title: Prognostic significance of deep vein thrombosis in patients presenting with acute symptomatic pulmonary embolism.
abstract: BACKGROUND
  Concomitant deep vein thrombosis (DVT) in patients with acute pulmonary embolism (PE) has an uncertain prognostic significance.
  
  
  OBJECTIVE
  In a cohort of patients with PE, this study compared the risk of death in those with and those without concomitant DVT.
  
  
  METHODS
  We conducted a prospective cohort study of outpatients diagnosed with a first episode of acute symptomatic PE. Patients underwent bilateral lower extremity venous compression ultrasonography to assess for concomitant DVT.
  
  
  RESULTS
  The primary study outcome, all-cause mortality, and the secondary outcome of PE-specific mortality were assessed during the 3 months of follow-up after PE diagnosis. Multivariate Cox proportional hazards regression was done to adjust for significant covariates. Of 707 patients diagnosed with PE, 51.2% (362 of 707) had concomitant DVT and 10.9% (77 of 707) died during follow-up. Patients with concomitant DVT had an increased all-cause mortality (adjusted hazard ratio [HR], 2.05; 95% confidence interval [CI], 1.24 to 3.38; P = 0.005) and PE-specific mortality (adjusted HR, 4.25; 95% CI, 1.61 to 11.25; P = 0.04) compared with those without concomitant DVT. In an external validation cohort of 4,476 patients with acute PE enrolled in the international multicenter RIETE Registry, concomitant DVT remained a significant predictor of all-cause (adjusted HR, 1.66; 95% CI, 1.28 to 2.15; P < 0.001) and PE-specific mortality (adjusted HR, 2.01; 95% CI, 1.18 to 3.44; P = 0.01).
  
  
  CONCLUSIONS
  In patients with a first episode of acute symptomatic PE, the presence of concomitant DVT is an independent predictor of death in the ensuing 3 months after diagnosis. Assessment of the thrombotic burden should assist with risk stratification of patients with acute PE.
authors.affiliation: Respiratory Department, Ramón y Cajal Hospital, 28034 Madrid, Spain. djc_69_98@yahoo.com
authors.forename: David
authors.initials: D
authors.lastname: Jiménez
authors.forename: Drahomir
authors.initials: D
authors.lastname: Aujesky
authors.forename: Gema
authors.initials: G
authors.lastname: Díaz
authors.forename: Manuel
authors.initials: M
authors.lastname: Monreal
authors.forename: Remedios
authors.initials: R
authors.lastname: Otero
authors.forename: David
authors.initials: D
authors.lastname: Martí
authors.forename: Elena
authors.initials: E
authors.lastname: Marín
authors.forename: Enrique
authors.initials: E
authors.lastname: Aracil
authors.forename: Antonio
authors.initials: A
authors.lastname: Sueiro
authors.forename: Roger D
authors.initials: RD
authors.lastname: Yusen
mesh_terms: D000208:Acute Disease; D000368:Aged; D005260:Female; D006801:Humans; D007866:Leg / Q000000981:diagnostic imaging; D008297:Male; D011379:Prognosis; D016016:Proportional Hazards Models; D011446:Prospective Studies; D011655:Pulmonary Embolism / Q000150:complications* / Q000401:mortality*; D012008:Recurrence; D014463:Ultrasonography; D020246:Venous Thrombosis / Q000150:complications* / Q000000981:diagnostic imaging