Analysis Of Factors Related To Prognosis Of Acute Pulmonary Embolism

ObjectiveA retrospective analysis was performed to analyze the clinical data of inpatients with Acute Pulmonary Embolism,to understand the prognosis of patients with Acute PE and explore the factors affecting the prognosis of patients with Acute PE and its value in clinical application.MethodWe collected the clinical data of patients with Acute PE admitted to the Shaanx-i Provincial people’s Hospital from July 1,2017 to July 1,2018,All patients with Acu tePE who met the inclusion and exclusion criteria of the study subjects.The prognosi-s of the patients at the 3 months after admission was used as an observation index.The clinical outcomes of discharged patients were followed up by telephone and the outpatient-related data.According to the results of different clinical outcomes after 3months,patients were divided into a good prognosis group and a poor prognosis gro-up（death,fatal bleeding event,reembolism）.Statistical analysis of clinical data of t-wo groups of patients were performed using SPSS software,version 20.0,to compare general clinical data,risk factors,comorbidities,clinical symptoms and signs,laborator findings,auxiliary examination results,treatment between the two groups.Numerical va-riables meeted normal distribution were expressed as means（standard deviations）,Th-e T-test was used for comparison between groups,otherwise Mann-Whitney U test w-ere used.Theχ² test was used for the count data expressed as percentage（%）,P<0.05was considered statistically significant.The statistically significant factors of univariate analysis were used for binary logistic regression analysis,the OR and 95%CI were c-alculated at the same time.The significance level wasα=0.05,and the independent ris-k factors and protective factors of prognosis in patients with Acute PE were obtain-d.Results1.A total of 256 cases of discharged patients diagnosed with"pulmonary embolism"or"pulmonary thromboembolism"were included.According to the inclusion and exclusion criteria of the study,113 cases were excluded and 143 cases were eventually included.108patients（75.5%）had a good prognosis including 55（38.5%）males and 53（37.1%）females,The average age was 63.89±12.762 years and the average hospitalization time was14.21±8.717 days.35 patients（24.5%）had a poor prognosis including 15（10.5%）males and 20（14%）females,The average age was 72.91±14.126 years and the average hospitalization time was 13.94±12.730 days.Among them,33 died,the mortality rate was23.1%,2 cases of fatal bleeding（1 case of brain stem hemorrhage,1 case of gastrointestinal bleeding）,and 1 case of re-embolization occurred.2.Univariate analysis showed there was a significant difference between the two groups in age,deep venous thrombosis,mechanical ventilation,acute myocardial infarction,chronic cardiac failure,neurological disease,activemalignancy,hypotension,increased respiratory rate,increased pulse rate,WBC,HB,NLR,RDW,CRE,cTn-I,BNP,PCT,P（A-a）O₂,normal electrocardiogram,Abnormalelectrocardiogram(sinustachycardia,STsegment change,S_IQ_IIIT_III),Echocardiography（rightventriculardysfunction,rightventricular enlargement）,the therepy of simple LMWH and LMWH combined new oral anticoagulant（P<0.05）.3.Multivariate analysis showed RDW（OR:1.392,95%CI:1.051¹.834）,S_IQ_IIIT_III（OR:35.778,95%CI:3.168⁴04.073）,right ventricular dysfunction（OR:3.651,95%CI:6.530¹89.587）are independent risk factors for poor prognosis in patients with Acute PE;LMWH combined with warfarin therepy（OR:0.105,95%CI:0.029⁰.375）,LMWH combined with new oral anticoagulant therepy（OR:0.029,95%CI:0.001⁰.077）are protective factors of prognosis in patients with Acute PE.Conclusions1.The prognosis of Acute PE is associated with age,deep venous thrombosis,mechanical ventilation,chronic heart failure,nervous system disease,active malignancy,hypotension,increased respiratory rate,pulse increase,WBC,HB,NLR,RDW,CRE,cTn-I,BNP,PCT,P（A-a）O₂,normal electrocardiogram,Abnormal electrocardiogram(sinus tachycardia,ST segmental changes,S_IQ_IIIT_III),Echocardiography（right ventricular dysfunction,right ventricular enlargement）,simple LMWH therapy,LMWH combined with new oral anticoagulant therapy.2.RDW,S_IQ_IIIT_III,and right ventricular dysfunction are independent risk factors of poor prognosis in patients with Acute PE.3.LMWH combined with warfarin therapy,LMWH combined with new oral anticoagul-ant therapy are protective factors of prognosis in patients with Acute PE.