Effect Of Renal Impairment On The Prognosis Of Acute Pulmonary Embolism

Objectives To explore the predictive value of renal function injury in the prognosis of acute pulmonary embolism(APE),and thus to provide a basis for the prognosis evaluation of APE.Methods Our study subjects were constrained to be firstly diagnosed with APE and age over 18 in the affiliated hospitals of North China University of Technology,Tangshan Workers' Hospital,and Kailuan General Hospital from January 1,2011 to December 31,2015.The ascertainment of APE is based on the "Guide to the diagnosis and treatment of acute pulmonary embolism" published by the European Society of Cardiology in 2014.By referring to medical records,general characteristics,clinical symptoms and signs,arterial blood gas parameters,imaging examination data,treatment status,concomitant diseases,and biochemical markers(creatinine,NT-Pro BNP,c Tn I)of included samples were collected.In this study,renal function was evaluated using a simplified formula of Chinese modified version of MDRD.The patient's prognostic information was gathered by telephone follow-up,including death,shock,cardiopulmonary resuscitation,mechanical ventilation,reoccurrence of APE.According to the outcomes,the prognosis was divided into two groups: good prognosis and poor prognosis group,respectively.The restrictive cubic spline was utilized to elucidate the dose-response relationship between renal function and outcome events,afterwords,a reasonable group approach was proposed on the basis of dose-response relationship.After finalizing the block of group,the Kaplan-Meier method was used to plot the cumulative survival rate.The log-rank test was used to compare the survival curves.Cox proportional hazards regression model was used to analyze the effect of renal impairment on poor prognosis of APE patients.Results 1 A total of 432 patients with APE were enrolled in the analysis,of which the men and women were 219(50.69%)and 213(49.31%),respectively.The patients were divided into three groups according to the dose-response relationship between GFR and poor prognosis of patients with APE: normal function group(GFR>90 m L/min),mild renal impairment group(60 m L/min <GFR <90 m L/min),moderate renal impairment group(GFR ?60 m L/min).The number of cases in each group was 287 cases(66.44%),110 cases(25.46%),and 35 cases(8.10%),respectively.After follow-up,142 cases followed by a poor prognosis.There were 59 deaths,27 shocks,3 cardiopulmonary resuscitation,9 mechanical ventilations,and 44 relapses.2 Among 432 patients with APE,the higher the rate of impaired renal function,the higher the proportion of poor prognosis(P for trend <0.001).With the worsening of renal function impairment,the proportion of poor prognosis is increased(P for trend <0.05).3 The median survival time in the normal renal function group was 57.96 months,the median survival time was 51.63 months in the mild renal injury group,and the median survival time was 47.21 months in the moderate renal function impairment group;moderate renal function was observed.The survival rate of the injured group was lower compared with the normal renal function group and the mild renal injury group(log-rank test,P=0.011).4 Adjusting for age,BMI,gender,pulse,systolic blood pressure,smoking,alcohol consumption,change of mental state,arterial oxygen saturation,tumor,chronic heart and lung disease,treatment,medication compliance,In comparision with the normal group,the patients in mild to moderate renal dysfunction group occur the adverse outcomes of poor prognosis with the effect size of HR(95%CI)being 2.97(1.26,6.99)and 3.65(1.31,10.14),respectively.Conclusions Renal function impairment is a potential risk factor for poor prognosis in APE patients,and with worsening renal function impairment,the prognosis of APE patients is worse.