非高危肺栓塞合并恶性肿瘤死亡相关因素及Charlson合并症指数的预测价值

Risk factors associated with mortality in patient with non-high-risk pulmonary embolism and cancer and the prognostic value of Charlson comorbidity index

目的调查非高危肺栓塞合并恶性肿瘤患者近期死亡的相关因素,并探讨Charlson合并症指数(CCI)的预测价值。方法纳入2015年5月至2018年4月四川大学华西医院内科住院患者中确诊的所有非高危肺栓塞合并恶性肿瘤的患者,根据住院期间是否死亡分为死亡组和存活组。通过单因素及多因素logistic回归模型分析探讨患者近期死亡的相关因素;以CCI量表对患者进行评分,探讨其对上述患者近期死亡的预测价值。结果最终选入195例非高危肺栓塞合并恶性肿瘤的患者,住院死亡率为16.4%(32/195)。单因素分析结果显示,男性(P=0.044)、年龄≥65岁(P=0.008)、卧床制动(P=0.001)、慢性肺部疾病(P=0.030)、中心静脉置管(P=0.015)、1个月内脑卒中(P=0.015)、肺炎(P=0.017)、呼吸衰竭(P=0.017)、糖尿病(P=0.005)和贫血(P=0.035)与患者近期死亡相关。在实验室检查指标中,死亡组的血红蛋白、血钠水平低于存活组(均P<0.05)。多因素logistic回归模型分析结果显示,年龄≥65岁(OR=3.01,95%CI:1.05-8.68,P=0.041)、卧床制动(OR=4.15,95%CI:1.37-12.54,P=0.012)、中心静脉置管(OR=16.10,95%CI:2.09-124.08,P=0.008)、1个月内脑卒中(OR=6.56,95%CI:1.05-40.95,P=0.044)和低钠血症(OR=2.75,95%CI:1.06-7.15,P=0.038)是肺栓塞合并恶性肿瘤患者近期死亡的独立相关因素。死亡组的CCI评分高于存活组[(5.66±2.96)分比(4.13±2.74)分,P=0.005],CCI≥4分的患者死亡风险是其他患者(CCI<4分)的4.25倍(OR=4.25,95%CI:1.83-9.89,P=0.001),且随后CCI评分每增加1分,死亡风险增加4.89倍(OR=4.89,95%CI:2.07-11.55,P<0.001)。生存分析也表明,CCI≥4分的患者存活率低于CCI评分<4分者(P<0.001)。结论年龄≥65岁、卧床制动、中心静脉置管、1月内脑卒中史、低钠血症是非高危肺栓塞合并恶性肿瘤患者近期死亡的独立相关因素;CCI评分在预测这类患者近期死亡风险中有一定价值,患者存在伴随疾病越多,死亡风险越高。

Objective To investigate the risk factors associated with mortality and the prognostic value of Charlson comorbidity index(CCI)for mortality in patients with non-high-risk pulmonary embolism complicated by caner.Methods Patients diagnosed with non-high-risk pulmonary embolism and caner from the medical departments of West China Hospital of Sichuan University from May,2015 to April,2018 were included in this study.The patients were classified into death group and survival group according to whether they died during hospitalization.Clinical information was collected and univariate along with multivariate analysis were performed in order to identify the independent risk factor related to short-term mortality in these patients.Besides,all the patients were assessed the comorbidity burden using CCI score and thereby to evaluate the prognostic value of CCI for short-time mortality.Results A total of 195 patients were included in this study,including 115 males and 80 females.In all,32 patients died during hospitalization and the mortality rate was 16.4%.Univariate analysis showed that male(P=0.044),age≥65y(P=0.008),staying in bed(P=0.001),chronic pulmonary diseases(P=0.030),central venous catheterization(P=0.015),stroke history within 1 month(P=0.015),pneumonia(P=0.017),respiratory failure(P=0.017),diabetes mellitus(P=0.005)and anemia(P=0.035)were related to short term mortality of these patients.As for laboratory examination results,levels of hemoglobin and sodium in death group were significantly lower than survival group(P<0.05).Multivariate logistic regression showed that age≥65y(OR=3.01,95%CI:1.05-8.68,P=0.041),staying in bed(OR=4.15,95%CI:1.37-12.54,P=0.012),central venous catheterization(OR=16.10,95%CI:2.09-124.08,P=0.008),stroke history within 1 month(OR=6.56,95%CI:1.05-40.95,P=0.044)and hyponatremia(OR=2.75,95%CI:1.06-7.15,P=0.038)were independent risk factors of short term mortality in these patients.Besides,CCI score in death group was significantly higher than that in survival group(5.66±2.96 vs 4.13±2.74,P=0.005).Pulmonary embolism patients with CCI≥4 were associated with 4.25-fold increased risk of mortality compared with patients with CCI<4(OR=4.25,95%CI:1.83-9.89,P=0.001),and the per additional 1-score increase of CCI after 4 was associated with 4.89-fold increased risk of mortality(OR=4.89,95%CI:2.07-11.55,P<0.001).Survival analysis showed that patients with CCI≥4 had lower survival rate than the patients with CCI<4 during hospitalization(P<0.001).Conclusions Age≥65y,staying in bed,central venous catheterization,stroke history within 1 month and hyponatremia are independent risk factor of short-term mortality in patients with non-high-risk pulmonary embolism and caner.CCI score has prognostic value of short term mortality in these patients,and the risk increases with the increase of comorbidities patients have.