Impact of clinical profile at admission on the outcomes in patients hospitalized for acute pulmonary embolism: data from the IPER Registry.
Mortality
Prognosis
Pulmonary embolism
Symptoms
Journal
Journal of thrombosis and thrombolysis
ISSN: 1573-742X
Titre abrégé: J Thromb Thrombolysis
Pays: Netherlands
ID NLM: 9502018
Informations de publication
Date de publication:
Jan 2023
Jan 2023
Historique:
accepted:
21
10
2022
pubmed:
10
11
2022
medline:
16
2
2023
entrez:
9
11
2022
Statut:
ppublish
Résumé
Acute pulmonary embolism (PE) is characterized by a large heterogeneity of clinical presentation and disease course. We investigate whether different symptom PE phenotypes in hemodynamically stable PE could be associated with 30-day mortality risk. Hemodynamically stable patients from the multicentre, prospective Italian Pulmonary Embolism Registry (IPER) (September 2006-August 2010) presenting the most common four clinical phenotypes (< 24 h onset dyspnoea, chest pain, pleuritic pain and phlebitis) at admission were included and compared to those who were asymptomatic at admission. Overall, 1365 (mean age 68.7 ± 15.3 years, 609 males) were evaluated. Recent onset dyspnoea (< 24 h), chest pain, pleuritic pain and phlebitis were observed in 28.4%, 19.7%, 12.9% and 25.2%, respectively while asymptomatic patients represented the remaining 13.6% of cases. PE presenting with recent dyspnoea onset and chest pain had a lower 30-day overall survival (log-rank p = 0.01 and p < 0.001, respectively). By contrast, there were no significant differences when comparing patients with pleuritic pain or phlebitis (log-rank p = 0.2). Similar findings were confirmed at the Cox multivariate regression analysis which indicated a higher mortality risk in patients with chest pain [HR 3.21, 95% CI 2.16-4.78, p < 0.001] or recent dyspnoea [HR 2.12, 95% CI 1.22-3.87, p = 0.002] independent of age, heart rate, presence of right ventricular dysfunction, positive cardiac troponin and administration of systemic thrombolysis. Hemodynamically stable PE patients presenting with chest pain or recent onset dyspnoea had a lower 30-day survival compared to those asymptomatic or presenting pleuritic or phlebitis pain.Trial registry ClinicalTrials.gov; No: NCT01604538).
Identifiants
pubmed: 36350468
doi: 10.1007/s11239-022-02726-1
pii: 10.1007/s11239-022-02726-1
doi:
Banques de données
ClinicalTrials.gov
['NCT01604538']
Types de publication
Clinical Trial
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
166-174Informations de copyright
© 2022. The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.
Références
Dudzinski DM, Giri J, Rosenfield K (2017) Interventional Treatment of Pulmonary Embolism. Circ Cardiovasc Interv 10:e004345
doi: 10.1161/CIRCINTERVENTIONS.116.004345
pubmed: 28213377
Goldhaber SZ, Bounameaux H (2012) Pulmonary embolism and deep vein thrombosis. Lancet 379:835–1846
doi: 10.1016/S0140-6736(11)61904-1
Barco S, Vicaut E, Klok FA, Lankeit M, Meyer G, Konstantinides SV, PEITHO Investigators (2018) Improved identification of thrombolysis candidates amongst intermediate-risk pulmonary embolism patients: implications for future trials. Eur Respir J 51:1701775
doi: 10.1183/13993003.01775-2017
pubmed: 29348184
