Clinical Characteristics And Death Risk Factors In Patients With Acute Pulmonary Embolism With Different Risk Stratification

Objective: The differences among the risk stratification were explored,simple clinical indicators to determine the risk stratification and factors influencing in-hospital mortality within each risk stratification were searched by analyzing the clinical data,laboratory indicators and imaging manifestations among different risk stratification,within each risk stratification,and different hospitalization transitions related to patients with acute pulmonary embolism(APE)from Yijishan Hospital,the First Affiliated Hospital of Wannan Medical College,from 2018 to 2022,so as to provide reference for clinical diagnosis and treatment and optimization of risk stratification.Methods: The clinical and laboratory data of 108 patients admitted for the first time with acute pulmonary embolism at Yiji Shan Hospital,the First Affiliated Hospital of Wanan Medical College from January 2018 to November 2022 were analyzed retrospectively.The patients were divided into low-risk,moderate-risk and high-risk acute pulmonary embolism group by hemodynamics,clinical indicators and s PESI score according to the relevant recommendations of risk stratification from 《 Guidelines for diagnosis,treatment and prevention of pulmonary thromboembolism(2018)》and European ESC guidelines(2019),and were divided into death group and non-death group according to their clinical regression.The differences of clinical data(including general data,underlying diseases and comorbidities),laboratory indexes(blood routine,cardiac marker indexes,renal function indexes,D-dimer,etc.)and imaging manifestations(CTPA,pulmonary angiography and lower extremity ultrasound)between different groups were described,compared and analyzed.Results: 1.The age,troponin,b-type natriuretic peptide,creatinine level of patients in the intermediate-risk group,and the age,white blood cell count,troponin,creatinine level of the high-risk group,compared with the lower risk acute pulmonary embolism group,there was a significant increase,and the comparison between the groups had a statistical difference,P<0.05,which was statistically significant.2.In the low-risk acute pulmonary embolism group,compared with the non-death group,the levels of troponin,d-dimer and NLR in the deceased group were significantly increased,and the difference was statistically significant(P<0.05);compared with the non-deceased group,the NLR and urea nitrogen levels in the intermediate-risk acute pulmonary embolism group were significantly increased,and the difference was statistically significant(P<0.05).In the acute pulmonary embolism group of the high-risk group,there was a statistically significant difference in the embolization site between the two groups compared with the non-death group(P<0.05).3.Multivariate binary logisitic regression analysis was performed in patients with intermediate-risk acute pulmonary embolism according to the outcome of hospitalization,and the results showed that the death group had higher urea nitrogen levels(OR=1.145,95%CI1.016-2.258,P=0.025).The roc curve of urea nitrogen was plotted,and the results showed that the Cut-off value of urea nitrogen was 5.505mmol/l,and the sensitivity and specificity of in-hospital death from intermediate-risk acute pulmonary embolism were88.9%,and the comprehensive evaluation rate was the highest for in-hospital death of intermediate-risk acute pulmonary embolism.Conclusion: 1.For risk stratification of APE patients,age,troponin,and creatinine levels may be useful for low-risk non-low-risk stratification.2.In patients with low-risk APE,troponin,d-dimer,and NLR may be associated with in-hospital all-cause mortality.3.In patients with intermediate risk APE,urea nitrogen and NLR levels may be associated with in-hospital all-cause mortality,and urea nitrogen may be an independent risk factor for in-hospital mortality.