Risk Factors for Pulmonary Embolism in Patients with Paralysis and Deep Venous Thrombosis

Abstract

Background. Venous thromboembolism is a frequent complication and an important cause of death in patients with paralysis. We aimed to investigate predictors of pulmonary embolism (PE) and the impact of PE on the survival of patients with paralysis in comparison to those with deep venous thrombosis or thrombophlebitis (DVT). Methods: Patients were selected by screening the German nationwide inpatient sample (2005–2017) for paralysis, and were stratified for venous thromboembolism (VTE) and the VTE-sub-entity PE (ICD-code I26). Impact of PE on mortality and predictors for PE were analyzed. Results: Overall, 7,873,769 hospitalizations of patients with paralysis were recorded in Germany 2005–2017, of whom 1.6% had VTE and 7.0% died. While annual hospitalizations increased (2005: 520,357 to 2017: 663,998) (β 12,421 (95% CI 10,807 to 14,034), p < 0.001), in-hospital mortality decreased from 7.5% to 6.7% (β −0.08% (95% CI −0.10% to −0.06%), p < 0.001). When focusing on 82,558 patients with paralysis hospitalized due to VTE (51.8% females; 58.3% aged ≥ 70 years) in 2005–2017, in-hospital mortality was significantly higher in patients with paralysis and PE than in those with DVT only (23.8% vs. 6.3%, p < 0.001). Cancer (OR 2.18 (95% CI 2.09–2.27), p < 0.001), heart failure (OR 1.83 (95% CI 1.76–1.91), p < 0.001), COPD (OR 1.63 (95% CI 1.53–1.72), p < 0.001) and obesity (OR 1.42 (95% CI 1.35–1.50), p < 0.001) were associated with PE. PE (OR 4.28 (95% CI 4.07–4.50), p < 0.001) was a strong predictor of in-hospital mortality. Conclusions: In Germany, annual hospitalizations of patients with paralysis increased in 2005–2017, in whom VTE and especially PE substantially affected in-hospital mortality. Cancer, heart failure, COPD, obesity and acute paraplegia were risk factors of PE.

Incidence and Risk Factors of Admission Deep Vein Thrombosis in Patients With Traumatic Fracture: A Multicenter Retrospective Study

“…Inclusion criteria consisted of the following: (1) patients diagnosed with a traumatic fracture; (2) patients who underwent fasting blood glucose, routine blood tests, and coagulation tests at admission; (3) patients who were examined via whole-leg compression ultrasound to detect DVT at admission. Exclusion criteria comprised the following: (1) patients with an open wound or neurovascular injury; (2) patients with unstable vital signs at admission; (3) patients with combined injuries and multiple fractures; (4) patients with a history of PE or DVT; (5) patients with tumors or who were pregnant; (6) patients who underwent long-term anticoagulation; and (7) patients with incomplete clinical data. The selection process is illustrated in Figure 1.…”

“… 5 It is well known that DVT is the main risk factor for PE. 6 Therefore, early prediction and intervention of DVT in high-risk patients with traumatic fractures have considerable clinical significance. Previous studies have mostly focused on preoperative DVT, while less attention has been paid to DVT that might have occurred at admission.…”

Prevalence and risk factors for proximal deep vein thrombosis at admission in patients with traumatic fractures: a multicenter retrospective study

“…The prevalence of early PE after trauma can be as high as 10%-42% (5). Studies have confirmed that VTE is a major risk factor for PE (6). Therefore, being able to predict deep vein thrombosis (DVT) in patients with traumatic fracture at the time of admission for implementing appropriate interventions is of considerable clinical importance.…”

Genetic Predisposition of Both Waist Circumference and Hip Circumference Increased the Risk of Venous Thromboembolism

“…VTE is a complex multifactorial disease that integrates genetics and many well-recognized traditional risk factors, such as hormone replacement therapy, cancer, heart failure, chronic obstructive pulmonary disease, trauma, surgery, immobilization, and paraplegia, have been identified. [3][4][5] In a retrospective cohort study, Stewart and Kline found that four components of metabolic syndrome: hyperlipidemia, hypertension, hyperglycemia, and abdominal obesity, were statistically associated with VTE. 6 Recently, some observational studies have also confirmed the correlation between obesity and VTE.…”