Analysis of risk factors for readmission within 90 days in patients with acute pulmonary embolism
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摘要: 目的 探讨影响急性肺栓塞患者90 d内再入院的危险因素。方法 连续性选取2016年1月1日—2021年6月30日首次于我院就诊，符合纳入和排除标准的肺栓塞病例。根据出院90 d内再入院情况，分为再入院组和对照组，分析两组的一般临床资料、实验室检验和影像学检查，通过单因素分析和Cox回归获得90 d内再入院的危险因素。结果 共纳入271例肺栓塞患者，其中再入院组29例，对照组242例。单因素分析显示两组慢性心肺疾病史比例、下肢水肿比例、血小板计数、PESI评分、sPESI评分、危险分层和肺动脉增宽(心脏彩超)的差异有统计学意义(P < 0.05)。Cox回归提示肺栓塞90 d内再入院的危险因素有下肢水肿(HR：2.288，95%CI 1.085~4.827)、舒张压(HR：1.026，95%CI 1.003~1.050)和危险分层(HR：1.553，95%CI 1.117~2.160)。结论 下肢水肿、舒张压升高和高危险分层是肺栓塞90 d内再入院的危险因素。Abstract: Objective To explore the risk factors affecting readmission within 90 days in patients with acute pulmonary embolism.Methods Patients diagnosed with pulmonary embolism in Guangdong Provincial hospital of Chinese Medicine for the first time from January 1, 2016 to June 30, 2021 were consecutively selected according to the inclusion and exclusion criteria. The included patients were divided into readmission group who readmitted within 90 days of discharge and control group. We analyzed the general clinical data, laboratory tests and imaging examinations of the two groups. The risk factors for readmission within 90 days were obtained by univariate analysis and Cox regression analysis.Results A total of 271 patients with pulmonary embolism were enrolled, including 29 patients in the readmission group and 242 patients in the control group. Single-factor analysis demonstrated that there were significant differences in the scale of history of chronic cardiopulmonary disease, the scale of lower extremity edema, the platelet count, PESI score, sPESI score, risk stratification and the scale of widened pulmonary artery trunk(cardiac color doppler ultrasound) between the two groups(P < 0.05). Cox regression analysis showed that lower extremity edema(HR: 2.288, 95%CI 1.085-4.827), diastolic blood pressure(HR: 1.026, 95%CI 1.003-1.050) and classification of pulmonary embolism severity(HR: 1.553, 95%CI 1.117-2.160) were risk factors for readmission within 90 days of pulmonary embolism.Conclusion Lower extremity edema, elevated diastolic blood pressure and high classification of pulmonary embolism severity were risk factors of readmission within 90 days for patients with pulmonary embolism.
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Key words:
- pulmonary embolism /
- readmission /
- risk factors /
- thrombus
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表 1 再入院组和对照组基本临床特征的比较
Table 1. General data
