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Decreased Haemoglobin Level Measured at Admission Predicts Long Term Mortality after the First Episode of Acute Pulmonary Embolism
Background: Decreased hemoglobin concentration was reported to predict long term prognosis in patients various cardiovascular diseases including congestive heart failure and coronary artery disease. We hypothesized that hemoglobin levels may be useful for post discharge prognostication after the fir...
Autores principales: | , , , , , , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
MDPI
2022
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9738807/ https://www.ncbi.nlm.nih.gov/pubmed/36498677 http://dx.doi.org/10.3390/jcm11237100 |
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author | Justyna, Aleksandra Dzikowska-Diduch, Olga Pacho, Szymon Ciurzyński, Michał Skowrońska, Marta Wyzgał-Chojecka, Anna Piotrowska-Kownacka, Dorota Pruszczyk, Katarzyna Pucyło, Szymon Sikora, Aleksandra Pruszczyk, Piotr |
author_facet | Justyna, Aleksandra Dzikowska-Diduch, Olga Pacho, Szymon Ciurzyński, Michał Skowrońska, Marta Wyzgał-Chojecka, Anna Piotrowska-Kownacka, Dorota Pruszczyk, Katarzyna Pucyło, Szymon Sikora, Aleksandra Pruszczyk, Piotr |
author_sort | Justyna, Aleksandra |
collection | PubMed |
description | Background: Decreased hemoglobin concentration was reported to predict long term prognosis in patients various cardiovascular diseases including congestive heart failure and coronary artery disease. We hypothesized that hemoglobin levels may be useful for post discharge prognostication after the first episode of acute pulmonary embolism. Therefore, the aim of the current study was to evaluate a potential prognostic value of a decreased hemoglobin levels measured at admission due to the first episode of acute PE for post discharge all cause mortality during at least 2 years follow up. Methods: This was a prospective, single-center, follow-up, observational, cohort study of consecutive survivors of the first PE episode. Patients were managed according to ESC current guidelines. After the discharge, all PE survivors were followed for at least 24 months in our outpatient clinic. Results: During 2 years follow-up from the group of 402 consecutive PE survivors 29 (7.2%) patients died. Non-survivors were older than survivors 81 years (40–93) vs. 63 years (18–97) p < 0.001 presented higher sPESI 2 (0–4) vs. 1 (0–5), p < 0.001 driven by a higher frequency of neoplasms (37.9% vs. 16.6%, p < 0.001); and had lower hemoglobin (Hb) level at admission 11.7 g/dL (6–14.8) vs. 13.1 g/dL (3.1–19.3), p < 0.001. Multivariable analysis showed that only Hb and age significantly predicted all cause post-discharge mortality. ROC analysis for all cause mortality showed AUC for hemoglobin 0.688 (95% CI 0.782–0.594), p < 0.001; and for age 0.735 (95% CI 0.651–0.819) p < 0.001. A group of 59 subjects with hemoglobin < 10.5 g/dL showed mortality rate of 16.9% (OR for mortality 4.19 (95% CI 1.82–9.65), p-value < 0.00, while among 79 patients with Hb > 14.3 g/dL only one death was detected. Interestingly, patients in age > 64 years hemoglobin levels < 13.2 g/dL compared to patients in the same age but with >13.2 g/dL showed OR 3.6 with 95% CI 1.3–10.1 p = 0.012 for death after the discharge. Conclusions: Lower haemoglobin measured in the acute phase especially in patients in age above 64 years showed significant impact on the prognosis and clinical outcomes in PE survivors. |
format | Online Article Text |
id | pubmed-9738807 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2022 |
publisher | MDPI |
record_format | MEDLINE/PubMed |
