Acute Pulmonary Embolism in Individuals Aged 80 and Older

Moutzouris, John P.; Chow, Vincent; Yong, A.; Chung, Tommy; Naganathan, Vasi; Kritharides, Leonard; Chwan, Austin Chin

doi:10.1111/jgs.13063

Cited by 10 publications

(13 citation statements)

References 9 publications

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“…Before the COVID-19 era, these data were confirmed, showing a four-to seven-fold increase in thrombotic complications in oncological patients compared with those in the general population [36]. Thus, the presence of oncological history was an independent mortality factor for elderly patients with PE events six months after hospital discharge [37]. Surprisingly, a traditional risk factor for PE as an oncological event has not been assessed in different COVID-19 patients [19,38].…”

Section: Discussion Key Findingsmentioning

confidence: 95%

Predictive Factors of Pulmonary Embolism in Older Patients with SARS-CoV-2: The OCTA-COVID-19 Study

Quezada-Feijoó

Ramos

Lozano-Montoya

et al. 2021

JCM

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Background: The risk of pulmonary embolism (PE) has not been studied in older patients affected by COVID-19. We aimed to assess PE incidence and risk factors in a population of older patients infected with SARS-CoV-2. Methods: An ambispective, observational cohort study. A total of 305 patients ≥ 75 years old had the SARS-CoV-2 infection from March to May 2020. The incidence rate of PE was estimated as the proportion of new cases within the whole sample. Youden’s index was used to assess the cutoff point of D-dimer. To select factors associated with the risk of PE, time-to-event analyses were performed using cause-specific hazard models. Results: In total, 305 patients with a median age of 87 years (62.3% female) were studied; 67.9% were referred from nursing homes and 90.4% received any type of anticoagulation. A total of 64.9% showed frailty and 44% presented with dementia. The PE incidence was 5.6%. The cutoff value of a D-dimer level over 2.59 mg/L showed a sensitivity of 82.4% and specificity of 73.8% in discriminating a PE diagnosis. In the multivariate analysis, the factors associated with PE were previous oncological events and D-dimer levels. Conclusions: The PE incidence was 5.6%, and major risk factors for PE were oncological antecedents and increased plasma D-dimer levels.

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Section: Discussion Key Findingsmentioning

confidence: 95%

Predictive Factors of Pulmonary Embolism in Older Patients with SARS-CoV-2: The OCTA-COVID-19 Study

Quezada-Feijoó

Ramos

Lozano-Montoya

et al. 2021

JCM

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“…In a previous study enrolled 24 patients with lung cancer and PE, Chuang et al showed that the most common symptoms were dyspnea (95.8%), hemoptysis (20.8%), cough (20.8%), chest pain (16.7%), body weight loss (8.3%), lower leg edema (8.3%), and shock (8.3%), which are not specific to lung cancer 25 [11]. Therefore, older patients with PE are less likely to present with chest pain and more likely to be hypoxic or have syncope 27,28 . In our study, 75.5% of older patients with PE presented with dyspnea, 9.4% with chest pain, and 3.8% with syncope, while 11.3% were asymptomatic.…”

Section: Discussionmentioning

confidence: 99%

“…. In another study enrolled28 cases with lung cancer having PE and 56 cases with lung cancer alone, Li et al found that 7.1% of patients with lung cancer complicated with PE were asymptomatic, and the incidence of cough (75.0% vs. 66.1%), stethalgia (25.0% vs. 7.1%), hemoptysis (14.3% vs. 19.6%), syncope (3.6% vs. 2.0%), palpitation (28.6% vs. 17.9%), and triad syndrome (3.6% vs. 0%) were similar between patients having lung cancer complicated with or without PE 26 . García Gómez LC conducted a hospital-based, case-control study included 413 patients with PE, 124 of whom were 80 years or older.…”

mentioning

confidence: 99%

Prognosis and risk factors in older patients with lung cancer and pulmonary embolism: a propensity score matching analysis