例(%), X±S, M(Q) 项目 再入院组(29例) 对照组(242例) t/Z/χ2 P 年龄/岁 63(24.00) 65(19.00) -0.464 0.643 男性 18(62.07) 109(45.04) 3.015 0.082 身高/m 1.65(0.20) 1.62(0.15) -0.660 0.509 体重/kg 62.34±14.26 63.62±13.97 0.404 0.686 BMI/(kg/m2) 23.90(5.00) 23.90(6.32) -0.404 0.686 住院时间/d 13(10.50) 14(10.00) -1.303 0.193 收缩压/mmHg 133.00±21.78 129.00±22.02 0.750 0.454 舒张压/mmHg 84.00±17.98 78.00±14.09 1.595 0.120 呼吸困难 21(72.41) 154(63.64) 0.872 0.350 胸痛 7(24.14) 65(26.86) 0.098 0.754 咯血 1(3.45) 11(4.55) — 1.000 下肢疼痛 2(6.90) 20(8.26) — 1.000 下肢水肿 12(41.38) 48(19.83) 6.973 0.008 精神状态改变 4(13.79) 22(9.09) — 0.499 手术史 4(13.79) 60(24.79) 1.737 0.187 肿瘤史 8(27.59) 63(26.03) 0.032 0.857 慢性心肺疾病史 15(51.72) 75(30.99) 5.018 0.025 PESI评分/分 101.00(45.50) 87.50(37.25) -1.993 0.046 PESI分级 -1.510 0.131 Ⅰ级 3(10.34) 52(21.49) Ⅱ级 7(24.14) 62(25.62) Ⅲ级 10(34.48) 60(24.79) Ⅳ级 2(6.90) 43(17.77) Ⅴ级 7(24.14) 25(10.33) sPESI评分/分 2(1.50) 1(1.00) -2.177 0.029 危险分层 -2.073 0.038 低危 10(34.48) 113(46.69) 中低危 7(24.14) 82(33.88) 中高危 5(17.24) 22(9.09) 高危 7(24.14) 25(10.33) 
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表 2 再入院组和对照组实验室检验的对比
Table 2. Laboratory test in two groups
X±S, M(Q) 项目 再入院组(29例) 对照组(242例) t/Z P pH 7.44(0.10) 7.43(0.05) -0.471 0.637 PaO2/mmHg 83.00(51.00) 80.00(32.25) -1.032 0.302 PaCO2/mmHg 33.00(8.00) 34.50(8.25) -1.249 0.212 乳酸/(mmol/L) 1.44(0.95) 1.50(1.10) -0.634 0.526 白细胞计数/(×109/L) 7.80(5.27) 9.18(4.41) -0.949 0.343 红细胞计数/(×1012/L) 4.36±1.00 4.23±0.79 0.796 0.427 血红蛋白/(g/L) 127.00(40.00) 125.00(30.25) -0.323 0.746 血小板计数/(×109/L) 198.00(96.50) 232.50(108.75) -2.086 0.037 D-二聚体/(mg/L) 9.33(14.56) 5.50(7.98) -1.356 0.175 总胆固醇/(mg/dL) 4.10(1.56) 4.42(1.63) -0.281 0.779 甘油三酯/(mmol/L) 1.15(0.76) 1.22(0.98) -0.142 0.887 高密度脂蛋白胆固醇/(mmol/L) 0.91(0.57) 0.97(0.44) -0.548 0.584 低密度脂蛋白胆固醇/(mmol/L) 2.63(1.62) 2.80(1.32) -0.145 0.884 NT-proBNP/(pg/mL) 1 718.00(2 849.86) 1 265.25(2 008.88) -0.938 0.348 cTnT/(μg/L) 0.032(0.055) 0.019(0.052) -1.290 0.197
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表 3 再入院组和对照组影像学检查的对比
Table 3. Imaging examination in two groups
例(%), M(Q) 项目 再入院组(29例) 对照组(242例) χ2/Z P CTPA 肺动脉干栓塞 2(6.90) 5(2.07) — 0.166 双侧肺动脉栓塞 6(20.69) 44(18.18) 0.108 0.742 单侧肺动脉栓塞 6(20.69) 48(19.83) 0.012 0.913 双侧叶段及以下的分支栓塞 15(51.72) 142(58.68) 0.514 0.474 单侧叶段及以下的分支栓塞 12(41.38) 99(40.91) 0.002 0.961 心脏彩超 EF值/% 70.00(7.50) 67.00(7.00) -1.687 0.092 右心室壁局部运动幅度下降 0 2(0.83) — 1.000 右心室/右心房扩大 10(34.48) 61(25.21) 1.152 0.283 三尖瓣反流速度增快 0 22(9.09) — 0.145 肺动脉干增宽 7(24.14) 24(9.92) — 0.032 下肢静脉彩超 1.558 0.212 有血栓 19(65.52) 129(53.31) 无血栓 10(34.48) 113(46.69)
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表 4 肺栓塞90天内再入院危险因素的Cox回归分析(Forward LR法)
Table 4. Cox regression analysis
项目 B S.E. Wald P HR HR的95%CI 下限 上限 下肢水肿 0.828 0.381 4.722 0.030 2.288 1.085 4.827 危险分层 0.440 0.168 6.855 0.009 1.553 1.117 2.160 舒张压 0.026 0.012 4.910 0.027 1.026 1.003 1.050
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