Stein PD, Beemath A, Matta F, Weg JG, Yusen RD, Hales CA, Hull RD, Leeper KV Jr, Sostman HD, Tapson VF, Buckley JD, Gottschalk A, Goodman LR, Wakefied TW, Woodard PK (2007) Clinical characteristics of patients with acute pulmonary embolism: Data from PIOPED II. Am J Med 120:871–879
doi: 10.1016/j.amjmed.2007.03.024
pmcid: 2071924
pubmed: 17904458
Riedel M (2001) Acute pulmonary embolism 1: pathophysiology, clinical presentation, and diagnosis. Heart 85:229–240
doi: 10.1136/heart.85.2.229
pmcid: 1729607
pubmed: 11156681
Casazza F, Becattini C, Bongarzoni A, Cuccia C, Roncon L, Favretto G, Zonzin P, Pignataro L, Agnelli G (2012) Clinical features and short term outcomes of patients with acute pulmonary embolism. The Italian Pulmonary Embolism Registry (IPER). Thromb Res 130:847–852
doi: 10.1016/j.thromres.2012.08.292
pubmed: 22921592
Casazza F, Pacchetti I, Rulli E, Roncon L, Zonzin P, Zuin M, Becattini C, Bongarzoni A, Pignataro L (2018) Prognostic significance of electrocardiogram at presentation in patients with pulmonary embolism of different severity. Thromb Res 163:123–127
doi: 10.1016/j.thromres.2018.01.025
pubmed: 29407623
orbicki A, Perrier A, Konstantinides S, Agnelli G, Galiè N, Pruszczyk P, Bengel F, Brady AJ, Ferreira D, Janssens U, Klepetko W, Mayer E, Remy-Jardin M, Bassand JP, ESC Committee for Practice Guidelines (CPG) (2008) Guidelines on the diagnosis and management of acute pulmonary embolism: the Task Force for the Diagnosis and Management of Acute Pulmonary Embolism of the European Society of Cardiology (ESC). Eur Heart J 29:2276–2315
doi: 10.1093/eurheartj/ehn310
Becattini C, Casazza F, Forgione C, Porro F, Fadin BM, Stucchi A, Lignani A, Conte L, Imperadore F, Bongarzoni A, Agnelli G (2013) Acute pulmonary embolism: external validation of an integrated risk stratification model. Chest 144:1539–1545
doi: 10.1378/chest.12-2938
pubmed: 23764909
Becattini C, Casazza F, Forgione C, Porro F, Fadin BM, Stucchi A, Lignani A, Conte L, Imperadore F, Bongarzoni A, Agnelli G (2014) Echocardiographic evolution of pulmonary artery pressure after acute pulmonary embolism. Results from IPER registry. Thromb Res 134:1224–1228
doi: 10.1016/j.thromres.2014.09.026
Righini M, Roy PM, Meyer G, Verschuren F, Aujesky D, Le Gal G (2011) The Simplified Pulmonary Embolism Severity Index (PESI): validation of a clinical prognostic model for pulmonary embolism. J Thromb Haemost 9:2115–2117
doi: 10.1111/j.1538-7836.2011.04469.x
pubmed: 21848693
Zondag W, Mos IC, Creemers-Schild D, Hoogerbrugge AD, Dekkers OM, Dolsma J, Eijsvogel M, Faber LM, Hofstee HM, Hovens MM, Jonkers GJ, van Kralingen KW, Kruip MJ, Vlasveld T, de Vreede MJ, Huisman MV, Hestia Study Investigators (2011) Outpatient treatment in patients with acute pulmonary embolism: the Hestia Study. J Thromb Haemost 9:1500–1507
doi: 10.1111/j.1538-7836.2011.04388.x
pubmed: 21645235
Rindi LV, Al Moghazi S, Donno DR, Cataldo MA, Petrosillo N (2022) Predictive scores for the diagnosis of Pulmonary Embolism in COVID-19: A systematic review. Int J Infect Dis 115:93–100
doi: 10.1016/j.ijid.2021.11.038
pubmed: 34848375
Aujesky D, Roy PM, Le Manach CP, Verschuren F, Meyer G, Obrosky DS, Stone RA, Cornuz J, Fine MJ (2006) Validation of a model to predict adverse outcomes in patients with pulmonary embolism. Eur Heart J 27:476–481
