Full Length ArticlePulmonary embolism prognostic factors and length of hospital stay: A cohort study
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.
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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.
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