医院获得性肺血栓栓塞症的临床特征与危险因素分析

Analysis of clinical characteristics of and risk factors for hospitalacquired pulmonary thromboembolism

背景与目的:有关医院获得性肺血栓栓塞症(HA-PTE)的流行病学数据大多来自单一病种的调查研究,对于全院范围内HA-PTE的调查研究尚少。因此,本研究对全院范围内HA-PTE患者流行病学及临床特征等进行分析,以期为HA-PTE防治与管理提供参考依据。方法:收集中南大学湘雅医院2018年1月1日—12月31日确诊HA-PTE患者(病例组)的临床资料和实验室检验数据,并根据性别、年龄、入院Caprini血栓风险评分等级、是否接受外科手术及手术等级,按1∶1匹配同期非HA-PTE患者作为对照组。分析HA-PTE患者的发病率、病死率、相关临床病理因素、危险因素及有价值的预测指标等。结果:2018年度122942例住院患者中确诊新发HA-PTE患者68例(0.55‰),无HA-PTE相关死亡病例。42.65%(29/68)的HA-PTE患者同时合并有深静脉血栓形成。HA-PTE患者主要分布在神经内科(14/68,20.59%)、普通外科(11/68,16.18%)和呼吸内科(8/68,11.76%)。单因素分析结果显示,病例组呼吸系统疾病、肺部感染及入住ICU的比例高于较对照组(OR=4.60,95%CI=1.75~12.10,P=0.002;OR=2.38,95%CI=1.04~5.43,P=0.040;OR=11.00,95%CI=1.42~85.20,P=0.022),总住院时长与住院总费用高于对照组(OR=1.11,95%CI=1.05~1.18,P<0.005;OR=1.01,95%CI=1.00~1.03,P=0.005),纤维蛋白原降解产物(FDP)水平高于对照组(OR=1.11,95%CI=1.03~1.20,P=0.004)。多因素分析结果显示,呼吸系统疾病(校正OR=3.58,95%CI=1.32~9.71,P=0.012)和入住ICU(校正OR=11.38,95%CI=1.38~93.54,P=0.024)是HA-PTE的独立危险因素。结论:患有呼吸系统疾病和入住过ICU的患者为HA-PTE的高危人群,神经内科、普通外科和呼吸内科是HA-PTE的高危科室,HA-PTE会导致患者的住院时长和医疗费用显著增高。FDP水平对于HA-PTE可能有一定的预测价值。

Background and Aims:Most of the epidemiological data on hospital-acquired pulmonary thromboembolism(HA-PTE)are from studies focusing on a single disease,but the hospital-wide epidemiological investigation of HA-PTE are still insufficient.Therefore,this study was conducted to analyse the epidemiological and clinical characteristics of HA-PTE in a hospital-wide setting,so as to provide a reference base for prevention and management of HA-PTE.Methods:The clinical and laboratory data of patients with newly diagnosed HA-PTE(case group)in Xiangya Hospital,Central South University from January 1 to December 31,2018 were collected,and inpatients without HA-PTE(control group)during the same period were matched by sex,age,Caprini thrombosis risk score at admission and whether undergoing surgery or not as well as the grade of surgery in a 1:1 ratio.The incidence,mortality,relevant clinicopathologic factors,risk factors and potential predictive indicators for HA-PTE patients were analysed.Results:Among the 122942 inpatients in 2018,a total of 68 cases(0.55‰)were diagnosed with PAPTE and no HA-PTE-related death occurred.There were 42.65%(29/68)HA-PTE cases with concomitant deep venous thrombosis.Majority of HA-PTE cases were from neurology ward(14/68,20.59%),general surgery ward(11/68,16.18%)and respiratory ward(8/68,11.76%).The results of univariate analysis showed that the proportions of cases with diseases of the respiratory system or lung infection and undergoing ICU admission in case group were higher than those in control group(OR=4.60,95%CI=1.75-12.10,P=0.002;OR=2.38,95%CI=1.04-5.43,P=0.040;OR=11.00,95%CI=1.42-85.20,P=0.022),the total length of hospital stay was longer and hospitalization expense was greater in case group than those in control group(OR=1.11,95%CI=1.05-1.18,P<0.005;OR=1.01,95%CI=1.00-1.03,P=0.005),and the level of fibrinogen degradation products(FDP)in case group was higher than that in control group(OR=1.11,95%CI=1.03-1.20,P=0.004).The results of multivariate analysis revealed that diseases of the respiratory system(adjusted OR=3.58,95%CI=1.32-9.71,P=0.012)and ICU stay(adjusted OR=11.38,95%CI=1.38-93.54,P=0.024)were independent risk factors for HA-PTE.Conclusion:Patients with diseases of the respiratory system or undergoing ICU stay are high-risk population for HA-PTE.Patients in neurology,general surgery and respiratory wards are at higher risk of HA-PTE.HA-PTE will result in significant prolonged hospital stay and increased medical costs.FDP level may have certain predictive value for HA-PTE.