Factors associated with the development of a lethal hospital outcome in patients with pulmonary embolism in different age groups
Evgeniya A. Shmidt , Svetlana A. Berns , Olga L. Barbarash , Alexey D. Erlikh , Dmitrii V. Duplyakov
Kazan medical journal ›› 2023, Vol. 104 ›› Issue (4) : 491 -500.
Factors associated with the development of a lethal hospital outcome in patients with pulmonary embolism in different age groups
Background. The study of the tactics of managing patients with pulmonary embolism in the hospital period allows to find new approaches to treatment to reduce mortality. At the same time, it is known that the risk factors for death in patients of different age categories differ.
Aim. To study the features of the course of the disease and risk factors for a fatal hospital outcome in patients with pulmonary embolism in different age groups of participants in the All-Russian registry, which was named SIRENA (RusSIan REgister of pulmoNAry embolism).
Material and methods. The study included 570 patients with pulmonary embolism (database of the SIRENA multicenter registry in 2018–2019), who underwent a standard examination. They were divided into two groups according to age: the first group was 18–69 years old inclusive (n=369), the second group was 70 years and older (n=201). Differences in clinical history, laboratory and instrumental parameters in the studied groups of patients were assessed. Statistical comparison of data was performed using the Mann–Whitney test, Pearson test, and Fisher's exact test. For a quantitative description of the closeness of the association of a sign with the outcome of the disease, the odds ratio with a 95% confidence interval was determined.
Results. In the group of patients aged 18–69 years, deaths occurred 3 times less frequently than in the group of patients aged 70 years and older (8.9 vs 26.3%; p <0.0001). The risk of death increases in the presence of atrial fibrillation by 2.6 times (p=0.032), anemia with hemoglobin <113 g/l — by 4.3 times (p=0.0002), chronic kidney disease — by 5.5 times (p=0.001), increase in blood creatinine >125 mmol/l — 5.8 times (p <0.001). Additional risk factors in patients aged 70 years and older are ischemic heart disease (p=0.02), a history of stroke (p=0.003), and immobilization for 12 months prior to hospitalization (p <0.0001).
Conclusion. In patients aged 18–69 years, atrial fibrillation, anemia, and impaired renal function are fatal risk factors; at the age of 70 years and older, along with these, previous immobilization and comorbid cardiovascular pathology have an adverse effect.
pulmonary embolism / SIRENA register / age / risk factors
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