spelling | pubmed-97388072022-12-11 Decreased Haemoglobin Level Measured at Admission Predicts Long Term Mortality after the First Episode of Acute Pulmonary Embolism Justyna, Aleksandra Dzikowska-Diduch, Olga Pacho, Szymon Ciurzyński, Michał Skowrońska, Marta Wyzgał-Chojecka, Anna Piotrowska-Kownacka, Dorota Pruszczyk, Katarzyna Pucyło, Szymon Sikora, Aleksandra Pruszczyk, Piotr J Clin Med Article Background: Decreased hemoglobin concentration was reported to predict long term prognosis in patients various cardiovascular diseases including congestive heart failure and coronary artery disease. We hypothesized that hemoglobin levels may be useful for post discharge prognostication after the first episode of acute pulmonary embolism. Therefore, the aim of the current study was to evaluate a potential prognostic value of a decreased hemoglobin levels measured at admission due to the first episode of acute PE for post discharge all cause mortality during at least 2 years follow up. Methods: This was a prospective, single-center, follow-up, observational, cohort study of consecutive survivors of the first PE episode. Patients were managed according to ESC current guidelines. After the discharge, all PE survivors were followed for at least 24 months in our outpatient clinic. Results: During 2 years follow-up from the group of 402 consecutive PE survivors 29 (7.2%) patients died. Non-survivors were older than survivors 81 years (40–93) vs. 63 years (18–97) p < 0.001 presented higher sPESI 2 (0–4) vs. 1 (0–5), p < 0.001 driven by a higher frequency of neoplasms (37.9% vs. 16.6%, p < 0.001); and had lower hemoglobin (Hb) level at admission 11.7 g/dL (6–14.8) vs. 13.1 g/dL (3.1–19.3), p < 0.001. Multivariable analysis showed that only Hb and age significantly predicted all cause post-discharge mortality. ROC analysis for all cause mortality showed AUC for hemoglobin 0.688 (95% CI 0.782–0.594), p < 0.001; and for age 0.735 (95% CI 0.651–0.819) p < 0.001. A group of 59 subjects with hemoglobin < 10.5 g/dL showed mortality rate of 16.9% (OR for mortality 4.19 (95% CI 1.82–9.65), p-value < 0.00, while among 79 patients with Hb > 14.3 g/dL only one death was detected. Interestingly, patients in age > 64 years hemoglobin levels < 13.2 g/dL compared to patients in the same age but with >13.2 g/dL showed OR 3.6 with 95% CI 1.3–10.1 p = 0.012 for death after the discharge. Conclusions: Lower haemoglobin measured in the acute phase especially in patients in age above 64 years showed significant impact on the prognosis and clinical outcomes in PE survivors. MDPI 2022-11-30 /pmc/articles/PMC9738807/ /pubmed/36498677 http://dx.doi.org/10.3390/jcm11237100 Text en © 2022 by the authors. https://creativecommons.org/licenses/by/4.0/Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (https://creativecommons.org/licenses/by/4.0/). |
spellingShingle | Article Justyna, Aleksandra Dzikowska-Diduch, Olga Pacho, Szymon Ciurzyński, Michał Skowrońska, Marta Wyzgał-Chojecka, Anna Piotrowska-Kownacka, Dorota Pruszczyk, Katarzyna Pucyło, Szymon Sikora, Aleksandra Pruszczyk, Piotr Decreased Haemoglobin Level Measured at Admission Predicts Long Term Mortality after the First Episode of Acute Pulmonary Embolism |
title | Decreased Haemoglobin Level Measured at Admission Predicts Long Term Mortality after the First Episode of Acute Pulmonary Embolism |
title_full | Decreased Haemoglobin Level Measured at Admission Predicts Long Term Mortality after the First Episode of Acute Pulmonary Embolism |
title_fullStr | Decreased Haemoglobin Level Measured at Admission Predicts Long Term Mortality after the First Episode of Acute Pulmonary Embolism |
title_full_unstemmed | Decreased Haemoglobin Level Measured at Admission Predicts Long Term Mortality after the First Episode of Acute Pulmonary Embolism |
title_short | Decreased Haemoglobin Level Measured at Admission Predicts Long Term Mortality after the First Episode of Acute Pulmonary Embolism |
title_sort | decreased haemoglobin level measured at admission predicts long term mortality after the first episode of acute pulmonary embolism |
topic | Article |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9738807/ https://www.ncbi.nlm.nih.gov/pubmed/36498677 http://dx.doi.org/10.3390/jcm11237100 |
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