老年患者急性肺栓塞后30天内死亡因素分析

Analysis of death factors within 30 days after acute pulmonary embolism in elderly patients

中文关键词: 老年  急性肺栓塞  30d全因死亡  肺血栓栓塞症危险分层  平均血小板体积  D-二聚体/纤维蛋白原比值

英文关键词: elderly  acute pulmonary embolism  all-cause death  pulmonary thromboembolism risk stratification  mean platelet volume  D-dimer/fibrinogen ratio

中文摘要:

      目的 探讨老年急性肺栓塞(APE)患者 30d 内各种死亡影响因素,评估各因素在 APE 预后的预测价值.方法 本研究采用回顾性分析,纳入2021 年1 月—2023 年5 月间于上海市静安区中心医院住院治疗的老年(年龄≥60 岁)APE患者共88 例.按发病时是否伴休克、低血压、心功能不全和心脏生物学指标升高等进行危险分层,并记录临床生命体征和实验室检查数据,随访患者确诊APE后30d内的生存状态.按照患者30d后存活与否分为存活组和死亡组,对比分析2 组患者的各项数据.结果 入选88 例病例中,存活和死亡患者的年龄、平均心率、平均收缩压、平均血小板体积(MPV)、D-二聚体/纤维蛋白原比值(DFR)和肺血栓栓塞症危险分层存在差异,差异有统计学意义(P＜0.05);单因素Logistic回归分析显示患者年龄、平均心率、下肢静脉血栓、MPV、DFR、肺血栓栓塞症危险分层是APE患者30d内全因死亡的影响因素(P＜0.05);多因素Logistic回归分析显示MPV、DFR和肺血栓栓塞症危险分层可作为APE患者30d内全因死亡的独立预测因子(P＜0.05).此外,在老年APE患者30d内全因死亡预测中,MPV、DFR和肺血栓栓塞症危险分层单独及三者联合诊断的受试者工作特征曲线(ROC)下面积(AUC)分别为0.762、0.839、0.821、0.926.结论 MPV、DFR和肺血栓栓塞症危险分层可以作为老年APE患者短期预后的独立预测因子,三者评估对老年APE患者30d内全因死亡具有较高的预测价值.

英文摘要:

      Objective To explore the influence factors of death within 30 days in elderly patients with acute pulmonary embolism(APE),and evaluate the predictive value of various factors in the prognosis of APE.Methods A total of 88 elderly APE patients(aged≥60 years)admitted to Central Hospital of Jing'an District from January 2021 to May 2023 were included in this study by retrospective analysis.Risk stratification was performed based on whether shock,hypotension,cardiac dysfunction,and elevated cardiac biological indicators were present at the onset of the disease.Their clinical vital signs and laboratory data were recorded,and their survival status was followed up within 30 days after diagnosis of APE.According to whether the patients survived after 30 days,they were divided into survival group and death group,and various data of the two groups were compared and analyzed.Results Among the 88 patients included,there were statistically significant differences in age,mean heart rate,mean systolic blood pressure,mean platelet volume(MPV),D-dimer/fibrinogen ratio(DFR)and risk stratification of pulmona-ry thromboembolism between the survival group and the death group(P＜0.05).Univariate logistic regression analysis showed that age,mean heart rate,lower limb venous thrombosis,MPV,DFR,and pulmonary thromboembolism risk stratification were the influencing factors for all-cause death in APE patients within 30 days(P＜0.05).Multivariate logistic regression analysis showed that MPV,DFR and pulmonary thromboembolism risk stratification were independent predictors of all-cause death within 30 days in APE patients(P＜0.05).In the prediction of all-cause death within 30 days in elderly APE patients,the area under re-ceiver operating characteristic curve(AUC)of MPV,DFR and pulmonary thromboembolism risk stratification alone and com-bined diagnosis were 0.762,0.839,0.821 and 0.926,respectively.Conclusion MPV,DFR and pulmonary thromboembolism risk stratification can serve as independent predictors of short-term prognosis in elderly APE patients.The combined assessment of the three indexes has a high predictive value for all-cause death within 30 days in elderly APE patients.