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Clinical Characteristics, Risk Factors, and Outcomes of Acute Pulmonary Embolism in Asian Population.

ABSTRACT: Acute pulmonary embolism (APE) is a common condition with increasing worldwide incidence. However, the clinical characteristics, risk factors, and clinical outcomes of APE in the Asian population especially in the Thai population are still limited. Therefore, the objective of this study was to identify the clinical characteristics, risk factors, and clinical outcomes of APE in the Asian population. A cross-sectional study was conducted on patients diagnosed with APE at Chiang Mai University Hospital, Thailand during 2011-2020. During the study period, 696 patients confirmed the diagnosis of APE with a mean age of 57.7 ± 15.7 years and 41.1% males. APE was suspected in 468 of 696 patients (67.2%), while 228 patients (32.8%) had incidental PE. Active malignancy during treatment was found in 388 (55.7%). Dyspnea, cough, and chest pain were the most common presenting symptoms. Respiratory failure was found in 129 patients (18.6%). The thirty-day all-cause mortality rate was 19.1%. PE-related mortality was 5.6%. Most PE-related mortality was high-risk PE. APE was not uncommon in the Asian population. Active cancer, especially lung cancer was the most common risk factors. High-risk and intermediate-high-risk PE were associated with high mortality. Risk stratification and prompt management are warranted to improve outcomes.

SUBMITTER: Bumroongkit C

PROVIDER: S-EPMC9741370 | biostudies-literature | 2022 Nov

REPOSITORIES: biostudies-literature

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Clinical Characteristics, Risk Factors, and Outcomes of Acute Pulmonary Embolism in Asian Population.

Bumroongkit Chaiwat C Deesomchok Athavudh A Liwsrisakun Chalerm C Pothirat Chaicharn C Theerakittikul Theerakorn T Limsukon Atikun A Trongtrakul Konlawij K Tajarernmuang Pattraporn P Niyatiwatchanchai Nutchanok N Phrommintikul Arintaya A Chaikitmongkol Tul T Euathrongchit Juntima J Rimsukcharoenchai Chartaroon C Inchai Juthamas J Chaiwong Warawut W

Journal of clinical medicine 20221125 23

<h4>Background</h4>Acute pulmonary embolism (APE) is a common condition with increasing worldwide incidence. However, the clinical characteristics, risk factors, and clinical outcomes of APE in the Asian population especially in the Thai population are still limited. Therefore, the objective of this study was to identify the clinical characteristics, risk factors, and clinical outcomes of APE in the Asian population.<h4>Methods</h4>A cross-sectional study was conducted on patients diagnosed with ...[more]

PMID: 36498530

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Project description:BackgroundPredicting the progression of acute pulmonary embolism to chronic pulmonary thromboembolism (CPTE) disease is essential to monitoring and improving the long-term prognosis of pulmonary embolism. We explored the risk factors for chronic persistence of thromboembolism after acute pulmonary embolism.MethodsCases with newly onset acute pulmonary embolism in the China-Japan Friendship Hospital from November 2016 to November 2019 were retrospectively analyzed. The clinical characteristics, serological examination results, and treatment strategies of acute pulmonary embolism patients were obtained through the electronic medical record system (Goodwill E-Health Info Co., Ltd.). Imaging parameters on computed tomography pulmonary angiography (CTPA) images at the onset of the acute pulmonary embolism were measured and counted. Notably, we propose a new parameter based on CTPA images: the ratio of Sd (sum of residual segmental pulmonary artery diameter) to MPAd (the main pulmonary artery diameter) (Sd/MPAd). After 3 months of regular treatment for acute pulmonary embolism, patients were classified into a CPTE group or a non-CPTE group based on the presence of residual embolus. All data were compared between the CPTE group and non-CPTE group. Furthermore, logistic regression analysis was used to investigate risk factors for the progression of acute pulmonary embolism to CPTE.ResultsA total of 77 cases (male:female = 1:1.26) were included in the study. There were 43 cases (55.84%) in the CPTE group and 34 cases in the non-CPTE group (44.16%). The results of univariate analysis showed that there were statistically significant differences between the 2 groups in risk stratification (χ2=8.043; P=0.005), protein S activity (χ2=5.551; P=0.018), the ratio of sum of residual segmental pulmonary artery diameter to the main pulmonary artery diameter (Sd/MPAd; t=-2.103; P=0.039), Mastora score (U=362.500; P<0.001), and embolus location (χ2=16.969; P<0.001). However, there were no statistically significant differences between the 2 groups in treatment options (P=0.381). According to multivariate logistic-regression analysis, protein S activity <55% (P=0.025), Sd/MPAd ≥1.97 (P=0.011), and an embolus being located in the central pulmonary artery (P<0.001) were independent risk factors for chronic persistence of thromboembolism following acute pulmonary embolism.ConclusionsThe protein S activity, location of the embolus, and Sd/MPAd on CTPA at the onset of acute pulmonary embolism may suggest the progression of acute pulmonary embolism to CPTE.

