Impact of renal function on the prognosis of acute pulmonary embolism patients: a systematic review and meta-analysis

Acute Pulmonary Embolism in Oman: A Situational Analysis

OBJECTIVES

Pulmonary embolism (PE) is increasingly prevalent in Oman. The aim of this situational analysis of PE among Omani patients was to study its predisposing factors, diagnostic issues, and optimal management.

METHODS

In this retrospective cross-sectional situational analysis, the subjects were Omani patients who were diagnosed with acute PE using computed tomography pulmonary angiogram from 2010-2021. The required data was collected from the hospital database and statistically analyzed.

RESULTS

The subjects were 438 patients diagnosed with PE, with a mean age of 53.3±18.5 years and mean body mass index of 29.7±7.3 kg/m2. Males were in a slight majority (223; 50.9%) and were older (55.0±18.5 years) than females (51.5±18.3 years). Two-thirds of the PE patients had hypertension and one-third had diabetes mellitus. Most patients presented with dyspnea and chest pain. Syncope was more common in females compared to males who mostly presented with hemoptysis. Nearly half of the patients had abnormal echocardiogram, and males had lower mean ejection fraction compared to females. Different modalities of management were used to treat patients' PE. Heparin was the most used anticoagulant followed by warfarin and direct oral anticoagulants. Out of the 122 PE patients who died during the study period, PE was the direct cause of death of 68 patients. The mortality was higher in males than in females.

CONCLUSIONS

The incidence of acute PE was similar among both male and female Omani patients. However, there were sex differences in risk factors, symptoms, investigations, and management of PE. Females presented with more severe PE, but mortality was higher in males.

Pulmonary embolism in chronic kidney disease and end-stage renal disease hospitalizations: Trends, outcomes, and predictors of mortality in the United States

BACKGROUND

It is well-known that patients with chronic kidney disease and end-stage renal disease are at increased risk of pulmonary embolism than patients with normal kidney function. However, the data on trends, outcomes, and predictors of mortality in pulmonary embolism patients with chronic kidney disease and end-stage renal disease in the United States are limited.

METHODS

We queried the National Inpatient Sample database from 2010 to 2014. International Classification of Diseases-Ninth Revision-Clinical Modification codes were used to identify patients with normal kidney function, chronic kidney disease, and end-stage renal disease. The frequency of pulmonary embolism, complications, in-hospital mortality, and length of stay were calculated for each cohort. Multivariable logistic regression models were constructed to determine the predictors of mortality.

RESULTS

In the study population (2010-2014), there were 766,176 pulmonary embolism hospitalizations with normal kidney function, 79,824 with chronic kidney disease, and 9147 with end-stage renal disease. Among the study cohorts, the mortality rate was 2.7% in normal kidney function, 4.5% in chronic kidney disease, and 6.8% in end-stage renal disease hospitalizations. Median length of stay was highest in the end-stage renal disease cohort and lowest in the normal kidney function cohort. After adjusting for confounders, pulmonary embolism patients with chronic kidney disease died 1.15 times more often than those with normal kidney function and pulmonary embolism patients with end-stage renal disease died 4.2 times more often than those with normal kidney function.

CONCLUSION

The mortality rate and length of stay in pulmonary embolism patients with chronic kidney disease and end-stage renal disease were significantly higher than those in pulmonary embolism patients with normal kidney function. Also, pulmonary embolism patients with chronic kidney disease and end-stage renal disease were at higher risk of in-hospital mortality than those with normal kidney function. There was statistically significant higher risk of mortality in elderly and Black patients with pulmonary embolism and concurrent chronic kidney disease or end-stage renal disease.