doi: 10.1093/eurheartj/ehi588
pubmed: 16207738
Aujesky D, Perrier A, Roy PM, Stone RA, Cornuz J, Meyer G, Obrosky DS, Fine MJ (2007) Validation of a clinical prognostic model to identify low-risk patients with pulmonary embolism. J Intern Med 261:597–604
doi: 10.1111/j.1365-2796.2007.01785.x
pubmed: 17547715
Jiménez D, Aujesky D, Moores L, Gómez V, Lobo JL, Uresandi F, Otero R, Monreal M, Muriel A, Yusen RD, RIETE Investigators (2010) Simplification of the pulmonary embolism severity index for prognostication in patients with acute symptomatic pulmonary embolism. Arch Intern Med 170:1383–1389
doi: 10.1001/archinternmed.2010.199
pubmed: 20696966
Coutance G, Cauderlier E, Ehtisham J, Hamon M, Hamon M (2011) The prognostic value of markers of right ventricular dysfunction in pulmonary embolism: a meta-analysis. Crit Care 15:R103
doi: 10.1186/cc10119
pmcid: 3219376
pubmed: 21443777
Becattini C, Agnelli G, Vedovati MC, Pruszczyk P, Casazza F, Grifoni S, Salvi A, Bianchi M, Douma R, Konstantinides S, Lankeit M, Duranti M (2011) Multidetector computed tomography for acute pulmonary embolism: diagnosis and risk stratification in a single test. Eur Heart J 32:1657–1663
doi: 10.1093/eurheartj/ehr108
pubmed: 21504936
Lankeit M, Jiménez D, Kostrubiec M, Dellas C, Kuhnert K, Hasenfuß G, Pruszczyk P, Konstantinides S (2014) Validation of N-terminal pro-brain natriuretic peptide cut-off values for risk stratification of pulmonary embolism. Eur Respir J 43:1669–1677
doi: 10.1183/09031936.00211613
pubmed: 24627529
Becattini C, Vedovati MC, Agnelli G (2007) Prognostic value of troponins in acute pulmonary embolism: a meta-analysis. Circulation 116:427–433
doi: 10.1161/CIRCULATIONAHA.106.680421
pubmed: 17606843
Sinagra G, Anzini M, Pereira NL, Bussani R, Finocchiaro G, Bartunek J, Merlo M (2016) Myocarditis in Clinical Practice. Mayo Clin Proc 91:1256–1266
doi: 10.1016/j.mayocp.2016.05.013
pubmed: 27489051
Kytö V, Sipilä J, Rautava P (2014) Clinical profile and influences on outcomes in patients hospitalized for acute pericarditis. Circulation 130:1601–1606
doi: 10.1161/CIRCULATIONAHA.114.010376
pubmed: 25205801
Vecchié A, Chiabrando JG, Dell MS, Bonaventura A, Mauro AG, Wohlford G, Van Tassell BW, Berrocal DH, Montecucco F, Beutler A, Paolini JF, Gal TS, Abbate A (2020) Clinical Presentation and Outcomes of Acute Pericarditis in a Large Urban Hospital in the United States of America. Chest 158:2556–2567
doi: 10.1016/j.chest.2020.07.039
pmcid: 7768931
pubmed: 32717264
Konstantinides SV, Meyer G, Becattini C, Bueno H, Geersing GJ, Harjola VP, Huisman MV, Humbert M, Jennings CS, Jiménez D, Kucher N, Lang IM, Lankeit M, Lorusso R, Mazzolai L, Meneveau N, Ní Áinle F, Prandoni P, Pruszczyk P, Righini M, Torbicki A, Van Belle E, Zamorano JL, ESC Scientific Document Group (2020) 2019 ESC Guidelines for the diagnosis and management of acute pulmonary embolism developed in collaboration with the European Respiratory Society (ERS). Eur Heart J 41:543–603
doi: 10.1093/eurheartj/ehz405
pubmed: 31504429
West J, Goodacre S, Sampson F (2007) The value of clinical features in the diagnosis of acute pulmonary embolism: systematic review and meta-analysis. QJM 100:763–769
doi: 10.1093/qjmed/hcm113
pubmed: 18089542