본문 바로가기
KERD
논문KCI 등재

Risk factors associated with provoked pulmonary embolism

1

조회

0

다운로드

0

인용

0

참고문헌

키워드

주제분류내과학

초록

Background/Aims: This study aimed to investigate the risk factors associated with provoked pulmonary embolism (PE). Methods: This retrospective cohort study included 237 patients with PE. Patients that had transient risk fac tors at diagnosis were classified as having provoked PE, with the remaining patients being classified as having unprovoked PE. The baseline clinical characteristics and factors associated with coagulation were compared. We evaluated the risk factors associated with provoked PE. Results: Of the 237 PE patients, 73 (30.8%) had provoked PE. The rate of respiratory failure and infection, as well as the disseminated intravascular coagulation score and ratio of right ventricular diameter to left ventricular diameter were signifi cantly higher in patients with provoked PE than in those with unprovoked PE. The protein and activity levels associated with coagu lation, including protein C antigen, protein S antigen, protein S activity, anti-thrombin III antigen, and factor VIII, were significantly lower in patients with provoked PE than in those with unprovoked PE. Multivariate analysis showed that infection (odds ratio [OR], 3.2; 95% confidence interval [CI], 1.4 to 7.4) and protein S activity (OR, 0.97; 95% CI, 0.95 to 0.99) were significantly associated with provoked PE. Conclusions: Protein S activity and presence of infection were important factors associated with provoked PE. We should pay attention to the presence of infection in patients with provoked PE.

Abstract

Background/Aims: This study aimed to investigate the risk factors associated with provoked pulmonary embolism (PE). Methods: This retrospective cohort study included 237 patients with PE. Patients that had transient risk fac tors at diagnosis were classified as having provoked PE, with the remaining patients being classified as having unprovoked PE. The baseline clinical characteristics and factors associated with coagulation were compared. We evaluated the risk factors associated with provoked PE. Results: Of the 237 PE patients, 73 (30.8%) had provoked PE. The rate of respiratory failure and infection, as well as the disseminated intravascular coagulation score and ratio of right ventricular diameter to left ventricular diameter were signifi cantly higher in patients with provoked PE than in those with unprovoked PE. The protein and activity levels associated with coagu lation, including protein C antigen, protein S antigen, protein S activity, anti-thrombin III antigen, and factor VIII, were significantly lower in patients with provoked PE than in those with unprovoked PE. Multivariate analysis showed that infection (odds ratio [OR], 3.2; 95% confidence interval [CI], 1.4 to 7.4) and protein S activity (OR, 0.97; 95% CI, 0.95 to 0.99) were significantly associated with provoked PE. Conclusions: Protein S activity and presence of infection were important factors associated with provoked PE. We should pay attention to the presence of infection in patients with provoked PE.

참고문헌 (30)

