Association of anaemia and mortality in patients with acute pulmonary embolism

David Jiménez; Carlos Escobar; David Martí; Gema Díaz; Jesús César; Ángel García-Avello; Antonio Sueiro; Roger D. Yusen

doi:10.1160/TH09-01-0003

Thrombosis and Haemostasis, Inhaltsverzeichnis

Thromb Haemost 2009; 102(01): 153-158
DOI: 10.1160/TH09-01-0003

New Technologies, Diagnostic Tools and Drugs

Schattauer GmbH

Association of anaemia and mortality in patients with acute pulmonary embolism

Autoren

David Jiménez

¹Respiratory Department, Ramón y Cajal Hospital, Madrid, Spain
Carlos Escobar

²Cardiology Department, Ramón y Cajal Hospital, Madrid, Spain
David Martí

²Cardiology Department, Ramón y Cajal Hospital, Madrid, Spain
Gema Díaz

¹Respiratory Department, Ramón y Cajal Hospital, Madrid, Spain
Jesús César

³Hematology Department, Ramón y Cajal Hospital, Madrid, Spain
Ángel García-Avello

³Hematology Department, Ramón y Cajal Hospital, Madrid, Spain
Antonio Sueiro

¹Respiratory Department, Ramón y Cajal Hospital, Madrid, Spain
Roger D. Yusen

⁴Divisions of Pulmonary and Critical Care Medicine and General Medical Sciences, Washington University School of Medicine, St. Louis, Missouri, USA

Abstract

Summary

This study aimed to evaluate the relationship between anaemia and pulmonary embolism (PE) prognosis. We analysed a cohort of 764 patients with acute PE referred to a single center for diagnosis and management. Patients were divided into groups by quartiles of haemoglobin (Hb): Hb < 11.7 g/dl; Hb 11.7 to 12.9 g/dl; Hb 13.0 to 14.1 g/dl; Hb > 14.1 g/dl. Patients had a mean Hb of 12.9 g/dl, and values ranged from to 4.3 to 19.5 g/dl. Lower Hb was associated with recent bleeding, an impaired haemodynamic profile and higher creatinine. Patients in the lower Hb quartiles more commonly had female gender (p < 0.001), a diagnosis of cancer (p < 0.001), and an indication for an inferior vena cava (IVC) filter (p < 0.002), compared to patients in the higher Hb quartiles. Patients in higher Hb quartiles had higher survival at three months (75%, 86%, 90% and 91% for lowest to highest quartiles, respectively). On multivariate analysis, adjusting for known PE prognostic factors, low Hb proved to be an independent predictor of mortality (hazard ratio [HR] 1.16, 95% confidence interval [CI] 1.05 to 1.28 for each decrease of 1 g/dl). Hb level remained an independent predictor of all-cause mortality when cancer patients were excluded from the analysis (adjusted HR 0.81; 95% CI, 0.66 to 0.99; p = 0.04). Moreover, patients with anaemia showed a higher risk of fatal PE (unadjusted HR 1.19, 95% CI 1.04 to 1.37). In conclusion, in patients with acute symptomatic PE, anaemia severity is associated with worsened survival.

Keywords

Clinical studies - lung - pulmonary embolism - anaemia - prognosis

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Referenzen

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