Dissection Of The Epidemiological Investigation And Analysis Of Relevant Assessment Models About Pulmonary Thromboembolism

BackgroundPulmonary thromboembolism is referred as a condition in which a blood clot from the venous system or the right heart blocks the pulmonary arteries.Due to urgent onset and high mortality,it’s significant for us to identify pulmonary thromboembolism and distinguish high-risk population as soon as possible in order to reduce the mortality.However,the clinical characteristics of Pulmonary thromboembolism are often atypical and the positive value of the scale used to evaluate the high-risk population of pulmonary thromboembolism is limited.ObjectiveTo make clinical workers to better understand PTE and provide certain reference to improve the related models,this study retrospectively analyzed information of patients with pulmonary thromboembolism,including clinical characteristics and related assessment models.MethodsWe collected the information of patients with pulmonary thromboembolism diagnosed by imaging and treated in Ruijin hospital affiliated to Shanghai Jiaotong university school of medicine,from January 1,2012 to December 31,2018.Basic data,risk factors,laboratory examination and imaging findings were conducted to be analyzed.Wells,Revised Geneva,Padua and Caprini models were used to evaluate each patient and be analyzed.ResultsIn total,165 patients were included in the study,being divided into provoked PTE(67.9%)and unprovoked PTE(32.1%).The major provoked factor is immobility(41.2%).When the age was less than or equal to 50 years old,the proportion of age less than or equal to 50 years old in unprovoked PTE was more than that of provoked PTE(17.0% vs.9.8%,24.5% vs.8.9%),especially in the 41~50 years old group(P=0.042).There was no significant difference in BMI between the provoked and unprovoked PTE.Cardiovascular disease is the most common comorbidity of PTE.Dyspnea was the most common clinical symptom(47.9%).There was a statistically significant difference in age-adjusted d-dimer between the provoked and unprovoked PTE(78.6% vs.52.8%,P=0.001).In univariate analysis of 10-day all-cause mortality,systolic blood pressure <100mm Hg,blood oxygen saturation <90%,syncope and s PESI were statistically different.In univariate analysis of 30-day all-cause mortality,systolic blood pressure <100mm Hg,blood oxygen saturation <90%,s PESI and Revised Geneva 3 were statistically different.The results of the models showed that there were 81(49.1%)patients in the Wells high-probability group,and all scale items between the high-probability and low-probability groups were statistically different significantly.75(45.5%)patients was labeled as high-probability group,which assessed by Revised Geneva model.The item,Previous VTE,was no statistical difference between the high and low-probability groups assessed by the Revised Geneva model.Eight-five(51.5%)patients were high-risk by the Padua model.Five risk factors in the Padua prediction score,such as active cancer,age more than 70 yrs,obesity,acute infection / rheumatologic disorder and ongoing hormonal treatment,were not different significantly between the low-risk group and high-risk group.Ninety-three(56.4%)patients were labeled as high-risk by the Caprini model.Twelve risk factors in the Caprini model,such as swollen legs,serious lung disease,medical patient at bed rest,major open surgery,laparoscopic surgery,malignancy,confined to bed,central venous access,history of VTE,lupus anticoagulant,stroke,hip,pelvis,or leg fracture,were different significantly between the low-risk group and high-risk group.Conclusions1、In this study,the mean age of 165 patients with pulmonary thromboembolism was(61.59±15.76)years.The most common symptom was dyspnea,and the most common comorbidity was cardiovascular disease.86.7% showed pulmonary arterial hypertension.2、Unprovoked PTE is younger than provoked PTE,and gender is no difference between two groups.3、The proportion of positive age-adjusted D-dimer in provoked PTE was higher than that in unprovoked PTE.4、Adjusting BMI threshold may be helpful to improve Padua and Caprini scores,which should be determined by prospective studies in Chinese population.5、Syncope would increase the risk of 10-day all-cause mortality,and Revised Geneva more than 2 points would improve 30-day all-cause mortality.