Clinical Features And Analysis Of Influencing Factors In Patients With Acute Pulmonary Thromboembolism

Objective:To explore the clinical features and influencing factors of different risk stratification of pulmonary thromboembolism(PTE),and to provide evidence for rational clinical decision-making of PTE in different risk stratification.Methods:Patients with PTE admitted to the Southwestern Medical University Affiliated Hospital from January 2014 to December 2018 were selected.According to the risk stratification criteria of PTE presented in the 2014 European Society of Cardiology(ESC)Guidelines for the Diagnosis and Management of Acute Pulmonary Embolism,the patients were divided into two groups high/medium risk group and low risk group.The clinical data of the two groups were collected.The basic conditions,risk factors and Amino terminal B-type brain natriuretic peptide(NT-BNP),Hypersensitive troponin I(hs-TnI),D-dimer(D dimer,DD),fiber Fibrinogen degradation product(FDP),serum lipid[total cholesterol(TC),triglyceride(TG),high density lipoprotein cholesterol(HDL-c),Low density lipoprotein cholesterol(LDL-c),apolipoprotein A(ApoA),apolipoprotein B(ApoB)] levels and CHA2DS2-VASc scores were compared in two groups.Binary multivariate logistic regression analysis was used to investigate the influencing factors of PTE risk stratification,and the ROC curve of age and CHA2DS2-VASc score on PTE risk stratification prediction value was drawn.Comparison of age and CHA2DS2-VASc scores in the two groups by Z-test predicting PTE risk stratification AUC.Results:144 patients with PTE were enrolled in the Department of Cardiology(n=63,43.8%),Pulmonary and Critical Care Medicine(n=41,28.5%),and Vascular Surgery(n=19,13.2%).The number of cases of PTE increased gradually from 2014 to 2018.There was a statistically significant difference of age between the two groups(p<0.05).The difference of gender,smoking,hypertension,coronary heart disease,diabetes,cerebrovascular disease,recent surgery,long-term bedridden history,trauma/fracture,chronic cardiopulmonary disease,tumor,chronic renal insufficiency,osteoporosis,autoim-mune disease in two groups was no significant difference(P>0.05).There was significant difference in the incidence of breathing difficulty and syncope between the two groups(p<0.05).The differences among palpitations,hemoptysis,sudden death,chest pain,triad(breathing difficulty,chest pain,hemoptysis)was not statistically significant(p>0.05).The incidence of tachycardia in the two groups was statistically significant(p<0.05).There was no significant difference in the incidence of fever,shortness of breath,wet snoring or wheezing,cyanosis,second heart sound hyperthyroidism,and lower limb asymmetrical swelling between two groups(p>0.05).The difference in two groups among TC,TG,HDL-c,LDL-c,ApoA,ApoB was not statistically significant(p>0.05).The levels of FDP,hs-TnI,NT-BNP and DD in the high/medium risk group were significantly higher than those in the low risk group(p<0.05).There was no significant difference in DD positive rate between the two groups(p>0.05).There was no significant difference in the place of deep venous thromboembolism between the two groups(p>0.05).Pulmonary arterial pressure increased in 56 cases(54.9%),which was the main echocardiographic manifestation of PTE.The age and CHA2DS2-VASc scores independently affected the PTE risk stratification and the OR and 95% CI were [OR=1.118,95% CI(1.067,1.172)],[OR=11.303,95% CI(4.146,30.810)].The ROC curve of CHA2DS2-VASc score and age predictioning PTE risk stratification value was plotted.The results showed that the AUC of CHA2DS2-VASc score predicting the PET risk stratification was 0.909 [95% CI(0.849,0.950)],and the cutoff value was 2 points(The Youden index is the largest),with a sensitivity of 75% and a specificity of 89.7%.The AUC of age predicting PTE risk stratification was 0.718 [95% CI(0.626,0.780)],the cutoff value was 67 years old(Youden index is the largest),with a sensitivity of 70.1% and a specificity of 80.6%.Z test was used to compare the two AUC,with a Z value of 3.827,95% CI(0.098,0.304)(p<0.001).Conclusion: If PTE patients have clinical signs and symptoms such as dyspnea,syncope and tachycardia,clinicians should be alert to the occurrence of high/intermediate risk PTE.Detection of hs-TnI,NT-BNP,DD,and FDP levels is helpful in assessing the condition of patients with PTE.Age and CHA2DS2-VASc scores can independently affect the risk stratification of PTE,and the CHA2DS2-VASc score is of higher value for predicting high/medium risk PTE.