title: In-hospital mortality for pulmonary embolism: relationship with chronic kidney disease and end-stage renal disease. The hospital admission and discharge database of the Emilia Romagna region of Italy.
abstract: The impact of chronic kidney disease (CKD) on the outcome of acute pulmonary embolism (PE) is uncertain. We aimed to evaluate the effect of renal dysfunction (defined by ICD-9-CM codification) on in-hospital mortality for PE. We considered all cases of PE (first event) recorded in the database of hospital admissions for the Emilia-Romagna region, Italy, from 1999 to 2009. The inclusion criterion was the presence, as a main discharge diagnosis, of acute PE codes according to ICD-9-CM. Diagnoses of immobilization, dementia, sepsis, skeletal fractures, hypertension, heart failure, myocardial infarction, diabetes mellitus, peripheral vascular disease, cerebrovascular disease, chronic pulmonary disease, pneumonia, malignancy, CKD and end-stage renal disease (ESRD) were also considered to evaluate comorbidity. The outcome was in-hospital mortality for PE, and multivariate logistic regression analyses was performed. We considered 24,690 cases of first episode of PE. In-hospital mortality for PE was not different in patients without renal dysfunction, with CKD, or ESRD (23.6 vs. 24 vs. 18 % p = ns). In-hospital mortality for PE was independently associated with age (OR 1.045, 95 % CI 1.042-1.048, p < 0.001), female sex (OR 1.322, 95 % CI 1.242-1.406, p < 0.001), hypertension (OR 1.096, 95 % CI 1.019-1.178, p = 0.013), diabetes mellitus (OR 1.120, 95 % CI 1.001-1.253, p = 0.049), dementia (OR 1.171, 95 % CI 1.020-1.346, p = 0.025), peripheral vascular disease (OR 1.349, 95 % CI 1.057-1.720, p = 0.016) and malignancy (OR 1.065, 95 % CI 1.016-1.116, p = 0.008). Age and comorbidity are associated with in-hospital mortality for PE, whereas CKD does not appear to be an independent predictor of adverse outcomes in patients hospitalized for PE.
authors.affiliation: Clinica Medica, Azienda Ospedaliera-Universitaria, University of Ferrara, via Aldo Moro 8, 44124, Cona, Ferrara, Italy, f.fabbian@ospfe.it.
authors.forename: Fabio
authors.initials: F
authors.lastname: Fabbian
authors.forename: Massimo
authors.initials: M
authors.lastname: Gallerani
authors.forename: Marco
authors.initials: M
authors.lastname: Pala
authors.forename: Alfredo
authors.initials: A
authors.lastname: De Giorgi
authors.forename: Raffaella
authors.initials: R
authors.lastname: Salmi
authors.forename: Fabio
authors.initials: F
authors.lastname: Manfredini
authors.forename: Francesco
authors.initials: F
authors.lastname: Portaluppi
authors.forename: Francesco
authors.initials: F
authors.lastname: Dentali
authors.forename: Walter
authors.initials: W
authors.lastname: Ageno
authors.forename: Dimitri P
authors.initials: DP
authors.lastname: Mikhailidis
authors.forename: Roberto
authors.initials: R
authors.lastname: Manfredini
mesh_terms: D000368:Aged; D003430:Cross-Sectional Studies; D016208:Databases, Factual; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D007558:Italy; D007676:Kidney Failure, Chronic / Q000150:complications; D008297:Male; D010343:Patient Admission / Q000706:statistics & numerical data; D010351:Patient Discharge / Q000706:statistics & numerical data; D011655:Pulmonary Embolism / Q000209:etiology* / Q000401:mortality*; D051436:Renal Insufficiency, Chronic / Q000150:complications*; D012189:Retrospective Studies