Influence Of Anemia On Short-term Prognosis In Patients With Acute Pulmonary Embolism

Objective: To evaluate the influence of anemia on short-term prognosis in patients with acute pulmonary embolism.Methods: From August 2008 to February 2014, a total of 204 patients with acute pulmonary artery embolism conformed by 64 Slice Multi-Detector Computed Tomography(MDCT) were enrolled in this study. Exclusion criteria: a history of blood transfusion within 2 weeks; serious insufficiency of hepatic and renal function, a history of hemodialysis within 3 months; chronic active hemorrhage; systemic immune system diseases and connective tissue disease; acute coronary syndrome and heart failure. Hemoglobin was measured by the blood cell analyzer(BECKMAM COULTET LH750/SYSMEX 2100D/SYSMEX 8001) within 2h after admission. Anemia was defined as a hemoglobin(Hb) concentration of <110 g/l in females, and <120 g/l in males. Patients were divided into two groups according to this criterion: anemia group [male(Hb) <120g/L, female(Hb) <110g/L, n=52] and non-anemia group [male(Hb) ≥120g/L(Hb), female(Hb)≥110g/L,n=152]. Anemia group according to hemoglobin level was divided into three groups,mild anemia group [(Hb)90≥ g/L,n=28]、moderate anemia group[(Hb)60 g/L≤Hb<90 g/L,n=17] and severe anemia group [(Hb)<60 g/L,n=7].Ultrasound cardiogram and artery blood gas were measured within 2 hours on admission at rest to observe right ventricular size,three tricuspid regurgitation velocity increase, right ventricular wall motion, the alveolar arterial oxygen pressure difference [P(A-a) O2], partial pressure of arterial carbon dioxide(Pa CO2), arterial partial pressure of oxygen(Pa O2). Blood gas, NT-pro BNP, Tn I, D-D dimer,H-FABP and UCG were compared to assess the incidence of respiratory failure, right heart failure, shock, death and other adverse events between the fuor groups. All calculations were analyzed with the aid of SPSS statistical software(version 19.0).The continuous variables were expressed as means with standard deviation for normally distributed variables while as median with interquartile range for non-normally distributed variables. The categorical variables were presented as percentages. Continuous variables were compared using the Student ANOVA and Non-parametric tests for normally distributed value and the Mann-Whitney U test for non-normally distributed. Proportions were compared using the Chi-square test, and if the expected frequency was<5, the Fisher exact test would be applied.Results:1 There was no significant difference between the four groups about mean age, gender distribution, cardiac function, hypertension, diabetes, COPD, renal function and medications used(all P value >0.05).2 There was significant difference about right ventricular wall motion, right ventricular diameter and three tricuspid regurgitation velocity increased in non-anemia group compared with anemia group(P<0.05). Significant differences were found about P(A-a)O2(77.68 mm Hg±36.60 mm Hgvs. was significantly increased in anemia group compared with non-anemia group(P< 0.05),and was gradually increased.Conclusions: Hemoglobin levels is a useul clinical indicator for evaluating right cardiac function, with the decrease of hemoglobin levels, clinical adverse event rates showed an increasing trend, risk stratification in patients with acute pulmonary artery embolism,which is a risk factor of short-term mortality rate in patients with acute pulmonary artery embolism.