دانلود رایگان مقاله شاخص شوک برای عاقبت و رده بندی خطر در آمبولی حاد ریه

Abstract

Introduction: Risk stratification of patients with acute pulmonary embolism (PE) is crucial in deciding appropriate therapy management. Shock index (SI) is rapidly available and a reliable parameter. We aimed to investigate SI for short term outcome in acute PE. Materials and methods: Data of 182 patients with acute PE were analysed retrospectively. SI was defined as heart rate divided by systolic blood pressure. Logistic regression models were calculated to investigate associations between SI and in-hospital-death, myocardial necrosis and presence of right ventricular dysfunction (RVD) respectively. Moreover ROC curves and cut-off values for SI predicting in-hospital death, myocardial necrosis and RVD were computed. Results: 182 patients (61.5% female, mean age 68.5
15.3 years) with acute PE event were included in the study. 5 patients (2.7%) died an in-hospital death. Logistic regression models revealed an association between SI and respectively inhospital death (OR 5.854, 95% CI 1.876e18.274, P Z 0.00234), myocardial necrosis (OR 5.043, 95% CI 1.362e18.674, P Z 0.0154) and RVD (OR 53.539, 95% CI 6.810e420.914, P Z 0.000155). ROC analysis for SI predicting in-hospital death, myocardial necrosis and RVD revealed an AUC of 0.806, 0.636 and 0.713 respectively with respectively SI cut-off values of 0.89, 0.75 and 0.54. Conclusions: SI is a significant predictor of in-hospital death, myocardial necrosis and RVD. The effectiveness of SI to predict in-hospital death is high with an optimal cut-off value of 0.89 for differentiation between PE patients with lower and higher risk to die in hospital after acute PE event.

Limitations

The most important study limitations are the small number of included PE patients and the retrospective study character. Therefore, follow-up examinations are missing. Beside the outcome marker in-hospital death, several study results have already shown the connection between myocardial necrosis as well as RVD and elevated mortality in the follow up. Therefore the surrogate parameters of myocardial necrosis and RVD are established and widely used risk stratification markers for the outcome of PE. Further limitations are the variability of our study data and the fact that conclusions are drawn upon regression analyses.