Analysis Of The Causes Of Prognosis In Patients With High-risk Pulmonary Embolism

Objective: This essay is to explore the causes of different prognosis in patients with high-risk pulmonary embolism by retrospective analysis of clinical features,laboratory indexes,imaging findings and intervention measures.Methods: the clinical data of 48 patients with confirmed and suspected high-risk PTE were collected from Jan.2013 to Dec.2019 in the first affiliated Hospital of Chongqing Medical University.The patients were divided into death group and survival group according to the prognosis of the disease after 15 days.The clinical data of age,gender,initial symptoms,basic diseases,treatment and laboratory examination were analyzed and compared.According to the prognosis of the disease after 15 days,26 patients who received thrombolytic therapy were divided into death group and survival group.The clinical data such as age,gender,first symptoms,basic diseases,treatment and laboratory examination,as well as safety indexes such as bleeding rate and nervous system damage were analyzed and compared.According to the prognosis of 15 days after onset,33 patients with high-risk pulmonary embolism confirmed were divided into death group and survival group.The clinical data such as respiratory and cardiac arrest,imaging examination,treatment and rate of ROSC were analyzed and compared.Statistical method: SPSS 26.0 was used to analyze the data,and P< 0.05 was considered statistically different.Evaluation of the value of statistically significant laboratory indicators in the prediction of death from high-risk pulmonary embolism using ROC curve analysis,the tangent point with the largest Youden’s index was selected as the best critical value,and its sensitivity and specificity were calculated.In the univariate analysis of survival time between groups,K-M method(product limit method)and log-rank test were used.After univariate analysis,Cox survival function was directly used for multivariate regression analysis.Results: 1.Analysis of death factors of patients with high-risk pulmonary embolism: the clinical data of 48 hospitalized patients with acute high-risk pulmonary embolism were included in this study,including27 cases in death group(56.25%)and 21 cases in survival group(43.75%).There were significant differences in suspected diagnosis,thrombolytic therapy,respiratory and cardiac arrest,loss of consciousness,dyspnea,NT-pro BNP and p H value between the death group and the survival group.NT-pro BNP is valuable in predicting the 15-day death of high-risk pulmonary embolism patients,and the area under the curve of ROC is0.735(95%CI:0.592 ～ 0.879,P=0.006).With 1440pg/m L as the positive cut-off point,the sensitivity and specificity of NT-pro BNP in predicting15-day death in high-risk PTE patients were 81.5% and 57.1%,respectively.Univariate survival analysis: suspected diagnosis,non-thrombolysis,loss of consciousness,respiratory and cardiac arrest,non-dyspnea state and NT-pro BNP≥1440pg/m L were predictive factors of death 15 days after onset.Cox regression model demonstrated that non-thrombolysis(HR=0.292,95%CI=0.104～0.817)and respiratory and cardiac arrest(HR=12.523,95%CI=2.414～64.975)were independent risk factors for death 15 days after onset in high-risk patients with pulmonary embolism.2.Analysis of death factors of patients with high-risk pulmonary embolism after thrombolysis: a total of 26 patients were treated with thrombolysis,including 18 patients in the survival group(85.71%)and 8patients in the death group(29.63%).There were significant differences in suspected diagnosis,respiratory and cardiac arrest,massive hemorrhage and c Tn I between the two groups.For c Tn I,the ROC curve was drawn,and the area under the ROC curve was 0.764(95% CI:0.530～0.998,P=0.035),indicating that this index is of predictive value in predicting15-day death of patients with high-risk PTE after thrombolysis.With0.133μg/L as the positive cut-off point,the sensitivity and specificity of c Tn I for predicting 15-day death in patients with high-risk PTE after thrombolysis were 87.5% and 72.2%,respectively.Univariate survival regression analysis showed that patients with suspected diagnosis,respiratory and cardiac arrest,massive hemorrhage and c Tn I≥0.133μg/L had a higher risk of death within 15 days after onset.Because the sample size is too small,this study did not establish a regression model for multi-factor analysis.3.Analysis of death factors of patients with confirmed high-risk pulmonary embolism : a total of 33 patients with high-risk pulmonary embolism were included in this study,including 13 cases in the death group(39.39%)and 20 cases in the survival group(60.61%).Patients with respiratory and cardiac arrest and without ROSC had a higher risk of death.Among the patients with respiratory and cardiac arrest,those who did not receive ROSC and did not receive thrombolysis all died.Conclusion: In patients with high-risk pulmonary embolism,without thrombolytic therapy,loss of consciousness,non-dyspnea state,respiratory and cardiac arrest predict a higher risk of death.In addition,suspected patients are more likely to die because of missing the opportunity of thrombolysis.NT-Pro BNP and c Tn I can be used as predictors of death in patients with high-risk pulmonary embolism and patients with high-risk pulmonary embolism after thrombolysis.Thrombolytic therapy can greatly reduce the risk of death of high-risk pulmonary embolism.No matter whether the spontaneous circulation is returned or not,patients diagnosed or suspected of high-risk pulmonary embolism should receive thrombolytic therapy immediately.