title: [Prognostic factors for patients with pulmonary thromboembolism after orthopaedic surgery].
abstract: OBJECTIVE
  To investigate the changes of serum enzymes and their prognostic value in patients with pulmonary thromboembolism after orthopaedic surgery.
  
  
  METHODS
  Clinical data of 134 cases of confirmed pulmonary thromboembolism after orthopaedic surgery from 1997 to 2010 were reviewed.The 134 cases were divided into dead group (n=28) and survival group (n=106). The clinical presentation, electrocardiogram, arterial oxygen pressure (PaO2), chest X-ray, echocardiography,and serum enzymes including alanine transaminase (ALT), aspartate aminotransferase (AST), gamma-glutamyl transpeptidase (γ-GT), lactate dehydrogenase (LDH), creatine kinase (CK) and creatine kinase isoenzyme (CK-MB) were analyzed. And multivariable Logistic regression was conducted to identify the risk factors of in-hospital death.
  
  
  RESULTS
  The average age of dead patients was higher than that of survival patients (P=0.043), while the P(O2) of dead patients was much lower than that of survival patients (P=0.035). The percentage of syncope, hypotension, right bundle-branch block and SIQIIITIII, pulmonary hypertension and right ventricular dysfunction in dead patients were higher than those in survival patients (P=0.009, P=0.041, P=0.018, P=0.030, P=0.042 and P=0.038), respectively. There were significant differences of elevated serum ALT, LDH and CK-MB levels between dead patients and survival patients (P=0.042, P=0.035 and P=0.017). Logistic regression indicated that the risk factors for death of patients with PTE after orthopaedic surgery were age (OR, 1.182; 95% CI, 1.010-1.383; P=0.036), hypoxemia (OR, 1.128; 95% CI, 1.018-1.249; P=0.022), hypotension (OR, 3.346; 95% CI, 1.116-10.031; P=0.031), right ventricular dysfunction (OR, 4.083; 95% CI, 1.040- 16.035; P=0.044) and elevated serum CK-MB levels (OR, 3.466; 95% CI, 1.054-11.400; P=0.041).
  
  
  CONCLUSIONS
  The incidence rate of elevated serum ALT, LDH and CK-MB levels in patients who died of pulmonary thromboembolism after orthopaedic surgery was higher than that of survival patients; Age, hypoxemia, hypotension and right ventricular dysfunction were independent risk factors of in-hospital death; The CK-MB might be a useful biomarker for risk stratification of acute PTE.
authors.affiliation: Department of Respiratory, Jishuitan Hospital, Beijing 100035, China.
authors.forename: Yun-jian
authors.initials: YJ
authors.lastname: Zhang
authors.forename: Ning
authors.initials: N
authors.lastname: Zhao
authors.forename: Guo-guang
authors.initials: GG
authors.lastname: Xia
authors.forename: Tian-shui
authors.initials: TS
authors.lastname: Li
authors.forename: Yan-xia
authors.initials: YX
authors.lastname: Wang
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D019644:Arthroplasty, Replacement, Hip / Q000009:adverse effects; D002423:Cause of Death; D052279:Creatine Kinase, MB Form / Q000097:blood*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D019637:Orthopedic Procedures / Q000009:adverse effects*; D011183:Postoperative Complications / Q000517:prevention & control*; D011379:Prognosis; D011655:Pulmonary Embolism / Q000209:etiology / Q000401:mortality / Q000517:prevention & control*; D012307:Risk Factors; D055815:Young Adult
chemical_list: D052279:Creatine Kinase, MB Form