Risk Stratification of Patients With Acute Symptomatic Pulmonary Embolism Based on Presence or Absence of Lower Extremity DVT: Systematic Review and Meta-analysis.

Autor:	Becattini C; Department of Internal and Cardiovascular Medicine, University of Perugia, Perugia, Italy., Cohen AT; Department of Haematological Medicine, Guys and St. Thomas' NHS Foundation Trust, London, England., Agnelli G; Department of Internal and Cardiovascular Medicine, University of Perugia, Perugia, Italy., Howard L; National Pulmonary Hypertension Service, Hammersmith Hospital, Imperial College Healthcare NHS Trust, London, England., Castejón B; Vascular Department, Ramón y Cajal Hospital, IRYCIS, Madrid, Spain., Trujillo-Santos J; Medicine Department, Santa Lucía Hospital, Cartagena, Murcia, Spain., Monreal M; Medicine Department, Germans Trias i Pujol Hospital, Badalona, Spain., Perrier A; Division of General Internal Medicine, Department of Internal Medicine, Rehabilitation, and Geriatrics, Geneva University Hospitals and Faculty of Medicine, Geneva, Switzerland., Yusen RD; Division of Pulmonary and Critical Care Medicine, Washington University School of Medicine, St. Louis, MO; Division of General Medical Sciences, Washington University School of Medicine, St. Louis, MO., Jiménez D; Respiratory Department, Ramón y Cajal Hospital and Alcala de Henares University, IRYCIS, Madrid, Spain. Electronic address: djimenez.hrc@gmail.com.
Jazyk:	angličtina
Zdroj:	Chest [Chest] 2016 Jan; Vol. 149 (1), pp. 192-200. Date of Electronic Publication: 2016 Jan 06.
DOI:	10.1378/chest.15-0808
Abstrakt:	Background: For patients diagnosed with acute pulmonary embolism (PE), the prognostic significance of concomitant DVT lacks clarity. Methods: We performed a meta-analysis of studies that enrolled patients with acute PE to assess the prognostic value of concomitant DVT for the primary outcome of 30-day all-cause mortality and the secondary outcome of 90-day PE-related adverse events. We conducted unrestricted searches of PubMed and Embase from 1980 through September 30, 2014, and used the terms "deep vein thrombosis," "pulmonary embolism," and "prognos*." We used a random-effects model to pool study results, Begg rank-correlation method to evaluate for publication bias, and I(2) testing to assess for heterogeneity. Results: The meta-analysis included a total of nine studies (10 cohorts, as one study had two cohorts) with 8,859 patients. Of the seven cohorts with 7,868 participants who had PE and provided results on the primary outcome, 4,379 (56%) had concomitant DVT; 272 of 4,379 (6.2%) patients with concomitant DVT died 30 days after the diagnosis of PE compared with 133 of 3,489 (3.8%) without DVT. Concomitant DVT had a significant association with 30-day all-cause mortality in all patients (seven cohorts; OR, 1.9; 95% CI, 1.5-2.4; I(2) = 0%). Concomitant DVT was not significantly associated with 90-day PE-related adverse outcomes (five cohorts; OR, 1.6; 95% CI, 0.8-3.4; I(2) = 75%). Conclusions: In patients diagnosed with acute symptomatic PE, concomitant DVT was significantly associated with an increased risk of death within 30 days of PE diagnosis. (Copyright © 2016 American College of Chest Physicians. Published by Elsevier Inc. All rights reserved.)
Databáze:	MEDLINE
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