Analysis Of Factors Relating To Risk Stratification And Hospital Outcome Of Low-medium Risk Acute Pulmonary Embolism Patients

ObjectiveTo investigate the clinical predictors which can be used to distinguish acute low-risk APE from the medium-risk and to indicate the hospital prognosis of low-medium risk acute pulmonary embolism(APE)patients,by analyzing factors of the clinical manifestation,auxiliary examination,treatment and hospital outcomes of low-risk and medium-risk APE patients.MethodWe respectively analyzed the clinical data of 137 patients with acute pulmonary embolism from November,2010 to November,2015.All of the data of 137 patients came from The First People's Hospital Affiliated to Shanghai Jiao Tong University(SJTU).We stratified the 137 patients into low-risk and medium-risk APE according to “The guideline of diagnosis and management of acute pulmonary embolism”,which was released by European society of cardiology(ESC)in 2008,and compared the clinical symptoms,auxiliary examination,treatment and hospital outcome of patients from the two different risk stratification groups.Result1.Compared with low-risk group,patients with medium-risk APE had a more common in medical ICU and cardiology department.In addition,low-risk APE was more common in respiratory department and intervention setting comparing with medium-risk APE.The difference was statistically significant.2.Compared with low-risk group,the symptoms of syncope and dyspnea were more often in patients with medium-risk APE.The difference was statistically significant.3.Compared with low-risk group,the platelet count(PLT),plateletcrit(PCT),platelet distribution width(PDW),aspartate aminotransferase(AST),simplified pulmonary embolism severity index(sPESI)score,pulmonary artery systolic pressure(PASP),heart rate(HR),and respiratory rate(RR)were higher,and the legth in ICU was longer in patients with medium-risk APE.The difference was statistically significant.4.Compared with low-risk group,the patients with medium-risk APE were more likely to secondary bleeding complications,and the difference was statistically significant.All patients were small bleeding events such as skin ecchymosis.5.We analyzed the clinical data of patients with acute low-medium risk plmonary embolism by Logistic multi-factor binary regression analysis and found that dyspnea(P=0.000,OR=11.771,95% CI: 3.996 ~ 34.678)was more commom in medium-risk APE patients.The aspertate aminotransferase(P=0.002,OR=1.056,95% CI: 1.021~1.093)was higer and the platelet count(P=0.005,OR=0.991,95% CI: 0.985~0.997)was lower in medium-risk APE patients.When the Cut-off values of aspertate aminotransferase(AST)and platelet(PLT)were 27.45 U/L and 200*10^9/L respectively,the general judgment right of acute low-medium risk pulmonary embolism patients was highest.6.We also analyzed the clinical data of patients with acute low-medium risk pulmonary embolism by Logistic binary regression analysis and found that the platelet distribution width(P=0.031,OR=1.482,95% CI: 1.036~2.120),the sPESI(P=0.023,OR=3.782,95% CI: 1.204~11.879)and malignant tumors(P=0.037,OR=10.177,95% CI: 1.145~90.472)were independent risk factors for mortality during hospitalization in patients with acute low-medium risk pulmonary embolism.When the Cut-off values of the platelet distribution width(PDW)and simplified pulmonary embolism severity index(sPESI)were 15.45 and 1.5 respectively,the general judgment right of hospital mortality in acute low-medium risk pulmonary embolism patients was highest.ConclusionWe can initially distinguish the low-risk APE from the medium-risk by the patients' clinical manifestations(dyspnea),platelet count(PLT),aspartate aminotransferase(AST).In addition,platelet distribution width(PDW),simplified pulmonary embolism severity index(sPESI)and malignant tumor(MT)can be used to evaluate the hospital mortality risk of patients with low-medium risk APE.Clinicians should take proper treatment measures as early as possible to improve the prognosis.