| Objective(s):To study the basic conditions,clinical characteristics and relevant laboratory indices,treatment and adverse events of patients with pulmonary embolism complicated by hepatocellular carcinoma,to analyze the risk factors of pulmonary embolism complicated by hepatocellular carcinoma,and to provide a theoretical basis for reducing the morbidity and mortality of pulmonary embolism complicated by hepatocellular carcinoma.Method(s):The data of patients diagnosed with hepatocellular carcinoma hospitalized in our hospital from June 2015 to June 2022 were retrospectively analyzed and divided into two groups according to the nadir criteria: 1 hepatocellular carcinoma combined with pulmonary embolism group: patients with hepatocellular carcinoma confirmed by CTPA combined with pulmonary embolism were enrolled;2hepatocellular carcinoma group: patients with hepatocellular carcinoma with pulmonary embolism excluded by CTPA were enrolled as controls.The general data(including age,gender,vital signs,past medical history),days of hospitalization,clinical manifestations,laboratory indexes,treatment,comorbidities,tumor stage,whether there was co-infection,adverse events during hospitalization,etc.were collected,and whether there were statistical differences in each index between the two groups were analyzed one by one,and the indexes with differences between the groups were subjected to binary logistic regression analysis to find out patients with hepatocellular carcinoma The risk factors for complications of pulmonary embolism in patients with hepatocellular carcinoma were analyzed.Results: With reference to the inclusion and exclusion criteria,157 patients with hepatocellular carcinoma were included.Hepatocellular carcinoma combined with pulmonary embolism group: 57 patients with confirmed hepatocellular carcinoma and combined with pulmonary embolism were included as the case group;hepatocellular carcinoma group: 100 patients with confirmed hepatocellular carcinoma and pulmonary embolism by CTPA exclusion were included as the control group.1.Comparison of general data(1)The mean age of the hepatocellular carcinoma combined with pulmonary embolism group was greater than that of the hepatocellular carcinoma group(58.65 ± 12.3 vs.53.75 ± 11.38,P < 0.05),and there were no statistical differences in gender composition,respiratory rate,pulse rate,and blood pressure between the two groups(P > 0.05);(2)13 patients(22.8%)in the hepatocellular carcinoma combined with pulmonary embolism group had cough symptoms and There were 8 patients(14.0%)with dyspnea and 5 patients(5%)with cough symptoms and 1 patient(1%)with dyspnea symptoms in the control group,and the proportion of patients with respiratory symptoms in the pulmonary embolism group was higher than that in the hepatocellular carcinoma group(P < 0.05),and there was no statistical difference in the proportion of patients with chest pain and hemoptysis manifestations in the hepatocellular carcinoma combined with pulmonary embolism group and the hepatocellular carcinoma group(P > 0.05).2.Comparison of comorbidities(1)The proportion of cirrhosis in the hepatocellular carcinoma combined with pulmonary embolism group was lower than that in the hepatocellular carcinoma group(77.2% vs.92%),the proportion of pleural effusion in the hepatocellular carcinoma combined with pulmonary embolism group was higher than that in the hepatocellular carcinoma group(68.4% vs.45%),and the differences were statistically significant(P < 0.05).(2)There was no statistical difference between the two groups in terms of combined hypertension,diabetes mellitus and coronary heart disease(P>0.05),and the proportion of patients with peritoneal effusion was comparable between the two groups(71.9% vs.64%),with no statistically significant difference(P>0.05).3.Comparison of laboratory indexes(1)Compared with the hepatocellular carcinoma group,the AST and PCT values were higher in the hepatocellular carcinoma combined with pulmonary embolism group,and the differences were statistically significant(P < 0.05);IL-6,HS-CRP and DD values were higher than those in the hepatocellular carcinoma group,and the differences were statistically significant(P < 0.01);(2)The plasma ALB concentration was lower in the hepatocellular carcinoma combined with pulmonary embolism group than in the hepatocellular carcinoma group,and the differences were statistically significant(P <0.01).4.Comparison of treatment status(1)The proportion of patients in the hepatocellular carcinoma combined with pulmonary embolism group receiving systemic chemotherapy was higher than that in the hepatocellular carcinoma group(8.8% vs.1%),and the difference was statistically significant(P < 0.05);(2)there was no statistical difference between the patients in the hepatocellular carcinoma combined with pulmonary embolism group and the hepatocellular carcinoma group undergoing thoracoabdominal placement,TACE,radiofrequency ablation,hepatectomy and targeted therapy(P > 0.05).5.Comparison of adverse events and hospitalization days(1)4 patients(7%)in the hepatocellular carcinoma combined with pulmonary embolism group had adverse events during hospitalization,including 3 deaths and 1 use of vasoactive drugs,and 1case(1%)in the hepatocellular carcinoma group used vasoactive drugs,with statistically significant differences between the two groups(P < 0.05);(2)the length of hospitalization in the hepatocellular carcinoma combined with pulmonary embolism group was greater than that in the hepatocellular carcinoma group((17(12,22.5)vs 14(10,18))The difference was statistically significant(P < 0.05).6.Multifactorial analysis A binary logistic regression equation was constructed by including age,ALB,IL-6,HS-CRP,D-dimer,cirrhosis,and infection,and the results revealed that age ≥ 56 years(OR=2.241,95% CI: 1.068-4.703,P=0.033),co-infection(OR=2.285,95% CI: 1.040-5.022,P=0.040)were independent risk factors for concurrent pulmonary embolism in patients with hepatocellular carcinoma,while the combination of cirrhosis may reduce the risk of pulmonary embolism in patients with hepatocellular carcinoma(OR=0.237,95% CI: 0.077-0.735,P=0.013).7.ROC curve analysis The ROC curves were plotted for the laboratory indices that were statistically different between the two groups.The results showed that ALB,IL-6,DD,and HS-CRP had certain diagnostic value for hepatocellular carcinoma combined with pulmonary embolism,and their diagnostic efficacy and 95%confidence intervals were 0.680(0.584-0.754),0.665(0.578-0.752),0.664(0.579-0.749),and 0.628(0.537-0.718),and the sensitivity and specificity of each index for the diagnosis of hepatocellular carcinoma combined with pulmonary embolism were(0.4,0.912),(0.789,0.59),(0.86,0.44),and(0.614,0.68),respectively.Conclusion(s):1.Age ≥56 years old and co-infection are independent risk factors for pulmonary embolism in patients with hepatocellular carcinoma;the combination of cirrhosis may reduce the risk of pulmonary embolism in patients with hepatocellular carcinoma.2.patients with hepatocellular carcinoma should be alerted to the occurrence of pulmonary embolism when they have pleural effusion,cough,dyspnea,decreased ALB,increased D-dimer,PCT,IL-6,HS-CRP,AST and other indicators.3.Pulmonary embolism prolongs patients’ hospital stay and increases the risk of adverse events,and patients’ bleeding risk should be specifically assessed in clinical work and actively treated with antithrombotic therapy. |
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