Project description:ImportanceMost patients presenting to US emergency departments (EDs) with acute pulmonary embolism (PE) are hospitalized, despite evidence from multiple society-based guidelines recommending consideration of outpatient treatment for those with low risk stratification scores. One barrier to outpatient treatment may be clinician concern regarding findings on PE-protocol computed tomography (CTPE), which are perceived as high risk but not incorporated into commonly used risk stratification tools.ObjectiveTo evaluate the association of concerning CTPE findings with outcomes and treatment of patients in the ED with acute, low-risk PE.Design, setting, and participantsThis cohort study used a registry of all acute PEs diagnosed in the adult ED of an academic medical center from October 10, 2016, to December 31, 2019. Acute PE cases were divided into high- and low-risk groups based on PE Severity Index (PESI) class alone or using a combination of PESI class and biomarker results. The low-risk group was further divided based on the presence of concerning CTPE findings: (1) bilateral central embolus, (2) right ventricle-to-left ventricle ratio greater than 1.0, (3) right ventricle enlargement, (4) septal abnormality, or (5) pulmonary infarction. Data analysis was conducted from June to October 2022.Main outcomes and measuresThe primary outcome was all-cause mortality at 7 and 30 days. Secondary outcomes included hospitalization, length of stay, need for intensive care, use of echocardiography and/or bedside ultrasonography, and activation of the PE response team (PERT) .ResultsOf 817 patients (median [IQR] age, 58 [47-71] years; 417 (51.0%) female patients; 129 [15.8%] Black and 645 [78.9%] White patients) with acute PEs, 331 (40.5%) were low risk and 486 (59.5%) were high risk by PESI score. Clinical outcomes were similar for all low-risk patients, with no 30-day deaths in the low-risk group with concerning CTPE findings (0 of 151 patients) vs 4 of 180 (2.2%) in the low-risk group without concerning CTPE findings and 88 (18.1%) in the high-risk group (P < .001). Low-risk patients with concerning CTPE findings were less frequently discharged from the ED than those without concerning CTPE findings (3 [2.0%] vs 14 [7.8%]; P = .01) and had more frequent echocardiography (87 [57.6%] vs 49 [27.2%]; P < .001) and PERT activation for consideration of advanced therapies (34 [22.5%] vs 11 [6.1%]; P < .001).Conclusions and relevanceIn this single-center study, CTPE findings widely believed to confer high risk were associated with increased hospitalization and resource utilization in patients with low-risk PE but not short-term adverse clinical outcomes.

Project description:IntroductionThe characteristics and clinical relevance of pleural effusion (PLEF) in acute pulmonary embolism (APE) are not fully understood.MethodsA single-centre, retrospective study was performed of patients admitted with APE classified according to the subsequent development or not of PLEF. A model was built to predict PLEF and its impact on 30-day all-cause mortality was investigated.ResultsA total of 1602 patients with APE were included (median age, 74 (61, 82) years; 674 men (42.1%); 382 (23.8%) with PLEF). PLEF was associated with a higher number of comorbidities (p=0.015); more peripheral APE (0.001); a higher frequency of pulmonary infarctions (p<0.001) and higher 30-day all-cause mortality (p=0.004) compared with those without PLEF. Bilateral PLEFs, as compared with unilateral, were associated with a higher number of comorbidities (p=0.009); more severe (simplified Pulmonary Embolism Severity Index ≥1; p<0.001) and higher 30-day all-cause mortality (p<0.001).On multivariate analysis, the presence of PLEF was associated with atrial fibrillation (OR 2.00; 95% CI 1.32 to 3.02), congestive heart failure (OR 3.00; 95% CI 1.81 to 5.00), pulmonary infarction (OR 3.19; 95% CI 2.38 to 4.29) and a Charlson index ≥3 (OR 1.59; 95% CI 1.03 to 2.45). The predictive model for PLEF had a moderate power of discrimination (area under the curve, AUC 0.76; 95% CI 0.73 to 0.79), whereas the predictive model for mortality showed a good predictive power (AUC 0.89; 95% CI 0.86 to 0.93). The presence of PLEF doubles the probability of death (OR 2.02; 95% CI 1.11 to 3.68). When PLEF is bilateral, the probability of death is four times higher, as compared with unilateral PLEF (OR 4.07; 95% CI 1.53 to 10.85; AUC 0.90; 95% CI 0.84 to 0.95).ConclusionsA significant number of APE patients develop PLEF. The model showed a good power of discrimination for the prediction of mortality. The probability of death from APE doubles in the presence of PLEF. Patients with APE and concomitant bilateral PLEF have a fourfold higher risk of mortality, as compared with patients with concomitant unilateral PLEF.

Dataset Information

Clinical Characteristics, Risk Factors, and Outcomes of Acute Pulmonary Embolism in Asian Population.

Publications

Clinical Characteristics, Risk Factors, and Outcomes of Acute Pulmonary Embolism in Asian Population.

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