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Predictors of hospital mortality in hemodynamically stable patients with pulmonary embolism.

Abstract：

BACKGROUND:Pulmonary embolism is associated with high mortality in patients with hypotension or circulatory shock. However, the association between some clinical variables and mortality is still unclear in hemodynamically stable patients. OBJECTIVES:To derive an in-hospital mortality risk stratification model in hemodynamically stable patients with pulmonary embolism. METHODS:This is a prospective multicenter cohort study of 582 consecutive patients admitted in emergency units or intensive care units with clinically suspected pulmonary embolism and whose diagnosis was confirmed by one or more of the following tests: pulmonary arteriography, spiral CT angiography, magnetic resonance angiography, Doppler echocardiography, pulmonary scintigraphy, or venous duplex scan. Data on demographics, comorbidities and clinical manifestations were collected and included in a logistic regression analysis so as to build the prediction model. RESULTS:Overall mortality was 14.1%. The following parameters were identified as independent death risk variables: age > 65 years, bed rest > 72h, chronic cor pulmonale, sinus tachycardia, and tachypnea. After risk stratification, mortalities of 5.4%, 17.8%, and 31.3% were found in the low, moderate and high-risk subgroups, respectively. The model showed 65.5% sensitivity and 80% specificity, with a 0.77 area under the curve. CONCLUSION:In hemodynamically stable patients with pulmonary embolism, age > 65 years, bed rest > 72h, chronic cor pulmonale, sinus tachycardia and tachypnea were independent predictors of in-hospital mortality. However, further validation of the prediction model in other populations is required so that it can be incorporated into the clinical practice.

journal_name

Arq Bras Cardiol

journal_title

Arquivos brasileiros de cardiologia

authors

Volschan A,Albuquerque D,Tura BR,Knibel M,Esteves JP,Bodanese LC,Silveira F,Pantoja J,Souza PC,Mansur J,Mesquita ET,EMEP (Estudo Multicêntrico de Embolia Pulmonar) investigators.

doi

10.1590/s0066-782x2009000800011

subject

Has Abstract

pub_date

2009-08-01 00:00:00

pages

135-40

issue

eissn

0066-782X

issn

1678-4170

pii

S0066-782X2009000800011

journal_volume

pub_type

杂志文章,多中心研究

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Predictors of hospital mortality in hemodynamically stable patients with pulmonary embolism.