Pulmonary embolism: mortality was high especially in patients with comorbidity.

Clinical bottom line (level 1b)

  1. A quarter of patients who have a pulmonary embolism were dead within one year, most within the first week.
  2. Only a tenth of these were directly attributed to the PE.
  3. A poor prognosis was associated with:
    • cancer (NNF = 2 for 12 months)
    • chronic lung disease (NNF = 2 for 12 months)
    • left heart failure (NNF = 4 for 12 months)
Carson et al: New England Journal of Medicine 1992; 326 (19): 1240-1245
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 teaching hospitals, USA

399 patients (aged 50% older than 60 years, 54% male) pulmonary embolism diagnosed by lung scan or pulmonary angiogram. 95% of patients were fully anticoagulated

Factors studied:
  • death
  • cancer
  • left heart failure
  • chronic lung disease
  • age >60




    • Multivariate analysis was used to adjust for confounding factors.

    99% followed for 12 months (by phone)
    Outcomes studied:
  • death at one week
  • death at one year
  • death from PE at one week
  • death from PE at one year
  • recurrent PE at one week
  • recurrent PE at one year

    • The evidence

    outcome time to outcome number of patients/total number %
    (95% CI)
    death at one week 12 months (by phone) 88/399 22%
    (18% to 26%)
    death at one year 12 months (by phone) 96/399 24%
    (20% to 28%)
    death from PE at one week 12 months (by phone) 8/399 2.0%
    (0.6% to 3.4%)
    death from PE at one year 12 months (by phone) 10/399 2.5%
    (1% to 4%)
    recurrent PE at one week 12 months (by phone) 16/399 4.0%
    (2% to 6%)
    recurrent PE at one year 12 months (by phone) 33/399 8.3%
    (6% to 11%)

    prognostic factor for
    death at one year     		time to outcome adjusted RR
    (95% CI)    		 NNF+
    (95% CI)
    cancer 12 months (by phone) 4.4
    (2.1 to 9.5)     		2
    (1 to 5)
    left heart failure 12 months (by phone) 2.6
    (1.2 to 5.7)     		4
    (1 to 28)
    chronic lung disease 12 months (by phone) 3.2
    (1.3 to 7.4)     		2
    (1 to 18)
    age >60 12 months (by phone) 1.4
    (0.5 to 3.4)     		21
    (-17 to 3)

    Comments

    1. This study shows that pulmonary embolism is often associated with general poor health.

    Citation

    1. Carson JL, Kelley MA, Duff A, et al: The clinical course of pulmonary embolism. New England Journal of Medicine 1992; 326 (19): 1240-1245
    Contributor: Chris Ball and Clare Wotton, Unknown Month 2000
    Reviewer:

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