Logistic Regression Analysis of Potential Prognostic Factors for Pulmonary Thromboembolisma

Yoo, Hugo Hyung Bok; Paiva, Sérgio Alberto Rupp de; Silveira, Liciana Vaz de Arruda; Queluz, Thais Thomaz

doi:10.1378/chest.123.3.813

Cited by 23 publications

(20 citation statements)

References 34 publications

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“…10,24 -26 Three studies did not have a control group, 9,27,28 whereas in 2 studies, VTE was diagnosed at postmortem examination. 29,30 Of the remaining 27 studies, 2 were excluded because no objective diagnosis of VTE was made, 31,32 and 3 studies were excluded because they described the same study group. [33][34][35] Additional data were requested from the authors of 2 studies but obtained for only 1 study.…”

Section: Study Characteristicsmentioning

confidence: 99%

Cardiovascular Risk Factors and Venous Thromboembolism

et al. 2008

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Background-The concept that venous thromboembolism (VTE) and atherosclerosis are 2 completely distinct entities has recently been challenged because patients with VTE have more asymptomatic atherosclerosis and more cardiovascular events than control subjects. We performed a meta-analysis to assess the association between cardiovascular risk factors and VTE. Methods and Results-Medline and EMBASE databases were searched to identify studies that evaluated the prevalence of major cardiovascular risk factors in VTE patients and control subjects. Studies were selected using a priori defined criteria, and each study was reviewed by 2 authors who abstracted data on study characteristics, study quality, and outcomes. Odds ratios or weighted means and 95% confidence intervals (CIs) were then calculated and pooled using a random-effects model. Statistical heterogeneity was evaluated through the use of 2 and I 2 statistics. Twenty-one case-control and cohort studies with a total of 63 552 patients met the inclusion criteria. Compared with control subjects, the risk of VTE was 2.33 for obesity (95% CI, 1.68 to 3.24), 1.51 for hypertension (95% CI, 1.23 to 1.85), 1.42 for diabetes mellitus (95% CI, 1.12 to 1.77), 1.18 for smoking (95% CI, 0.95 to 1.46), and 1.16 for hypercholesterolemia (95% CI, 0.67 to 2.02). Weighted mean high-density lipoprotein cholesterol levels were significantly lower in VTE patients, whereas no difference was observed for total and low-density lipoprotein cholesterol levels. Significant heterogeneity among studies was present in all subgroups except for the diabetes mellitus subgroup. Higher-quality studies were more homogeneous, and significant associations remained unchanged. Conclusions-Cardiovascular

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Section: Study Characteristicsmentioning

confidence: 99%

Cardiovascular Risk Factors and Venous Thromboembolism

et al. 2008

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“…Despite the recognized efficacy of autopsy as a tool for medical education and as a method for the evaluation of diagnostic accuracy in general, (23) the reduction in autopsy rates is a phenomenon observed worldwide, (9)(10)(11)(23)(24)(25) possibly due to the interaction of a number of factors, such as the development of sensitive diagnostic methods, which reduce the need for autopsy to investigate the cause of death; the aging of the population, which makes death be interpreted as a natural part of the process; a lack of interest on the part of the team of professionals, who question the validity of the procedure; the fear of assigning blame to the physician in charge; and the idea that autopsy findings can set a precedent for filing a medical malpractice lawsuit. (9,11,25) Consequently, autopsy studies have become scarce in the literature, and the potential of autopsies for diagnosis, medical education and evaluation of the quality of diagnosis has been minimized.…”

Section: Discussionmentioning

confidence: 99%

Determinantes morfológicos de prognóstico em pneumonia nosocomial: um estudo em autópsias

et al. 2010

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Objective: To determine the prevalence of nosocomial pneumonia in autopsies at a public university hospital; to identify the risk factors for nosocomial pneumonia and the potential prognostic factors associated with fatal nosocomial pneumonia and with fatal aspiration pneumonia; and to determine whether anatomopathological findings correlate with nosocomial pneumonia or aspiration pneumonia. Methods: A retrospective study involving 199 autopsied patients, older than 1 year of age, who had been admitted to the São Paulo State University Botucatu School of Medicine Hospital das Clínicas and died of nosocomial pneumonia (underlying or contributing cause), between 1999 and 2006. Demographic, clinical and anatomopathological variables were tested regarding their association with the outcomes (fatal nosocomial pneumonia and fatal aspiration pneumonia). The significant variables were analyzed using multivariate analysis. Results: The mean age was 59 ± 19 years. The prevalence of nosocomial pneumonia in autopsies was 29%, and the disease was the cause of death in 22.6% of the autopsied patients. Fatal nosocomial pneumonia correlated with the following anatomopathological findings: tobacco-associated structural lesions (OR = 3.23; 95% CI: 1.26-2.95; p = 0.02) and bilateral pneumonia (OR = 3.23; 95% CI: 1.26-8.30; p = 0.01). None of the variables were found to be significantly associated with fatal aspiration pneumonia. Conclusions: In our sample, there was a high prevalence of nosocomial pneumonia, which was responsible for almost 25% of all of the deaths. Smoking-related structural lesions and bilateral pneumonia all favored mortality. These findings corroborate the results of various clinical studies on nosocomial pneumonia.Keywords: Autopsy; Risk factors; Prognosis; Pneumonia, aspiration; Pneumonia/mortality. ResumoObjetivo: Determinar a prevalência de pneumonia nosocomial nas autópsias em um hospital público universitário; identificar os fatores de risco relacionados à pneumonia nosocomial e os potenciais fatores prognósticos relacionados à ocorrência de pneumonia nosocomial fatal; e correlacionar os achados anatomopatológicos com a ocorrência de pneumonia nosocomial e/ou pneumonia aspirativa. Métodos: Estudo retrospectivo de 199 pacientes autopsiados, maiores de 1 ano de idade, internados no Hospital das Clínicas da Faculdade de Medicina de Botucatu da Universidade Estadual Paulista entre 1999 e 2006, cuja causa de morte (causa básica ou associada) foi pneumonia nosocomial. Testou-se a associação dos dados demográficos, clínicos e anatomopatológicos com os desfechos pneumonia nosocomial fatal e pneumonia aspirativa fatal. As variáveis significativas entraram na análise multivariada. Resultados: A idade média foi de 59 ± 19 anos. A prevalência de pneumonia nosocomial em autópsias foi 29%, e essa foi a causa mortis de 22,6% dos pacientes autopsiados. A pneumonia nosocomial fatal correlacionou-se com os achados anatomopatológicos de alterações estruturais tabágicas (OR = 3,23; IC95%: 1,26-2,95; p = 0,02) e acom...

