title: Risk Stratification of Patients With Acute Symptomatic Pulmonary Embolism Based on Presence or Absence of Lower Extremity DVT: Systematic Review and Meta-analysis.
abstract: BACKGROUND
  For patients diagnosed with acute pulmonary embolism (PE), the prognostic significance of concomitant DVT lacks clarity.
  
  
  METHODS
  We performed a meta-analysis of studies that enrolled patients with acute PE to assess the prognostic value of concomitant DVT for the primary outcome of 30-day all-cause mortality and the secondary outcome of 90-day PE-related adverse events. We conducted unrestricted searches of PubMed and Embase from 1980 through September 30, 2014, and used the terms "deep vein thrombosis," "pulmonary embolism," and "prognos*." We used a random-effects model to pool study results, Begg rank-correlation method to evaluate for publication bias, and I(2) testing to assess for heterogeneity.
  
  
  RESULTS
  The meta-analysis included a total of nine studies (10 cohorts, as one study had two cohorts) with 8,859 patients. Of the seven cohorts with 7,868 participants who had PE and provided results on the primary outcome, 4,379 (56%) had concomitant DVT; 272 of 4,379 (6.2%) patients with concomitant DVT died 30 days after the diagnosis of PE compared with 133 of 3,489 (3.8%) without DVT. Concomitant DVT had a significant association with 30-day all-cause mortality in all patients (seven cohorts; OR, 1.9; 95% CI, 1.5-2.4; I(2) = 0%). Concomitant DVT was not significantly associated with 90-day PE-related adverse outcomes (five cohorts; OR, 1.6; 95% CI, 0.8-3.4; I(2) = 75%).
  
  
  CONCLUSIONS
  In patients diagnosed with acute symptomatic PE, concomitant DVT was significantly associated with an increased risk of death within 30 days of PE diagnosis.
authors.affiliation: Department of Internal and Cardiovascular Medicine, University of Perugia, Perugia, Italy.
authors.forename: Cecilia
authors.initials: C
authors.lastname: Becattini
authors.affiliation: Department of Haematological Medicine, Guys and St. Thomas' NHS Foundation Trust, London, England.
authors.forename: Alexander T
authors.initials: AT
authors.lastname: Cohen
authors.affiliation: Department of Internal and Cardiovascular Medicine, University of Perugia, Perugia, Italy.
authors.forename: Giancarlo
authors.initials: G
authors.lastname: Agnelli
authors.affiliation: National Pulmonary Hypertension Service, Hammersmith Hospital, Imperial College Healthcare NHS Trust, London, England.
authors.forename: Luke
authors.initials: L
authors.lastname: Howard
authors.affiliation: Vascular Department, Ramón y Cajal Hospital, IRYCIS, Madrid, Spain.
authors.forename: Borja
authors.initials: B
authors.lastname: Castejón
authors.affiliation: Medicine Department, Santa Lucía Hospital, Cartagena, Murcia, Spain.
authors.forename: Javier
authors.initials: J
authors.lastname: Trujillo-Santos
authors.affiliation: Medicine Department, Germans Trias i Pujol Hospital, Badalona, Spain.
authors.forename: Manuel
authors.initials: M
authors.lastname: Monreal
authors.affiliation: Division of General Internal Medicine, Department of Internal Medicine, Rehabilitation, and Geriatrics, Geneva University Hospitals and Faculty of Medicine, Geneva, Switzerland.
authors.forename: Arnaud
authors.initials: A
authors.lastname: Perrier
authors.affiliation: Division of Pulmonary and Critical Care Medicine, Washington University School of Medicine, St. Louis, MO; Division of General Medical Sciences, Washington University School of Medicine, St. Louis, MO.
authors.forename: Roger D
authors.initials: RD
authors.lastname: Yusen
authors.affiliation: Respiratory Department, Ramón y Cajal Hospital and Alcala de Henares University, IRYCIS, Madrid, Spain. Electronic address: djimenez.hrc@gmail.com.
authors.forename: David
authors.initials: D
authors.lastname: Jiménez
mesh_terms: D000208:Acute Disease; D006801:Humans; D035002:Lower Extremity / Q000098:blood supply*; D011379:Prognosis; D011655:Pulmonary Embolism / Q000150:complications* / Q000175:diagnosis* / Q000401:mortality; D018570:Risk Assessment; D020246:Venous Thrombosis / Q000150:complications* / Q000175:diagnosis* / Q000401:mortality
keywords: deep vein thrombosis; meta-analysis; mortality; prognosis; pulmonary embolism