  1. Lindblad B, "Autopsy-verified pulmonary embolism in a surgical department: analysis of the period from 1951 to 1988", Br J Surg, 78, pp.849~852 (1991)
  2. Sandler DA, "Autopsy proven pulmonary embolism in hospital patients: are we detecting enough deep vein thrombosis?", J R Soc Med, 82, pp.203~205 (1989)
  3. Bagot CN, "Virchow and his triad: a question of attribution", Br J Haematol, 143, pp.180~190 (2008)
  4. Kucher N., "Clinical practice: deep-vein thrombosis of the upper extremities", N Engl J Med, 364, pp.861~869 (2011)
  5. Lapner ST, "Diagnosis and management of pulmonary embolism", BMJ, 346, pp.f757~ (2013)
  6. British Thoracic Society Standards of Care Committee Pulmonary Embolism Guideline Development Group., "British Thoracic Society guidelines for the management of suspected acute pulmonary embolism", Thorax, 58, pp.470~483 (2003)
  7. Howard LS, "NICE guideline: management of venous thromboembolic diseases and role of thrombophilia testing", Thorax, 68, pp.391~393 (2013)
  8. Carson JL, "The clinical course of pulmonary embolism", N Engl J Med, 326, pp.1240~1245 (1992)
  9. Christiansen SC, "Thrombophilia, clinical factors, and recurrent venous thrombotic events", JAMA, 293, pp.2352~2361 (2005)
  10. Klok FA, "Risk of arterial cardiovascular events in patients after pulmonary embolism", Blood, 114, pp.1484~1488 (2009)
  11. Sorensen HT, "The risk of a diagnosis of cancer after primary deep venous thrombosis or pulmonary embolism", N Engl J Med, 338, pp.1169~1173 (1998)
  12. Kearon C, "Comparison of 1 month with 3 months of anticoagulation for a first episode of venous thromboembolism associated with a transient risk factor", J Thromb Haemost, 2, pp.743~749 (2004)
  13. Levine MN, "Optimal duration of oral anticoagulant therapy: a randomized trial comparing four weeks with three months of warfarin in patients with proximal deep vein thrombosis", Thromb Haemost, 74, pp.606~611 (1995)
  14. Schulman S, "A comparison of six weeks with six months of oral anticoagulant therapy after a first episode of venous thromboembolism:duration of Anticoagulation Trial Study Group", N Engl J Med, 332, pp.1661~1665 (1995)
  15. Prandoni P, "Deep-vein thrombosis and the incidence of subsequent symptomatic cancer", N Engl J Med, 327, pp.1128~1133 (1992)
  16. Pinede L, "Comparison of 3 and 6 months of oral anticoagulant therapy after a first episode of proximal deep vein thrombosis or pulmonary embolism and comparison of 6 and 12 weeks of therapy after isolated calf deep vein thrombosis", Circulation, 103, pp.2453~2460 (2001)
  17. Cushman M, "Deep vein thrombosis and pulmonary embolism in two cohorts: the longitudinal investigation of thromboembolism etiology", Am J Med, 117, pp.19~25 (2004)
  18. Huisman MV, "Diagnostic management of acute deep vein thrombosis and pulmonary embolism", J Thromb Haemost, 11, pp.412~422 (2013)
  19. Chong LY, "Management of venous thromboembolic diseases and the role of thrombophilia testing:summary of NICE guidance", BMJ, 344, pp.e3979~ (2012)
  20. van der Meer RW, "Right ventricular dysfunction and pulmonary obstruction index at helical CT: prediction of clinical outcome during 3-month follow-up in patients with acute pulmonary embolism", Radiology, 235, pp.798~803 (2005)
  21. Ghuysen A, "Computed tomographic pulmonary angiography and prognostic significance in patients with acute pulmonary embolism", Thorax, 60, pp.956~961 (2005)
  22. Taylor FB Jr, "Towards definition, clinical and laboratory criteria, and a scoring system for disseminated intravascular coagulation", Thromb Haemost, 86, pp.1327~1330 (2001)
  23. Levi M., "Current understanding of disseminated intravascular coagulation", Br J Haematol, 124, pp.567~576 (2004)
  24. D’Angelo A, "Acquired deficiencies of protein S: protein S activity during oral anticoagulation, in liver disease, and in disseminated intravascular coagulation", J Clin Invest, 81, pp.1445~1454 (1988)
  25. Bucciarelli P, "Risk of venous thromboembolism and clinical manifestations in carriers of antithrombin, protein C, protein S deficiency, or activated protein C resistance: a multicenter collaborative family study", Arterioscler Thromb Vasc Biol, 19, pp.1026~1033 (1999)
  26. Koster T, "Role of clotting factor VIII in effect of von Willebrand factor on occurrence of deep-vein thrombosis", Lancet, 345, pp.152~155 (1995)
  27. Wells PS, "Elevated factor VIII is a risk factor for idiopathic venous thromboembolism in Canada: is it necessary to define a new upper reference range for factor VIII?", Thromb Haemost, 93, pp.842~846 (2005)
  28. Broekmans AW, "Hereditary protein S deficiency and venous thrombo-embolism:a study in three Dutch families", Thromb Haemost, 53, pp.273~277 (1985)
  29. Levi M, "Disseminated intravascular coagulation in infectious disease", Semin Thromb Hemost, 36, pp.367~377 (2010)
  30. Engesser L, "Hereditary protein S deficiency: clinical manifestations", Ann Intern Med, 106, pp.677~682 (1987)

관련 논문AI추천

The Pulmonary Embolism Severity Index in Predicting the Prognosis of Patients With Pulmonary Embolism정훈, 권성욱, 김정아, 남궁준, 도준형, 이성윤, 이원로, 장제호, 좌윤정, 최원호, 최윤호대한내과학회 · The Korean Journal of Internal Medicine2009 · 제24권 제2호Differential clinical manifestations and clinical outcome of cancer-related pulmonary embolismDuk-Kyung Kim, Eun Kyoung Kim, Haseong Chang, Hye Yun Park, Min Sun Kim, Sung-A Chang, Sun Hye Shin, Su Yeon Lee, Taek Kyu Park대한내과학회 · The Korean Journal of Internal Medicine2020 · 제35권 제2호Epidemiological trend of pulmonary thromboembolism at a tertiary hospital in Korea김재열, 박인원, 박태윤, 신종욱, 정재우, 최병휘, 최재철대한내과학회 · The Korean Journal of Internal Medicine2017 · 제32권 제6호Hereditary protein S deficiency presenting acute pulmonary embolism강성희, 김성혜, 김지완, 김현중, 박수연, 안상희, 유형민, 정상만영남대학교 의과대학 · Journal of Yeungnam Medical Science2014 · 제31권 제1호근위부 심부정맥 혈전증에서 유증상 폐색전증과 무증상 폐색전증의 비교고승현, 김균무, 김동훈, 서영우, 장재석, 장태창영남대학교 의과대학 · Journal of Yeungnam Medical Science2017 · 제34권 제2호The predictive value of echocardiography for chronic thromboembolic pulmonary hypertension after acute pulmonary embolism in Korea박진섭, 안진희, 오준혁, 이한철, 이혜원, 차광수, 최정현, 홍택종대한내과학회 · The Korean Journal of Internal Medicine2017 · 제32권 제1호

이 간행물의 다른 논문 (25건)