Analysis of risk factors for acute moderate to high risk pulmonary thromboembolism in adults / 中国医师杂志

ABSTRACT

Objective:To investigate the risk factors according to the clinical data of the adult patients with acute moderate to high risk pulmonary thromboembolism (PTE).Methods:The clinical data of 100 adult patients with acute moderate-risk PTE in Hunan Provincial People′s Hospital from June 2019 to March 2022 were analyzed retrospectively. According to the risk stratification, they were divided into moderate to low risk group (34 cases) and moderate to high risk group (66 cases). The laboratory data and clinical data of all adult patients were collected, and the independent risk factors of acute moderate to high risk PTE in adults were analyzed by binary logistic regression; Receiver operating characteristic (ROC) curve was used to analyze the predictive ability of independent risk factors for acute moderate to high risk PTE.Results:There were 34 patients with moderate to low risk PTE, 20 males and 14 females, aged 16-86 (60.2±15.5)years, 66 patients with moderate to high risk PTE, 36 males and 30 females, aged 34-82(63.6±9.6)years. There was no significant difference in age, gender and risk factors between the two groups (all P>0.05). The tumor history of concomitant diseases in moderate to high risk group was significantly higher than that in moderate to low risk group, and the symptoms of dyspnea and shortness of breath in moderate to high risk group were significantly higher than those in moderate to low risk group (all P>0.05). The levels of troponin I, shock index (SI) and N-terminal B-type brain natriuretic peptide precursor (NT-proBNP) in moderate to high risk group were significantly higher than those in moderate to low risk group, while the levels of PaO 2 and oxygenation index in moderate to high risk group were significantly lower than those in moderate to low risk group, with statistical significant difference (all P<0.05). Echocardiographic results showed that there were significant differences in right ventricular inner diameter (RV), left ventricular inner diameter (LV), RV/LV, tricuspid regurgitation velocity and pulmonary systolic pressure between moderate to high risk PTE patients and moderate to low risk PTE patients (all P>0.05). CTPA results showed that RV, RV/LV, main pulmonary artery diameter and thrombus load in moderate to high risk PTE patients were significantly higher than those in moderate to low risk PTE patients (all P<0.05). Multivariate binary logistic regression analysis showed that SI, NT-proBNP and RV were independent predictors of moderate to high risk PTE (all P<0.05). The combined detection of SI, NT-proBNP and RV had a good predictive value for moderate to high risk PTE. The area under ROC curve (AUC) was 0.984, the sensitivity and specificity were 90.32% and 97.73%, respectively. The negative predictive value was 87.8%, and the positive predictive value was 98.2%. Conclusions:SI, NT-proBNP, RV of echocardiography and RV of CTPA are the predictors of acute moderate to high risk PTE in adults, which provided a strong supplement for the risk stratification of acute moderate risk PTE in adults.