ABSTRACT
OBJECTIVE: To analyze the clinical features of patients with pulmonary thromboembolism complicated with pleural effusion and to explore the factors affecting pleural effusion caused by pulmonary thromboembolism and the prognostic factors of patients with pulmonary thromboembolism.METHODS: Clinical data of 150 patients with confirmed pulmonary thromboembolism were all obtained from the national multi-center registration and research database of pulmonary thromboembolism in our hospital from January 2012 to December 2018.Patients with pulmonary thromboembolism were divided into two groups:group of pulmonary thromboembolism combined with pleural effusion and group without pleural effusion.The differences between the two groups in demographic characteristics,basic diseases,clinical manifestations and laboratory examination results were retrospectively compared.RESULTS: In the 150 patients with pulmonary thromboembolism,there were 48 patients with pleural effusion,accounting for 32%.Compared with the without pleural effusion,the pulmonary thromboembolism with pleural effusion was more common after surgery or traumatic history(22% vs.8%),chest pain(54% vs.22%),dyspnea(65% vs.39%)and fever(8% vs.1%)had a higher incidence,white blood cell count(10.75 × 109/L vs.8.56×109/L),C-reactive protein(67.45 mg/dL vs.17.21 mg/dL)and prothrombin time(13.75 s vs.12.20 s)increased significantly,the difference being significant(P<0.05).Multivariate Logistic regression analysis showed that C-reactive protein,chest pain and dyspnea were independent influencing factors of pleural effusion in patients with pulmonary thromboembolism(OR values were 1.011,2.922,2.308,P<0.05).Kaplan-Meier survival analysis showed that the patients with pleural effusion had poor prognosis.Multivariate Cox risk regression analysis showed that pleural effusion was an independent risk factor for poor prognosis in patients with pulmonary thromboembolism.CONCLUSION: The patients with pulmonary thromboembolism have high incidence of pleural effusion,especially after surgery or trauma;in patients with unexplained pleural effusion,if there is chest pain and dyspnea,and elevated C-reactive protein,pulmonary thromboembolism should be highly suspected of.If necessary,computed tomography pulmonary angiography should be performed to confirm the diagnosis.Pleural effusion is an independent risk factor for poor prognosis in patients with PTE.
ABSTRACT
<p><b>BACKGROUND</b>The clinical significance of acute vasoreactivity testing (AVT) in patients with chronic thromboembolic pulmonary hypertension (CTEPH) remains unclear. We analyzed changes in hemodynamics and oxygenation dynamics indices after AVT in patients with CTEPH using patients with pulmonary arterial hypertension (PAH) as controls.</p><p><b>METHODS</b>We analyzed retrospectively the results of AVT in 80 patients with PAH and 175 patients with CTEPH registered in the research database of Beijing Chao-Yang Hospital between October 2005 and August 2014. Demographic variables, cardiopulmonary indicators, and laboratory findings were compared in these two subgroups. A long-term follow-up was conducted in patients with CTEPH. Between-group comparisons were performed using the independent-sample t-test or the rank sum test, within-group comparisons were conducted using the paired t-test or the Wilcoxon signed-rank test, and count data were analyzed using the Chi-squared test. Survival was estimated using the Kaplan-Meier method and log-rank test.</p><p><b>RESULTS</b>The rates of positive response to AVT were similar in the CTEPH (25/175, 14.3%) and PAH (9/80, 11.3%) groups (P > 0.05). Factors significantly associated a positive response to AVT in the CTEPH group were level of N-terminal pro-brain natriuretic peptide (≤1131.000 ng/L), mean pulmonary arterial pressure (mPAP, ≤44.500 mmHg), pulmonary vascular resistance (PVR, ≤846.500 dyn·s-1·m-5), cardiac output (CO, ≥3.475 L/min), and mixed venous oxygen partial pressure (PvO2, ≥35.150 mmHg). Inhalation of iloprost resulted in similar changes in mean blood pressure, mPAP, PVR, systemic vascular resistance, CO, arterial oxygen saturation (SaO2), mixed venous oxygen saturation, partial pressure of oxygen in arterial blood (PaO2), PvO2, and intrapulmonary shunt (Qs/Qt) in the PAH and CTEPH groups (all P > 0.05). The survival time in patients with CTEPH with a negative response to AVT was somewhat shorter than that in AVT-responders although the difference was not statistically significant (χ2 =3.613, P = 0.057). The survival time of patients with CTEPH who received calcium channel blockers (CCBs) was longer than that in the group with only basic treatment and not shorter than that of patients who receiving targeted drugs or underwent pulmonary endarterectomy (PEA) although there was no significant difference between the four different treatment regimens (χ2 =3.069, P = 0.381).</p><p><b>CONCLUSIONS</b>The rates of positive response to AVT were similar in the CTEPH and PAH groups, and iloprost inhalation induced similar changes in hemodynamics and oxygenation dynamics indices. A positive response to AVT in the CTEPH group was significantly correlated with milder disease and better survival. Patients with CTEPH who cannot undergo PEA or receive targeted therapy but have a positive response to AVT might benefit from CCB treatment.</p>