Clinical Characteristics And Progonosis Of Non-high-risk Acute Pulmonary Thromboembolism In Different Age Groups

Objective:To investigate the clinical characteristics and prognostic factors of non-high-risk acute pulmonary embolism(APE)in different age groups.Methods:A total of 286 patients with pulmonary embolism admitted to the Affiliated Hospital of Southwest Medical University from July 2013 to August 2019 were retrospectively collected,and 153 non-high-risk APE patients meeting inclusion criteria were selected as the study objects.The 90-day prognosis of discharged patients was obtained by telephone or consulting the outpatient electronic medical record system,and the clinical data and 90-day prognosis of all patients were collected.The subjects were divided into the non-elderly group(< 65 years old)and the elderly group(?65 years old)according to age,and the demographic characteristics,clinical symptoms,basic diseases,risk factors,laboratory indicators,imaging characteristics,complication,90-day prognosis and other indicators of the patients in the two groups were compared.Univariate and multivariate Logistic regression analysis was used to explore predictors of the prognosis of non-high-risk APE,and the receiver operating characteristic curve(ROC)of the predictive value of indicators to the 90-day prognosis of non-high-risk APE was drawn.The Z test was performed to compare the area under the subject operating characteristic curve(AUC)of the predictors.Results:A total of 153 non-high-risk APE patients were included in the study,including 86 males and 67 females aged 24-86 years,with an average age of 66.04±12.83 years.According to age,they were divided into elderly group(?65 years old)and non-elderly group(< 65 years old).In the non-elderly group,there were 57 cases(37.3%),aged 24-64,with an average age of 52.53±9.70,including 34 males and 23 females.In the elderly group,there were 96 cases(62.7%),aged 65-86,with an average age of 74.06±5.78,including 52 males and 44 females.The patients were followed up for 90 days,with 128 survivors and 25 deaths.The proportion of elderly patients with hypertension,coronary heart disease,cerebrovascular disease and arrhythmia was higher than that of non-elderly patients(P < 0.05).Two groups of patients with gender,history of smoking,drinking,dyslipidemia,diabetes,or other organic heart disease,chronic obstructive pulmonary disease,chronic renal insufficiency,first suffering from malignant tumor medical history,history of VTE,history of trauma surgery/fracture,history of surgery within 4 weeks,long-term bed/brake risk factors such as comparison,there were no statistically significant difference(P>0.05).Two groups of patients with common clinical symptoms of dyspnea and shortness of breath,chest pain,palpitation,cough and expectoration,two groups of patients with chest pain,heart palpitations compare the difference was statistically significant(P < 0.05),two groups of coughing coughing up phlegm,haemoptysis,dyspnea,abdominal pain and shortness of breath,syncope,unilateral lower limb swelling,unilateral lower limb pain,there was no statistically significant difference(P>0.05).The lymphocyte count,albumin,total cholesterol,triglyceride,LDL cholesterol and apolipoprotein B in the elderly group were lower than those in the non-elderly group(P < 0.05).The mean platelet volume of the elderly group was higher than that of the non-elderly group(P< 0.05).Two groups of patients white blood cell count,neutrophil count,neutrophil and lymphocyte ratio(NLR),red blood cell distribution width(RDW),hemoglobin,platelet,random blood glucose,creatinine,uric acid,D-dimer,fibrinogen degradation products(FDP),troponin T,high-density lipoprotein cholesterol and apolipoprotein A(ApoA)comparing is no statistical significance(P>0.05).The difference in risk stratification and simplified Wells score between the two groups was statistically significant(P < 0.05),while the difference in revised Geneva score between the two groups was not statistically significant(P > 0.05).Respiratory failure,deep vein thrombosis,varicose veins of lower extremities,pleural effusion,pericardial effusion,polyserous effusion,sPESI score and 90-day prognosis of the two groups showed no significant difference(P > 0.05).There was no significant difference in the location and type of thromboembolism between the two groups(P >0.05).Multivariate Logistic regression analysis showed that age(OR=1.147,95%CI:1.056-1.246),NLR(OR=1.091,95%CI:1.004-1.185),RDW(OR=1.964,95%CI:1.320-2.922),FDP(OR=1.017,95%CI:1.003-1.030),and ApoA(OR= 0.108,95%CI:0.014-0.842)were independent predictors of 90-day prognosis of non-high-risk APE.ROC curves of the above predictors were drawn.The results showed that the AUC of age,NLR and RDW were all > 0.7,the specificity was 85.2%,74.2% and 57.0%,and the sensitivity was 52.0%,88.0% and 88.0%,respectively.The AUC of FDP and ApoA were both < 0.7.The Z test compared the AUC of age,NLR and RDW were not statistically significant(P>0.05).Conclusion:1.Elderly non-high-risk APE patients are often associated with hypertension,cerebrovascular disease,coronary heart disease,arrhythmia and other basic diseases,and are prone to palpitations.Non-elderly patients are more likely to experience chest pain.2.Lymphocytes,albumin,total cholesterol,triglycerides and LDL-C in elderly non-high-risk APE patients were lower than those in non-elderly non-high-risk APE patients,suggesting that the elderly group may have more severe inflammatory responses.3.Age,NLR and RDW were independent predictors of 90-day prognosis of non-high-risk APE,with no statistical difference in the predictive efficacy of the three.