Elsevier

Thrombosis Research

Volume 156, August 2017, Pages 155-159
Thrombosis Research

Full Length Article
Pulmonary embolism prognostic factors and length of hospital stay: A cohort study

https://doi.org/10.1016/j.thromres.2017.06.009Get rights and content

Highlights

  • Length of hospital stay was not influenced by single or combined PE prognostic markers.

  • NEWS, a non PE-specific validated score, was associated with length of hospital stay.

  • A time-dependent trend towards a reduction of hospital stay duration was found.

Abstract

Introduction

Patients with pulmonary embolism (PE) are commonly admitted to hospital for their initial treatment. We aimed to assess the association of length of hospital stay with commonly available clinical variables and their combinations.

Methods

A retrospective multicenter cohort study was conducted on consecutive PE patients admitted to eight Italian centers. Logistic regression analysis was performed to evaluate the association between the length of hospital stay and the Pulmonary Embolism Severity Index (PESI) parameters, National Early Warning Score (NEWS) and other possible determinants.

Results

We enrolled 391 patients, with a median hospital stay of 10 days (IQR 7–14). Among PESI parameters, only oxygen saturation < 90% was significantly associated with length of hospital stay at univariable analysis (OR 1.99; 95% CI 1.3–3.2). At multivariable analysis, NEWS ≥ 5 was associated with prolonged hospitalization (OR 3.14; 95% CI 1.2–8.3). A difference of median hospital stay was found between simplified PESI high and low risk groups (10 and 9 days, respectively, p = 0.027).

Discussion

The median duration of hospital stay was generally long and not influenced by single parameters of PESI or common prognostic factors. The difference of one day between the low- and high-risk groups according to simplified PESI was not clinically significant.

Introduction

Pulmonary embolism (PE) is the third most frequent acute cardiovascular disease after acute coronary syndromes and stroke, with an incidence rate of 55.4 and 40.6 events per year per 100,000 inhabitants for women and men, respectively [1]. PE is associated with a wide prognostic spectrum, ranging from prompt resolution of symptoms after few hours of treatment to sudden death. PE patients are commonly admitted to hospital for their initial treatment, though some of them, who are at low risk of adverse outcomes (~ 1% of in-hospital mortality), may be suitable for a short-hospital stay or even complete home-treatment [2], [3], [4], [5].

Prognostic stratification is crucial to tailor treatment and optimise the duration of hospital stay [6], [7], [8]. In recent years, several clinical, laboratory and imaging parameters have been associated with the risk of adverse events after PE [2]. Physicians are expected to take into account all these variables, but there is no evidence on the best parameters to rely on. Moreover, only few validated tools, such as low blood pressure, have been properly validated and may effectively improve patient outcomes and/or reduce costs [2], [9].

Therefore, we planned a retrospective study to explore if length of hospital-stay for PE was influenced by commonly available clinical variables for stratifying PE patients and their combinations (i.e. the Pulmonary Embolism Severity Index (PESI), its simplified version (sPESI), and the National Early Warning Score (NEWS) [10], [11], [12], [13]). In addition, we explored whether length of hospital stay of PE patients was influenced by common laboratory and imaging parameters, and if any difference exists in length of hospital stay of some frail PE patients, such as the elderly and cancer patients.

Section snippets

Methods

A multicenter national retrospective cohort study was performed on consecutive adult patients with objectively diagnosed PE (by means of computed tomography pulmonary angiography (CTPA), pulmonary angiography, or lung scan) within 72 h from hospital admission. No exclusion criteria were applied, except for age ≤ 18 years. The study was conducted in eight Italian internal medicine units, from 2011 to 2013. The Medical Ethical Committee of the coordinating center, University of Insubria, Varese,

Results

391 patients with an objective diagnosis of PE were included in the study. Median age was 77 years (IQR 69–84), 165 patients (42.2%) were males. Active cancer was present in 87 patients (22.3%). Complete baseline characteristics are presented in Table 4.

Initial PE treatment was administered according to local practice: 332 patients (84.9%) received low molecular weight heparin or fondaparinux, 33 (8.4%) received unfractionated heparin and 7 (1.8%) received pharmacological thrombolysis. Before

Discussion

The study shows that, in the clinical context of Italian internal medicine units, the duration of hospital stay for PE was generally long (median 10 days) both in frail patients (eg patients with cancer, impaired renal function, advanced age) and in the general population. The analysis suggests that length of hospital stay was not influenced by any single clinical variable and their retrospective combination in the original and simplified PESI score. A combination of clinical parameters in the

Role of funding

This study was not funded.

Declaration of interest

The authors have no conflicts to declare.

References (16)

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