患者中,530 例为非高风险患者。非高风险患者分为两组:第一组--病情好转出院的患者(479 - 90.4%),第二组--住院期间死亡的患者(51 - 9.6%)。对临床、病理、生化、仪器参数和死亡率进行了测量,并进行了统计分析。多变量向量分析确定的独立因素与非高危 PE 患者的院内死亡率相关:心房颤动(AF)、肥胖、静脉血栓栓塞症(VTE)病史;血氧饱和度(SpO2)、收缩压(SBP)水平较低;平均肺动脉压(PAP)较高;心率(HR)≥ 110 次/分。还进行了 ROC 分析,以确定与非高危 PE 患者院内死亡率相关的因素阈值:SBP ≤ 124 mm Hg、HR ≥ 110 bts/min、平均 PAP ≥ 54 mm Hg。心房颤动对院内死亡率的影响用 Kaplan - Meier 表示。有几个因素与非高危 PE 患者的院内死亡率增加有关:年龄˃ 54 岁、SBP ≤ 124 mm Hg、VTE 病史、肥胖、房颤;SpO2 ≤ 87 %、平均 PAP ≥ 54 mm Hg、HR ≥ 110 bpm。
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Risk factors for adverse outcome among patients with non-high risk pulmonary embolism
The aim – to determine the factors which have influence on hospital mortality in patients with non-high risk pulmonary embolism (PE).Materials and methods. We analysed 635 medical cards of patients (pts) with diagnosis «Pulmonary Embolism (PE)» who were hospitalised to Kharkiv City Clinical Hospital No.8. during 01.01.2017 – 01.01.2023. The inclusion criteria was diagnosis «PE» verified by multispiral computed tomography angiography (CTPA) of pulmonary arteries and/or by autopsy. Among the 635 pts, 530 were non-high risk. The non-high risk pts were divided into 2 groups: Group I – pts who were discharged with improved status (479 – 90.4 %), Group II – pts who died during hospitalisation (51 – 9.6 %). Clinical, anamnestic, biochemical, instrumental parameters, mortality rates were measured; statistical analysis was done.Results and discussion. The independent factors identified by multivariate vector analysis were associated with in-hospital mortality in pts with non-high risk PE: atrial fibrillation (AF), obesity, history of venous thromboembolism (VTE); lower levels of blood oxygen saturation (SpO2), systolic blood pressure (SBP); higher mean pulmonary arterial pressure (PAP); heart rate (HR) ≥ 110 beats/min. An ROC analysis was also performed to determine the thresholds of factors associated with in-hospital mortality in patients with non-high risk PE: SBP ≤ 124 mm Hg, HR ≥ 110 bts/min, mean PAP ≥ 54 mm Hg. Impact of AF on in-hospital mortality was depicted by Kaplan – Meier.Conclusions. Several factors were associated with increased in-hospital mortality in patients with non-high risk PE: age ˃ 54 years, SBP ≤ 124 mm Hg, history of VTE, obesity, AF; SpO2 ≤ 87 %, mean PAP ≥ 54 mm Hg, HR ≥ 110 bpm.
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Risk factors for adverse outcome among patients with non-high risk pulmonary embolism Статеві та клініко-інструментальні паралелі рівнів ліпопротеїн(а) в пацієнтів з дуже високим серцево-судинним ризиком Вибір блокатора ренін-ангіотензин-альдостеронової системи для лікування серцевої недостатності при гострому міокардиті Характеристика пацієнтів з ішемічною хворобою серця та стабільною стенокардією в Україні, оцінка підходів до їх лікування за даними багатоцентрового дослідження GO-OD Порівняльний аналіз субклінічного тривожно-депресивного синдрому в пацієнтів із гострим інфарктом міокарда з елевацією сегмента ST до та під час активних бойових дій у Харківській області
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