BACKGROUNDS:Pulmonary embolism (PE) is frequent in subjects with chronic obstructive pulmonary disease (COPD) and associated with high mortality. This multi-center retrospective study was performed to investigate if secondary polycythemia is associated with in-hospital mortality in COPD patients with low-risk PE. METHODS:We identified COPD patients with proven PE between October, 2005 and October, 2015. Patients in risk classes III-V on the basis of the PESI score were excluded. We extracted demographic, clinical and laboratory information at the time of admission from medical records. All subjects were followed until hospital discharge to identify all-cause mortality. RESULTS:We enrolled 629 consecutive patients with COPD and PE at low risk: 132 of them (21.0%) with and 497 (79.0%) without secondary polycythemia. Compared with those without polycythemia, the polycythemia group had significantly lower forced expiratory volume in one second (FEV1) level (0.9±0.3 vs. 1.4±0.5, P=0.000), lower PaO2 and SpO2 as well as higher PaCO2 (P=0.03, P=0.03 and P=0.000, respectively). COPD patients with polycythemia had a higher proportion of arrhythmia in electrocardiogram (ECG) (49.5% vs. 35.7%, P=0.02), a longer hospital duration time (15.3±10.1 vs. 9.7±9.1, P=0.001), a higher mechanical ventilation rate (noninvasive and invasive, 51.7% vs. 30.3%, P=0.04 and 31.0% vs. 7.9%, P=0.04, respectively), and a higher in-hospital mortality (12.1% vs. 6.6%, P=0.04). Multivariate logistic regression analysis revealed that polycythemia was associated with mortality in COPD patients with low-risk PE (adjusted OR 1.11; 95% CI, 1.04-1.66). CONCLUSIONS:Polycythemia is an independent risk factor for all-cause in-hospital mortality in COPD patients with PE at low risk.

译文

背景:肺栓塞(PE)在患有慢性阻塞性肺疾病(COPD)的受试者中很常见,并伴有较高的死亡率。这项多中心回顾性研究旨在调查低危PE的COPD患者继发性红细胞增多症是否与院内死亡率相关。
方法:我们在2005年10月至2015年10月之间确定了COPD确诊为PEPD的患者。根据PESI评分将风险级别为III-V的患者排除在外。我们在入院时从病历中提取了人口统计学,临床和实验室信息。随访所有受试者直至出院以确定全因死亡率。
结果:我们纳入了629例低危的COPD和PE患者,其中132例(21.0%)有继发性红细胞增多症,497例(79.0%)无继发性红细胞增多症。与没有红细胞增多症的人相比,红细胞增多症组的一秒钟强迫呼气量(FEV1)水平显着降低(0.9±0.3对1.4±0.5,P = 0.000),PaO2和SpO2降低,PaCO2升高(P = 0.03 ,分别为P = 0.03和P = 0.000)。 COPD合并红细胞增多症的患者在心电图(ECG)中的心律失常比例更高(49.5%vs. 35.7%,P = 0.02),住院时间更长(15.3±10.1 vs. 9.7±9.1,P = 0.001),更高机械通气率(无创和有创,分别为51.7%和30.3%,P = 0.04和31.0%vs. 7.9%,P = 0.04),以及更高的院内死亡率(12.1%vs. 6.6%,P = 0.04)。多元logistic回归分析显示,低危PE的COPD患者的红细胞增多症与死亡率相关(校正OR 1.11; 95%CI 1.04-1.66)。
结论:红细胞增多症是低危PE患者COPD全院住院死亡率的独立危险因素。

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