Differences in clinical and echocardiographic variables and mortality predictors among older patients with pulmonary embolism

Ösken, Altuğ; Yelgeç, Nizamettin Selçuk; Şekerci, Sena Sert; Asarcıklı, Lale Dinç; Dayı, Şennur Ünal; Çam, Neşe

doi:10.1007/s40520-021-01882-3

Cited by 6 publications

(4 citation statements)

References 36 publications

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“…Fourteen observational studies assessed the role of TAPSE in the prediction of short-term death [10,11,45,60,[62][63][64][65][70][71][72][73][74][75] (Supplementary Table 3). A formal meta-analysis on the association between TAPSE and clinical outcome is reported below.…”

Section: Critical Reviewmentioning

confidence: 99%

Prognostic role of different findings at echocardiography in acute pulmonary embolism: a critical review and meta-analysis

Cimini

Candeloro²,

Pływaczewska³

et al. 2022

ERJ Open Res

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BackgroundRight ventricle dysfunction (RVD) at echocardiography predicts mortality in patients with acute pulmonary embolism (PE), but heterogenous definitions of RVD have been used. We performed a meta-analysis to assess the role of different definitions of RVD and of individual parameters of RVD as predictors of death.MethodsA systematic search for studies including patients with confirmed PE reporting on RV assessment at echocardiography and death in the acute phase was performed. The primary study outcome was death in-hospital or at 30 days.ResultsRVD at echocardiography, regardless of its definition, was associated with increased risk of death (RR 1.49, 95%CI 1.24–1.79, I2=64%) and PE-related death (RR 3.77, 95% CI 1.61–8.80, I2=0%) in all-comers with PE, and with death in hemodynamically stable patients (RR 1.52, 95%CI 1.15–2.00, I2=73%). The association with death was confirmed for RVD defined as the presence of at least one criterion or at least two criteria for RV overload. In all-comers with PE, increased RV/LV ratio (RR 1.61, 95% CI 1.90–2.39) and abnormal TAPSE (RR 2.29 CI 1.45–3.59) but not increased RV diameter were associated with death; in hemodynamically stable patients, neither RV/LV ratio (RR 1.11 CI 95% 0.91–1.35) nor TAPSE (RR 2.29, 95% CI 0.97–5.44) were significantly associated with death.ConclusionEchocardiography showing RVD is a useful tool for risk stratification in all-comers with acute PE and in hemodynamically stable patients. The prognostic value of individual parameters of RVD in hemodynamically stable patients remains controversial.

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Section: Critical Reviewmentioning

confidence: 99%

Prognostic role of different findings at echocardiography in acute pulmonary embolism: a critical review and meta-analysis

Cimini

Candeloro²,

Pływaczewska³

et al. 2022

ERJ Open Res

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“…Another study including hemodynamic stable PE patients showed that older patients could lead to experience higher rates of right ventricle dysfunction and dilatation, atrial fibrillation during acute PE, which identified age as independent predictors of in-hospital mortality as well. [10] Additionally, older age that could induce hypercoagulability of the organism, is known as one of the risk factors for the occurrence of VTE. [11] Aging is also related with an elevated prevalence of chronic complications and alterations in immune system causing an augmented susceptibility to septicemia which causes or contributes to nearly one-third of all death in hospital.…”

Section: Discussionmentioning

confidence: 99%

Identifying prognostic factors for pulmonary embolism patients with hemodynamic decompensation admitted to the intensive care unit

