Risk Factors Of Death In 333 Patients With Acute Pulmonary Embolism

Objective:Investigation of the related risk factors of death events in patients with acute pulmonary embolism(APE)will help to conduct a prognosis assessment in these patients,and early identify and treat the high-risk patients to reduce mortality.Methods:A retrospective analysis of 333 patients in the First Clinical Hospital of Jilin University from January 1,2014 to October 31,2019,who were diagnosed as APE and were hospitalized for the first time by CT pulmonary angiography(Computed Tomography pulmonary angiography,CTPA),collected information as age,gender,length of hospital stay,triggers,past medical history,first clinical symptoms,laboratory data,imaging data,sPESI score and disease events.The patients were followed up until June 30,2020.According to the follow-up results,the patients were divided into survival group and death group.The average follow-up was 678.47 days,and the follow-up deadline was June 30,2020.All data were analyzed using SPSS 25.0 software.The rate of counting data(percentage)was expressed.Pearson chi-square test or Fisher’s exact probability method was used for comparison between the two groups.The Kolmogorov-Smirnov method was used to test the normality of the measurement data.The data conforming to normal distribution were expressed as mean ± standard deviation(±s).The independent sample t test was used for the comparison between the two groups.Data that did not conform to the normal distribution were represented by the median(inter-quartile range)M(Q25,Q75),and Mann-Whitney U test was used for comparison between two groups.When the multivariate binary logistic stepwise regression analysis was used,only variables with p<0.05 were included in the univariate analysis,and odds ratio(OR)and 95% confidence interval(CI)were calculated.For the selected continuous risk factors,draw the receiver operating characteristic(ROC)curve,to calculate the area under the curve(AUC),sensitivity,specificity and Youden index.The variable value corresponding to the maximum Youden index is the best cutoff value.Combined with the follow-up time,the Kaplan-Meier survival curve was further drawn,and the Log-rank test and Mantle-Haenszel test were used.Combined with the follow-up time,the Kaplan Meier survival curve was further drawn and univariate Cox regression analysis was used to screen out the factors with p< 0.05 in univariate Cox regression analysis and put them into the multivariate Cox regression model.With forward stepwise regression method,the factors with p< 0.05 can be finally confirmed as the independent risk factors for death in patients with APE.Results:1.A total of 333 patients with APE were enrolled in this study.216 patients(64.86%)in the survival group were 64.36±14.25 years old;117 patients(35.14%)in the death group were 70.23±13.27 years old.The age of the death group was higher than that of the survival group(p<0.05).2.The univariate analysis showed that compared with the survival group,the incidence of syncope and active tumor in the death group was higher(p<0.05),and the incidence of cough and sputum was lower(p<0.05);albumin in the death group,e GFR,and arterial partial pressure of oxygen were significantly lower than the survival group(p<0.05),while the percentage of neutrophils,creatinine,NT-proBNP,troponin T,Ddimer,sPESI score,sPESI score ≥ 1 ratio are significantly higher than the survival group(p<0.05).3.After multivariate logistics regression analysis,we found that age,active tumor,NT-proBNP and D-dimer were statistically significant.The risk of death of APE increased by 3.8%(95% CI: 1.017-1.060,p< 0.05)with age increasing by 1 year;the risk of death of patients with active malignant tumor increased by 4.738 times(95% CI: 1.734-18.986,p< 0.05)compared with patients without active malignant tumor;the risk of death of APE increased by 0.2% with NT-proBNP increasing by 1 unit(95% CI: 0.999-1.004,p< 0.05),and for each unit of D-dimer increased,the risk of death of APE increased by 12.5%(95% CI: 1.077-1.175,p< 0.05).4.After plotting age,NT-proBNP,D-dimer and troponin T receiver operating curve(ROC),it can be seen that the AUC value of age is 0.626,and when the best cutoff value is 73.5,the sensitivity is 73.1 %,the specificity is 49.6%;the AUC value of troponin T is 0.609,when the best cut-off value is 0.012,the sensitivity is 90.6%,the specificity is 28.2%;the AUC value of NT-proBNP is 0.581,When the best cut-off value is 675,the sensitivity is 65.0% and the specificity is 50.0%;the AUC value of Ddimer is 0.735,and when the best cut-off value is 6.565,the sensitivity is 69.0% and the specificity is 68.4 %.5.According to the D-dimer the best cut-off value,then combined with sPESI score,.Kaplan-Meier survival curves were drawn respectively.The results showed that the average survival time of D-dimer ≤6.565ug/ml group was 1806.27±73.31 days.The mean survival time of D-dimer > 6.565ug/ml group was 1062.14±94.05 days,and the median survival time was 793 days.The risk of death in the high D-dimer group was 2.228 times higher than that in the low D-dimer group by Log-rank test(95%CI: 2.230-4.672,p< 0.05).In the low D-dimer group,the mean survival time of sPESI score was 2027.1±110.6 days.In the low D-dimer group,the mean survival time of sPESI score high-risk group was 1678.7±89.8 days;In the high D-dimer level group,the mean survival time of the low-risk group with sPESI score was 1129.4±191.9 days.In the high D-dimer level group,the mean survival time in the high-risk sPESI group was 1021.3±98.9 days,and the median survival time was 751 days(p< 0.05).6.Combined with survival time,univariate and multivariate Cox regression analysis showed that male(HR=0.593,95%CI : 0.400~0.880,p<0.05),elderly(HR=1.022,95%CI: 1.007~1.038,p< 0.05),active malignant tumor(HR=2.232,95%CI: 1.181~4.220,p< 0.05)and high D-dimer level(HR=1.078,95%CI: 1.048~1.108,p< 0.05)were independent risk factors for death from APE.Conclusions:1.The age of the death group of acute pulmonary embolism patients is higher than that of the survival group.2.The incidence of syncope and malignant tumors is higher in the APE death group.3.When D-dimer ≥6.565ug/ml,the risk of death in APE increased by 2.228 times.4.When D-dimer level and sPESI score were combined to predict the risk of death in patients with APE,high D-dimer level and sPESI score ≥1 had lower overall survival and an increased risk of death than those with high D-dimer level alone.5.Male,elderly,active malignant tumor and high D-dimer level are independent risk factors for death from APE.