title: Fatal pulmonary embolism in hospitalized patients: a large autopsy-based matched case-control study.
abstract: OBJECTIVE
  Pulmonary embolism is an underdiagnosed major cause of death for hospitalized patients. The objective of this study was to identify the conditions associated with fatal pulmonary embolism in this population.
  
  
  METHODS
  A total of 13,074 autopsy records were evaluated in a case-control study. Patients were matched by age, sex, and year of death, and factors potentially associated with fatal pulmonary embolism were analyzed using univariate and multivariate conditional logistic regression.
  
  
  RESULTS
  Pulmonary embolism was considered fatal in 328 (2.5%) patients. In the multivariate analysis, conditions that were more common in patients who died of pulmonary embolism were atherosclerosis, congestive heart failure, and neurological surgery. Some conditions were negatively associated with fatal pulmonary embolism, including hemorrhagic stroke, aortic aneurism, cirrhosis, acquired immune deficiency syndrome, and pneumonia. In the control group, patients with hemorrhagic stroke and aortic aneurism had short hospital stays (8.5 and 8.8 days, respectively), and the hemorrhage itself was the main cause of death in most of them (90.6% and 68.4%, respectively), which may have prevented the development of pulmonary embolism. Cirrhotic patients in the control group also had short hospital stays (7 days), and 50% died from bleeding complications.
  
  
  CONCLUSIONS
  In this large autopsy study, atherosclerosis, congestive heart failure, and neurological surgery were diagnoses associated with fatal pulmonary embolism.
authors.affiliation: Faculdade de Medicina da Universidade de São Paulo, Department of Medicine, São Paulo/SP, Brazil.
authors.forename: Solange Aparecida Petilo
authors.initials: SA
authors.lastname: Carvalho Bricola
authors.forename: Edison Ferreira
authors.initials: EF
authors.lastname: Paiva
authors.forename: Arnaldo
authors.initials: A
authors.lastname: Lichtenstein
authors.forename: Reinaldo José
authors.initials: RJ
authors.lastname: Gianini
authors.forename: Jurandir Godoy
authors.initials: JG
authors.lastname: Duarte
authors.forename: Samuel Katsuyuki
authors.initials: SK
authors.lastname: Shinjo
authors.forename: Jose
authors.initials: J
authors.lastname: Eluf-Neto
authors.forename: Milton
authors.initials: M
authors.lastname: Arruda Martins
mesh_terms: D000328:Adult; D000369:Aged, 80 and over; D001344:Autopsy; D016022:Case-Control Studies; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D008297:Male; D008875:Middle Aged; D011655:Pulmonary Embolism / Q000401:mortality* / Q000473:pathology; D012307:Risk Factors