The Value Of Antithrombin Ⅲ In Predicting In-hospital Mortality And Optimizing Risk Stratification In Acute Pulmonary Thromboembolism

Objective: Pulmonary thromboembolism(PTE)is a clinical syndrome of pulmonary artery obstruction caused by endogenous or exogenous embolism,wcich leads to pulmonary circulation and right heart dysfunction.Antithrombin III(ATIII)is an important part of the coagulation system and plays an important role in thrombus formation and anticoagulation of heparin.This study aims to explore the value of antithrombin III in predicting in-hospital mortality and optimizing risk stratification of ATIII in PTE.Methods: A retrospective study included 204 patients with confirmed PTE which were admitted to Fujian Provincial Hospital from May 2012 to June 2019.The clinical data of the study is consist of basic conditions,morbilities,laboratory examinations(blood routine,biochemical,coagulation,cardiac function)and scoring system(APACHE II、s PESI)within 24 hours after admission.Using the maximum area under the working curve to determine the cut-off value of antithrombin III to predict hospital death,according to the occurrence of hospital death group to explore the factors affecting hospital death,and then through the resulting factors to further establish logistics regression model to explore the independent risk factors affecting hospital death,and then according to the independent risk factors to study whether there is an optimization effect on the original risk stratification.A new scoring model for risk stratification combined with antithrombin III for predicting in-hospital mortality was proposed using a nomogram.The relationship between ATIII and PTE in-hospital death was analyzed,and explored the value of ATIII to optimize risk stratification.Results: For ATIII,the area under receiver operating characteristic of predicting in-hospital mortality was 0.719,with a cut-off value of 77.7%(sensitivity 64.71%,specificity 80.21%).The patients were divided into ATIII≤77.7% group(n=48)and ATIII>77.7% group(n=126)according to the cut-off value,and we found significant statistically differences in chronic heart failure,white blood cells count,platelets count,ALT,albumin and troponin I(P < 0.05).According to the in-hospital mortality,patients were divided into the death group(n=17)and the survival group(n=187),and the differences in count of white blood cells,ATIII,d-dimeric,ALT,albumin,e GFR and APECHE II were statistically significant.Logistic regression analysis was used to find that ATIII≤77.7% and WBC were independent risk factors for in-hospital death.The risk stratification and the risk stratification combined ATIII were predicted by the area under receiver operating characteristic,and the AUC was 0.705 and 0.813,respectively,with P<0.05.A new scoring model of risk stratification combined with ATIII to predict in-hospital death was showed by nomogram.Conclusion: This study found that ATIII≤77.7% was an independent risk factor for in-hospital death,and was beneficial to optimize risk stratification.The mechanism may be related to thrombosis,right ventricular dysfunction and inflammatory response.