title: Prognostic significance of early diagnosis in acute pulmonary thromboembolism with circulatory failure.
abstract: Despite the advances in our understanding of venous thromboembolic disease, the prevalence of pulmonary thromboembolism (PTE) at autopsy has not changed over 3 decades. When patients survive long enough to have a diagnosis of massive PTE and start receiving treatment, the outlook is considered to be moderately good. However, the diagnosis is often difficult to obtain and is frequently missed. We hypothesize that mortality of acute PTE is reduced by early diagnosis. Eighty-five patients with acute PTE with circulatory failure who survived 1 h after the onset were divided into two groups: the early Dx group consisted of the patients whose disease was diagnosed as acute PTE within 24 h of the onset, and the Late Dx group included patients whose disease was not diagnosed within 24 h of onset, or died without clinical diagnosis between 1 and 24 h after the onset. Overall mortality was significantly low in the Early Dx group compared with that of the Late Dx group (21.6% vs 67.6%, P < 0.0001). Multiple logistic regression analysis demonstrated that a reduction in in-hospital mortality was associated with early diagnosis (odds ratio for in-hospital death, 0.094; 95% confidence interval, 0.03-0.33). The results of our study suggested that early diagnosis might favorably affect the in-hospital clinical outcome of hemodynamically unstable patients with acute PTE.
authors.affiliation: First Department of Internal Medicine, Mie University, 2-174 Edobashi, Tsu 514-8507, Japan.
authors.forename: Masahiro
authors.initials: M
authors.lastname: Ota
authors.forename: Mashio
authors.initials: M
authors.lastname: Nakamura
authors.forename: Norikazu
authors.initials: N
authors.lastname: Yamada
authors.forename: Takahiro
authors.initials: T
authors.lastname: Yazu
authors.forename: Ken
authors.initials: K
authors.lastname: Ishikura
authors.forename: Naoto
authors.initials: N
authors.lastname: Hiraoka
authors.forename: Hideki
authors.initials: H
authors.lastname: Tanaka
authors.forename: Hirofumi
authors.initials: H
authors.lastname: Fujioka
authors.forename: Naoki
authors.initials: N
authors.lastname: Isaka
authors.forename: Takeshi
authors.initials: T
authors.lastname: Nakano
mesh_terms: D000293:Adolescent; D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D000925:Anticoagulants / Q000627:therapeutic use; D017128:Embolectomy; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D007564:Japan; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D011655:Pulmonary Embolism / Q000175:diagnosis* / Q000401:mortality / Q000503:physiopathology*; D012008:Recurrence; D012189:Retrospective Studies; D012769:Shock / Q000150:complications*; D016019:Survival Analysis; D015912:Thrombolytic Therapy; D013997:Time Factors
chemical_list: D000925:Anticoagulants