Pulmonary embolism: a sixth died within a year.

Clinical bottom line (level 1b)

  1. One in six patients who had a pulmonary embolism were dead within a year.
  2. Patients who were male, had been recently immobilised, had surgery in the last three months or have a history of thrombophlebitis were at an increased risk of dying.
Quinn et al: Journal of the American Medical Association 1992; 268 (13): 1689-1696
Expires September 2003

The study

Prospective cohort study with objective outcomes, adjusted for confounding factors, not validated in an independent set of patients.

Setting: six clinical centres, USA

902 patients (aged range 18 to 98 years; mean 56, 55% female) who had ventilation-perfusion scan for suspected pulmonary embolism in PIOPED study

Factors studied:
  • immobilisation
  • surgery within three months
  • history of thrombophlebitis




    • Multivariate analysis was used to adjust for confounding factors.

    100% followed for 12 months
    Outcomes studied:
  • risk factor- PE in men: death
  • PE in women: death
  • PE: recurrence of PE
  • death

    • The evidence

    outcome time to outcome number of patients/total number %
    (95% CI)
    risk factor- PE in men: death 12 months 33/406 8.1%
    (4.8% to 11%)
    PE in women: death 12 months 104/496 21%
    (17% to 25%)
    PE: recurrence of PE 12 months 216/902 24%
    (20% to 28%)
    death 12 months 137/902 15%
    (13% to 17%)

    prognostic factor for
    death     		time to outcome unadjusted RR
    (95% CI)    		 NNF+
    (95% CI)
    immobilisation 12 months 1.76
    (1.43 to 2.15)     		9
    (6 to 16)
    surgery within three months 12 months 1.69
    (1.38 to 2.07)     		10
    (6 to 18)
    history of thrombophlebitis 12 months 1.34
    (1.03 to 1.81)     		20
    (8 to 220)

    • risk factor for death- male: multivariate analysis estimate 0.25: p<0.01

    Comments

    1. Relative risks noted are small - as are the number of patients. No test-set validation was done - i.e. risk factors detected may not be very important or data dependant.

    Citation

    1. Quinn DL, Taylor Thompson B, Terrin ML, et al: A prospective investigation of pulmonary embolism in women and men. Journal of the American Medical Association 1992; 268 (13): 1689-1696
    Contributor: Chris Ball and Clare Wotton, Unknown Month 2000
    Reviewer:

    Clinical Question.
    Patient pulmonary embolism
    Intervention or Exposure risk factors
    Outcome death