Peng,

Chen,

Luo

et al. 2024

Medicine

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We aimed to determine prognostic indicators of PE patients with hemodynamic decompensation admitted to the ICU. PE patients with hemodynamic decompensation at ICU admission from Medical Information Mart for Intensive Care IV database were included. Least absolute shrinkage and selection operator with 2 specific lambdas were performed to reduce the dimension of variables after univariate analysis. Then we conducted multivariate logistic regression analysis and 2 models were built. A total of 548 patients were included, among whom 187 died. Lactate, creatine-kinase MB, troponin-T were significantly higher in death group. Eight common factors were screened out from first model statistically mostly in consistent with second model: older age, decreased hemoglobin, elevated anion gap, elevated International Standard Ratio (INR), elevated respiratory rate, decreased temperature, decreased blood oxygen saturation (SpO2) and the onset of cardiac arrest were significantly risk factors for in-Hospital mortality. The nonlinear relationships between these indicators and mortality were showed by the restricted cubic spline and cutoff values were determined. Our study demonstrated that age, hemoglobin levels, anion gap levels, INR, respiratory rate, temperature, SpO2 levels, the onset of cardiac arrest could be applied to predict mortality of PE patients with hemodynamic decompensation at ICU admission.

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“…All cause death increased from 2.3% to 7.4% with age group ( p < 0.001). Beside the impact of age itself on mortality, high comorbidity rate such as changes in cardiac function and renal function due to various diseases and age-related fragility all contribute to poor prognosis of old patients [ 10 , 24 ]. In clinical practice, in fear of bleeding events, some physicians may mistake advanced age and comorbidity as a contraindication to treatment like anticoagulation and thrombolysis [ 25 ].…”

Section: Discussionmentioning

confidence: 99%

Clinical characteristics and mortality predictors among very old patients with pulmonary thromboembolism: a multicenter study report

Zhou,

Yang,

Zhai

et al. 2024

BMC Pulm Med

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Background Clinical characteristics of patients with pulmonary thromboembolism have been described in previous studies. Although very old patients with pulmonary thromboembolism are a special group based on comorbidities and age, they do not receive special attention. Objective This study aims to explore the clinical characteristics and mortality predictors among very old patients with pulmonary thromboembolism in a relatively large population. Design and participants The study included a total of 7438 patients from a national, multicenter, registry study, the China pUlmonary thromboembolism REgistry Study (CURES). Consecutive patients with acute pulmonary thromboembolism were enrolled and were divided into three groups. Comparisons were performed between these three groups in terms of clinical characteristics, comorbidities and in-hospital prognosis. Mortality predictors were analyzed in very old patients with pulmonary embolism. Key results In 7,438 patients with acute pulmonary thromboembolism, 609 patients aged equal to or greater than 80 years (male 354 (58.1%)). There were 2743 patients aged between 65 and 79 years (male 1313 (48%)) and 4095 patients aged younger than 65 years (male 2272 (55.5%)). Patients with advanced age had significantly more comorbidities and worse condition, however, some predisposing factors were more obvious in younger patients with pulmonary thromboembolism. PaO2 < 60 mmHg, eGFR < 60 mL/min/1.73m2, malignancy, anticoagulation as first therapy were mortality predictors for all-cause death in very old patients with pulmonary thromboembolism. The analysis found that younger patients were more likely to have chest pain, hemoptysis (the difference was statistically significant) and dyspnea triad. Conclusion In very old population diagnosed with pulmonary thromboembolism, worse laboratory results, atypical symptoms and physical signs were common. Mortality was very high and comorbid conditions were their features compared to younger patients. PaO2 < 60 mmHg, eGFR < 60 mL/min/1.73m2 and malignancy were positive mortality predictors for all-cause death in very old patients with pulmonary thromboembolism while anticoagulation as first therapy was negative mortality predictors.

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Differences in clinical and echocardiographic variables and mortality predictors among older patients with pulmonary embolism

Cited by 6 publications

References 36 publications

Prognostic role of different findings at echocardiography in acute pulmonary embolism: a critical review and meta-analysis

Prognostic role of different findings at echocardiography in acute pulmonary embolism: a critical review and meta-analysis

Identifying prognostic factors for pulmonary embolism patients with hemodynamic decompensation admitted to the intensive care unit

Clinical characteristics and mortality predictors among very old patients with pulmonary thromboembolism: a multicenter study report

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