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“…In the literature, PTE prevalence in autopsies varies because study results depend on diverse factors such as autopsy rate, number of cases, type of hospital, attentiveness and patience of the pathologists when looking for thrombi, and the preparation of the material to be examined (2,6) . Despite this variation, PTE prevalence in autopsy studies seems to have been decreasing over the past few years (4,(7)(8)(9) . This phenomenon is probably more closely related to the improvement in prevention, the development of new diagnostic tools and therapeutic advances than to a reduction in autopsy rates, which has become a worldwide phenomenon (4,(7)(8)(9)(10) .…”

Section: Discussionmentioning

confidence: 99%

“…Despite this variation, PTE prevalence in autopsy studies seems to have been decreasing over the past few years (4,(7)(8)(9) . This phenomenon is probably more closely related to the improvement in prevention, the development of new diagnostic tools and therapeutic advances than to a reduction in autopsy rates, which has become a worldwide phenomenon (4,(7)(8)(9)(10) . However, it is possible that, although the rate of PTE in autopsied patients has been decreasing, it may be increasing in the population of patients not submitted to autopsy due to adequate prevention and therapy.…”

Section: Discussionmentioning

confidence: 99%

“…A wellestablished routine, consisting of sequential and systematic procedures, was followed. In this method, topography and in locus alterations to the organs are analyzed initially, followed by dissection and analysis of the organs in accordance with a detailed description given in a previous study (4) . Statistical analysis: We used the Student's t-test for data related to age and these data are expressed as means ± standard deviation and variation.…”

Section: Methodsmentioning

confidence: 99%

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Achados clínicopatológicos na tromboembolia pulmonar: estudo de 24 anos de autópsias

Yoo¹,

Mendes²,

Alem³

et al. 2004

J. bras. pneumol.

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Background: Pulmonary thromboembolism (PTE) is still an enigmatic disorder in many epidemiological and clinical features, remaining one of the most commonly misdiagnosed disorders.Objective: To describe the prevalence and pathological findings of PTE in a series of autopsies, to correlate these findings with underlying diseases, and to verify the frequency of PTE clinically suspected before death. Method:The reports on 5261 consecutive autopsies performed from 1979 to 2002 in a Brazilian tertiary referral medical school were reviewed for a retrospective study. From the medical records and autopsy reports of the patients found with macroscopically and/or microscopically documented PTE, were gathered data on demographics, underlying diseases, antemortem suspicion of PTE, and probable PTE site of origin. Results:The autopsy rate was 42.0% and PTE was found in 544 patients. In 225 cases, PTE was the main cause of death (fatal PTE). Infections (p=0.0003) were associated with nonfatal PTE and trauma (p=0.007) with fatal PTE. The rate of antemortem unsuspected PTE was 84.6% and 40.0% of these patients presented fatal PTE. Diseases of the circulatory system (p=0.0001), infections (p<0.0001), diseases of the digestive system (p=0.0001), neoplasia (p=0.024) and trauma (p=0.005) were associated with unsuspected PTE. The most frequent PTE site of origin was the lower limbs (48.9%). Probable PTE sites of origin such as right-sided cardiac chambers (p=0.012) and pelvic veins (p=0.015) were associated with fatal PTE. Conclusion:A large number of cases do not have antemortem suspicion of PTE. Special attention should be paid to the possibility of PTE in patients with diseases of the circulatory system, infections, diseases of the digestive system, neoplasia, and trauma.

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Logistic Regression Analysis of Potential Prognostic Factors for Pulmonary Thromboembolisma

Cited by 23 publications

References 34 publications

Cardiovascular Risk Factors and Venous Thromboembolism

Cardiovascular Risk Factors and Venous Thromboembolism

Determinantes morfológicos de prognóstico em pneumonia nosocomial: um estudo em autópsias

Achados clínicopatológicos na tromboembolia pulmonar: estudo de 24 anos de autópsias

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