Patient Outcomes after Acute Pulmonary Embolism

Klok, Frederikus A.; Zondag, Wendy; Kralingen, Klaas W. van; Dijk, Arie P.J. van; Tamsma, Jouke T.; Heyning, Fenna H.; Vliegen, Hubert W.; Huisman, Menno V.

doi:10.1164/rccm.200907-1141oc

Cited by 143 publications

(38 citation statements)

References 30 publications

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“…Not surprisingly, active cancer was the major predictor of death after acute PE during the follow-up period, which is consistent with earlier studies [17, 18]; however, CrCl and eGFR retained significance when cancer was considered in multivariate analysis. Patients with CrCl < 60 mL/min had up to 21-fold and 8-fold elevated risk of death during the 90-day and 1-year follow-up period, respectively.…”

Section: Discussionsupporting

confidence: 90%

Glomerular Filtration Rate as a Prognostic Factor for Long-Term Mortality after Acute Pulmonary Embolism

2019

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Background: In-hospital mortality for patients presenting with acute pulmonary embolism (PE) has been reported to be up to 7 times higher for patients with decreased estimated glomerular filtration rate (eGFR). However, few studies have assessed its effect on long-term mortality. Objective: To determine the impact of eGFR and creatinine clearance (CrCl) on long-term all-cause mortality following acute PE in association with other routine laboratory analyses and comorbidities. Patients/Methods: The prospective study enrolled 141 consecutive patients presenting with objectively confirmed acute PE. Demographic, clinical data, comorbidities, and laboratory values were recorded. CrCl and GFR were estimated using the Cockcroft-Gault, MDRD, and chronic kidney disease (CKD)-EPI equations. Patients were followed up at 90 days and 1 year after the event. Results: In univariate analyses, age, active cancer, PE severity index (PESI), CrCl and eGFR, D-dimer value, and high-density lipoprotein level were found to be significantly associated with mortality in 90 days and 1 year. Additionally, body mass index was significant in the 1-year follow-up. CrCl by Cockcroft-Gault (90-day: area under the curve [AUC] 0.763; 1-year: AUC 0.718) demonstrated higher discriminatory power for predicting mortality than eGFR by the MDRD (AUC 0.686; AUC 0.609) and CKD-EPI (AUC 0.697; AUC 0.630) equations. In multivariate analyses, active cancer, CrCl by Cockcroft-Gault (90-day: hazard ratio [HR] 0.948, 95% CI 0.919–0.979; 1-year: HR 0.967, 95% CI 0.943–0.991), eGFR by CKD-EPI (90-day: HR 0.948, 95% CI 0.915–0.983; 1-year: HR 0.971, 95% CI 0.945–0.998) were found to be independent predictors of mortality. eGFR by MDRD, D-dimer, and PESI value were significant prognostic factors for 90-day mortality. Conclusion: Decreased renal function is a prognostic factor for increased all-cause mortality 90 days and 1 year after acute PE.

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Section: Discussionsupporting

confidence: 90%

Glomerular Filtration Rate as a Prognostic Factor for Long-Term Mortality after Acute Pulmonary Embolism

2019

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“…These illnesses have previously been found to be important baseline characteristics of patients presenting with venous thromboembolism [1,18] and were predictors of long-term survival [1]. In addition to these chronic diseases, Heit et al [1] also reported increasing age, smoking status, chronic renal disease and neurologic disease to be independent predictors of long-term survival in their large inception cohort of patients suffering from venous thromboembolism.…”

Section: Discussionmentioning

confidence: 99%

Prognostic Impact of the Charlson Comorbidity Index on Mortality following Acute Pulmonary Embolism

Chow

Yong

et al. 2012

Respiration

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Objectives: It was the aim of this study to determine the prognostic significance of the Charlson Comorbidity Index (CCI) following acute pulmonary embolism (PE) and assess the prognosis of patients without comorbidities (defined as a CCI score of 0). Methods: Outcomes of 1,023 consecutive patients admitted with confirmed PE were tracked after a median of 3.7 years (25-75th interquartile range 1.5-6.1 years). All were assigned a non-age-adjusted CCI score. Results: The median CCI score was 1.0 (interquartile range 0.0-3.0). Three hundred and fifty-one (34%) patients had a CCI score of 0. Only 1 (0.3%) of 31 in-hospital deaths occurred in patients with a CCI score of 0. Long-term mortality for these patients was similar to the population-derived age- and sex-matched mortality rate, and was significantly better than for those with a CCI score ≥1 (12.5 vs. 47.5%; p < 0.0001 adjusted for age and sex). In multivariate analysis, CCI (per 1-score increase) independently predicted in-hospital (hazard ratio 1.27, 95% confidence interval 1.09-1.49; p = 0.003) and post-discharge (hazard ratio 1.35, 95% confidence interval 1.29-1.42; p < 0.0001) death. The c statistics for the multivariate prediction models for in-hospital (incorporating CCI score and serum sodium level) and post-discharge death (age, CCI score, hyperlipidemia, serum sodium and hemoglobin) were 0.738 and 0.788, respectively (both p < 0.0001). Conclusion: The CCI can be incorporated into risk models, with good discriminatory power, for predicting in-hospital and long-term outcomes following acute PE. Patients with a CCI score of 0 have a favorable long-term outcome following acute PE.

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“…With greater awareness of the disease, it is being more widely recognized, with estimates following an episode of acute pulmonary embolus ranging from 0.8 to 8% in autopsy series, US healthcare insurance databases, and retrospective and prospective studies [5-10]. To put this into perspective, this would mean a prevalence of between 11 and 109 per million cases.…”

Section: Introductionmentioning

confidence: 99%

Chronic thromboembolic pulmonary hypertension: time for research in pathophysiology to catch up with developments in treatment

Toshner

Pepke‐Zaba

2014

F1000Prime Rep

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The modern treatment era in chronic thromboembolic disease has seen significant advances in both surgical and medical treatment. One such treatment, the pulmonary endarterectomy (where established chronic organized thrombus is removed), has dramatically affected morbidity and mortality. These advances have outstripped basic research into the causes and pathophysiology of disease, which remain largely poorly understood. In this review, we will set out to explain some of the historical reasons for this, including the difficulties inherent in human studies and the lack of good animal models. We will review some of the recent advances in pathophysiology from registries and translational research, and we will summarize the treatment options, with some discussion of very recently published work, including medical and surgical treatments, both traditional and more experimental work in non-invasive techniques.

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Patient Outcomes after Acute Pulmonary Embolism

Abstract: The clinical course of acute PE is complicated by high rates of serious adverse events, which occur in half of the patients within 4 years.

Cited by 143 publications

References 30 publications

Glomerular Filtration Rate as a Prognostic Factor for Long-Term Mortality after Acute Pulmonary Embolism

Glomerular Filtration Rate as a Prognostic Factor for Long-Term Mortality after Acute Pulmonary Embolism

Prognostic Impact of the Charlson Comorbidity Index on Mortality following Acute Pulmonary Embolism

Chronic thromboembolic pulmonary hypertension: time for research in pathophysiology to catch up with developments in treatment

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