Factors associated with the development of a lethal hospital outcome in patients with pulmonary embolism in different age groups

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Abstract

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.

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About the authors

Evgeniya A. Shmidt

Research Institute for Complex Problems of Cardiovascular Diseases

Author for correspondence.
Email: e.a.shmidt@mail.ru
ORCID iD: 0000-0003-3215-2140

M.D., D. Sci. (Med.), Leading Research Associate, Laboratory of Circulation Pathology, Division of Clinical Cardiology

Russian Federation, Kemerovo, Russia

Svetlana A. Berns

Research Institute for Complex Problems of Cardiovascular Diseases; National Medical Research Center for Therapy and Preventive Medicine

Email: svberns@yandex.ru
ORCID iD: 0000-0003-1002-1895

M.D., D. Sci. (Med.), Prof., Depart. of Therapy; Leading Research Associate, Laboratory of Circulation Pathology, Division of Clinical Cardiology

Russian Federation, Kemerovo, Russia; Moscow, Russia

Olga L. Barbarash

Research Institute for Complex Problems of Cardiovascular Diseases

Email: shmidt@kemcardio.ru
ORCID iD: 0000-0002-4642-3610

M.D., D. Sci. (Med.), Prof., Acad. of the Russian Academy of Sciences, Director

Russian Federation, Kemerovo, Russia

Alexey D. Erlikh

Russian National Research Medical University named after N.I. Pirogov; City Clinical Hospital No. 29 named after N.E. Bauman

Email: alexeyerlikh@gmail.com

M.D., D. Sci. (Med.), Prof., Depart. of Faculty Therapy of Medicine Faculty; Head of Depart., Cardiac Resuscitation Depart.

Moscow, Russia; Moscow, Russia

Dmitrii V. Duplyakov

Samara Regional Clinical Cardiological Dispensary named after V.P. Polyakov; Samara State Medical University,

Email: shmidt@kemcardio.ru
ORCID iD: 0000-0002-6453-2976

M.D., D. Sci. (Med.), Prof., Medical Director, Samara Regional Clinical Cardiology Dispensary; Prof., Depart. of Cardiology and Cardiovascular Surgery

Russian Federation, Samara, Russia; Samara, Russia

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2. Рис. 1. ROC-кривая риска развития смерти на госпитальном этапе в зависимости от возраста у пациентов с тромбоэмболией лёгочной артерии (AUC 0,684; р <0,0001)

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3. Рис. 2. ROC-кривые риска смерти на госпитальном этапе у пациентов 70 лет и старше (А) с показателем риска по шкале PESI более 142 баллов (р=0,001), а у пациентов 18–69 лет (Б) — более 89 баллов (р=0,001); PESI — индекс тяжести лёгочной эмболии

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