The Influence Of ApoA-?on The Prognosis Of Patients With Pulmonary Embolism

Objective:The aim was to investigate the relationship between ApoA-?(Apolipoprotein A-?)which was detected at admission and all-case death within a year in patients with pulmonary embolism(PE).Methods:From Aug 1st,2013 to Dec 31 th,2018,a total of 161 patients who were hospitalized with diagnosis of PE in the Affiliated Hospital of Southwest Medical University were retrospectively screened.All of patients was confirmed by clinical features and CT(computerized tomography)pulmonary angiography or pulmonary angiography and was on first-contact and received standard treatment in our hospital.General datas(Age at admission,sex,blood pressure,survival data),underlying disease(hypertension,diabetes mellitus,coronary heart disease,cerebrovascular disease,malignant tumor,surgical history within 3 months,autoimmune diseases),laboratory test(apolipoprotein A1,apolipoprotein B,triglyceride,total cholesterol,troponin I or troponin T,brain natriuretic peptide or N-terminal brain natriuretic peptide),image examination(CT pulmonary angiography,pulmonary angiography,color doppler ultrasound of heart,color doppler ultrasound of blood vessels in lower extremities),therapeutic schedules(anticoagulation,thrombolysis,use of statins)were obtained from medical record.Survival data after discharge and medication were followed up by the outpatient ortelephone.Follow-up was started with the charge time,follow-up time was 1year,and the end-event was all-cause death.This study was approved by the ethics committee of our hospital(KY2020067).According to the optimal cut-off value of ApoA-?in predicting the all-case death in patients with pulmonary embolism by ROC(receiver operating characteristic curve),the patients were divided respectively into 2 groups which included low level group and high level group.Clinical features,classification,therapeutic schedules and blood-lipid level were compared between the two groups.The correlation between ApoA-?and classification was detected by Spearman correlation analysis.Kaplan-Meier method was applied to draw the survival curves which were compared by Log-rank test.The variables included ApoA-?which potentially influenced the prognosis were analyzed by univariate and multivariate Cox proportional hazards regression model analysis respectively.Results:82 males and 79 females were included in this research.The mean age was 65.80±13.06 years.During follow-up period,34 patients died by all-cause and the mortality within a year was 21.12%.The optimal cut-off of ApoA-? by ROC was 0.965g/l and the AUC was 0.702(95% CI:0.599-0.805),sensitivity was 0.618,specificity was 0.780,P<0.01.The high level group was ApoA-? ?0.965g/L,and the low level group was ApoA-?<0.965g/L.The numbers of dead patients of low level ApoA-?group(n=49),and high level ApoA-? group(n=112)were respectively 13,21.The mortality was 11.61%,42.86% respectively.There were no significant differences in age,basic diseases(except hypertension),classification,therapeutic schedules(except statins)and TG(triglyceride)level between 2groups(P ? 0.05).Compared to low level group,TC(total cholesterol)level,ApoB level and proportions of female,hypertension and use of statins were higher in high level group.The mortality of patients in the low level group was significantly higher than that in the high level group.ApoA-? was negatively correlated with classification(r=-0.192,P=0.015).Univariate Cox proportional hazards regression model analysis and clinical significance showed that age(clinical significance),high-risk PE,malignant tumor,the use of statins,the level of TC,ApoA-?and thrombolysis influenced the prognosis of patients(P ? 0.2).Multivariate Cox proportional hazards regression model analysis concluded that age,malignant tumor,level of ApoA-?and the use of statins influenced the prognosis of patients(P ?0.05).Log-rank test indicated that survival rate of low level group was significantly lower than high level group(P?0.05),with statistical significance.Conclusion:The decrease of ApoA-? levels is related with all-case death within a year of patients with PE.The decrease of ApoA-?level detected in admission is independent risk factors in prognosis of PE.Therefore,it can provide a sample and cheap method to evaluate the prognosis of PE.