[Prevalence and severity of pulmonary embolism are dependent on clinical and paraclinical parameters : Analysis of 1,943 consecutive patients with CT pulmonary angiography]. / Prävalenz und Schwere der Lungenarterienembolie in Abhängigkeit von klinischen und paraklinischen Parametern : Analyse von 1943 konsekutiven Patienten mit CT-Pulmonalisangiographie.
Med Klin Intensivmed Notfmed
; 112(3): 227-238, 2017 Apr.
Article
em De
| MEDLINE
| ID: mdl-26931133
ABSTRACT
BACKGROUND:
Patients with pulmonary embolism (PE) have heterogeneous symptoms. Clinical scores and age-adjusted Ddimer should help clinicians to establish the correct diagnosis.METHODS:
A cohort of 1,943 consecutive patients with positive Ddimer levels who were referred for CT pulmonary angiography (CTPA) over a period of 5 years to rule PE in or out were retrospectively analyzed.RESULTS:
On CTPA n = 362 (19 %) had PE. The prevalence of PE increased stepwise with increasing Ddimer levels (prevalence of PE with 10 percentiles of Ddimers was 3 %, 4 %, 7 %, 8 %, 8 %, 21 %, 20 %, 27 %, 37 %, 52 %; p < 0.001). Ddimers > 2.0 were significantly associated with PE (OR 7.17 95 % CI 5.27-9.76, p < 0.001). Chest discomfort and tachypnea showed no association with PE. Dyspnoea, pleuritic pain, and general fatigue showed significant associations with age pleuritic chest pain was more frequent in patients aged < 76 years than in patients aged > 76 years (15 % vs 3 %; p < 0.001) and was highly significantly associated with PE (OR 4.99 95 % CI 2.83-8.81; p < 0.001). General fatigue was more prevalent in patients aged > 76 years (44 % vs 24 %; p < 0.001). PE patients with Ddimers > 6.0 mg/l were hemodynamically more compromised than patients with Ddimers < 6.0 mg/l tachycardia 32 % vs 20 %, p = 0.015; right ventricular strain on echocardiography 38 % vs 23 %, p = 0.003; right ventricular strain on ECG 27 % vs 13 %; p = 0.001; resuscitation 4 % vs 0 %, p = 0.003; lytic therapy 6 % vs 1 %, p = 0.014.CONCLUSION:
The symptoms of PE patients are often vague. Particularly in older patients, fatigue may be the only symptom. The absolute level of Ddimers, particularly > 2.0 mg/l, is a strong predictor of PE. A Ddimer level > 6.0 mg/l is associated with more severe hemodynamic impairment in patients with PE.Palavras-chave
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Base de dados:
MEDLINE
Assunto principal:
Embolia Pulmonar
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Angiografia por Tomografia Computadorizada
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Pulmão
Idioma:
De
Ano de publicação:
2017
Tipo de documento:
Article