The epidemiology and diagnostic approach to acute pulmonary embolism in the university hospital [Epidemiološki pokazatelji i dijagnostički pristup bolesniku s akutnom plućnom embolijom u kliničkoj bolnici]

Sharma, Mirella and Degoricija, Vesna and Legac, Ante and Gradišer, Marina and Vučičević, Željko (2009) The epidemiology and diagnostic approach to acute pulmonary embolism in the university hospital [Epidemiološki pokazatelji i dijagnostički pristup bolesniku s akutnom plućnom embolijom u kliničkoj bolnici]. Collegium Antropologicum, 33 (1). pp. 57-63. ISSN 0350-6134

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Abstract

The aim of this retrospective study was to evaluate the demographics and clinical characteristics of patients with pulmonary embolism treated in medical intensive care unit (ICU) at the University Hospital during a six-year period, and to assess the impact of several risk factors on patients' survival. The study included 165 patients, mean age 69.3 +/- 13.7 years, predominantly female (70.3%). Dominant symptom was dyspnea (97.0%), the most common sign tachypnea (69.6%). Pulmonary embolism was confirmed by high-probability ventilation/perfusion lung scan or multidetector computed tomography in 71.5% and was regarded as massive in 63 (38.2%), submassive in 23 (13.9%) and non massive in 79 patients (47.9%). Mean hospital stay was 5.7 +/- 4.4 days for ICU, and 14.8 +/- 9.1 days, overall. The ICU mortality was 26.7% and in-hospital mortality 30.9%. No statistical difference in mortality between male and female patients was observed (30.6% and 31.0%, respectively; p = 0.965), but prolonged immobilization (p = 0.002), recent operation (p = 0.034) or malignancy (p = 0.009) were shown to influence the outcome. Although a number of risk factors for developing pulmonary embolism have been identified and heparin prophylaxis along with early mobilization proposed to reduce the incidence, pulmonary embolism remains an important clinical problem with high mortality rate. The diagnostics should not wait and the therapy should start as soon as possible.

Abstract in Croatian

Cilj ove retrospektivne studije bio je procijeniti demografske i kliničke karakteristike bolesnika s plućnom embolijom liječenih u internističkoj jedinici intenzivnog liječenja (JIL) u Kliničkoj bolnici tijekom šestogodišnjeg perioda, s procjenom značaja pojedinih rizičnih čimbenika na njihovo preživljenje. U studiju je uključeno 165 bolesnika, prosječne dobi 69,3 ± 13,7 godina, 70,3% ispitivane populacije su činile žene. Kao najčešći simptom zabilježena je dispneja (97,0%), a kao najčešći klinički znak tahipneja (69,6%). Plućna je embolija dokazana ventilacijsko-perfuzijskom scintigrafijom pluća ili multidetektorskom kompjuteriziranom tomografijom u 71,5% bolesnika, stratificiranih u skupine s masivnom plućnom embolijom (63 bolesnika – 38,2%), submasivnom (23 bolesnika – 13,9%) i ne masivnom plućnom embolijom (79 bolesnika – 47,9%). Prosječno trajanje liječenja u JIL iznosilo je 5,7 ± 4,4 dana, a ukupno 14,8 ± 9,1 dana. Smrtnost u JIL iznosila je 26,7%, a cjelokupna bolnička smrtnost 30,9%. Nije na|eno statistički značajne razlike u smrtnosti bolesnika po spolu (30,6%:31,0%, p=0,965), dokazan je statistički značajan utjecaj dugotrajne imobilizacije (p=0,002), nedavnog operativnog zahvata (p=0,034) i maligne bolesti (p=0,009) na ishod liječenja. Iako su definirani različiti rizični čimbenici za nastanak plućne embolije, te je uz ranu mobilizaciju bolesnika predložena i profilaksa heparinom u cilju smanjenja incidencije, ova bolest je i dalje značajan klinički i epidemiološki problem s visokom smrtnošću. Dijagnostički postupak ne smije odlagati početak liječenja.

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