Liu

Wang

Yuan

et al. 2020

Sci Rep

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older patients, especially those with malignancy, may have an increased risk of pulmonary embolism (pe). However, few studies have evaluated the clinical characteristics and prognosis of older patients. We evaluated the clinical characteristics, prognosis, and risk factors in older patients with lung cancer complicated with pe. this was a single-center, prospective cohort study. older patients (≥65 years) with lung cancer admitted in Beijing Hospital from January 2006 to December 2016 were enrolled. The patients were divided into two groups according to the presence of pe using propensity score matching (PSM). After PSM, one hundred and six patients (53 per group) with an average age of (77.3 ± 10.9) years were enrolled. Adenocarcinoma was the most common histology in patients with PE (52.8%, n = 28), and most lung cancer patients were in stages III and IV (59.4%, n = 63). Patients with PE were stratified to low risk (52.8%, n = 28), intermediate-low risk (24.5%, n = 13), intermediate-high risk (15.1%, n = 8), high-risk (7.5%, n = 4) subgroups. Most PE patients presented with dyspnea (75.5%), and the majority of patients (86.8%, n = 46) developed PE within 3 months after the diagnosis of cancer. The median follow-up time was 23.7 months (12.0-62.0 months), and 7 patients (6.6%) were lost to follow-up. During the follow-up period, 92 patients (86.8%) died, including 8 cases (8.7%) of PE-related death, 73 (79.3%) of tumor death, and 11 (11.9%) of unknown cause. There were significant differences in all-cause mortality (94.3% vs. 83.0%) and PE-related mortality (15.1% vs. 0) between the PE and control groups, but the rate of tumor-related mortality (75.5% vs. 66.0%) was comparable between the groups. Among the 92 patients who died, the mortality rates at 3, 6, 12, and > 12 months after tumor diagnosis were 33.0% (33/106), 57.5% (61/106), 78.3% (83/106), and 89.6% (95/106), respectively. Kaplan-Meier survival analysis showed that the median overall survival time was significantly different between the PE and the control groups (4.3 vs. 9.2 months, P = 0.0015). Multivariate stepwise logistic regression analysis showed that age ≥ 77 years (OR = 2.58, 95%CI: 1.66-4.01), clinical stage III-IV (OR = 2.21, 95%CI: 1.03-4.74), adenocarcinoma (OR = 3.24, 95%CI: 1.75-6.00), high D-dimer (≥600 mg/L) (OR = 2.73, 95%CI: 1.25-5.96), and low partial pressure of oxygen (PaO 2 ; <75 mmHg) (OR = 2.85, 95%CI: 1.74-4.67) were independent risk factors for PE in older patients with lung cancer. Older patients with lung cancer and PE often have poor prognosis. Advanced age, clinical stage III-IV, adenocarcinoma, high D-dimer level, and low PaO 2 are independent risk factors for pe.With age, older individuals are at high risk of thromboembolic events. Cancer is an established cause of venous thrombosis 1 ; once a thrombus forms, venous thromboembolism (VTE) and even pulmonary embolism (PE) can result, leading to serious adverse events such as heart failure, respiratory failure, and sudden death. The prevalence of malignancy in patients with...

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“…The outcomes of patients admitted to our tertiary institution (Concord Hospital, University of Sydney, Australia) with confirmed PE had been reported previously (6,11,12). For the current study, consecutive patients admitted with a primary diagnosis of acute PE between January 2000 and December 2012 were identified from the PE database maintained by the Cardiology Department.…”

Section: Study Populationmentioning

confidence: 99%

High mortality in patients presenting with acute pulmonary embolism and elevated INR not on anticoagulant therapy

Wong

Lau

et al. 2016

Thromb Haemost

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The prognostic significance of patients presenting with pulmonary embolism (PE) and elevated International Normalised Ratio (INR) not on anticoagulant therapy has not been described. We investigated whether these patients had higher mortality compared to patients with normal INR. A retrospective study of patients admitted to a tertiary hospital with acute PE from 2000 to 2012 was undertaken, with study outcomes tracked using a state-wide death registry. Patients were excluded if they were taking anticoagulants or had inadequate documentation of their INR and medication status. Of the 1,039 patients identified, 94 (9 %) had an elevated INR (> 1.2) in the absence of anticoagulant use. These patients had higher mortality at six months follow-up (26 % vs 6 %, p< 0.001) compared to controls (INR ≤ 1.2). An INR > 1.2 at diagnosis was an independent predictor of death at six months post-PE (hazard ratio [HR] 2.9, 95 % confidence interval [CI] 1.8-4.7, p< 0.001). The addition of INR to a multivariable model that included the simplified pulmonary embolism severity index (sPESI), chest pain, and serum sodium led to a significant net reclassification improvement estimated at 8.1 %. The final model's C statistic increased significantly by 0.04 (95 % CI 0.01-0.08, p=0.03) to 0.83 compared to sPESI alone (0.79). In summary, patients presenting with acute PE and elevated INR while not on anticoagulant therapy appear to be at high risk of death. Future validation studies in independent cohorts will clarify if this novel finding can be usefully incorporated into clinical decision making in patients with acute PE.

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Acute Pulmonary Embolism in Individuals Aged 80 and Older

Cited by 10 publications

References 9 publications

Predictive Factors of Pulmonary Embolism in Older Patients with SARS-CoV-2: The OCTA-COVID-19 Study

Predictive Factors of Pulmonary Embolism in Older Patients with SARS-CoV-2: The OCTA-COVID-19 Study

Prognosis and risk factors in older patients with lung cancer and pulmonary embolism: a propensity score matching analysis

High mortality in patients presenting with acute pulmonary embolism and elevated INR not on anticoagulant therapy

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