Predictors of survival after deep vein thrombosis and pulmonary embolism - A population-based, cohort study
Predictors of survival after deep vein thrombosis and pulmonary embolism - A population-based, cohort study
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DOI：
10.1001/archinte.159.5.445
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发表时间：
1999-03-08
影响因子：
--
通讯作者：
Melton, LJ
中科院分区：
文献类型：
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作者：
Heit, JA;Silverstein, MD;Melton, LJ
背景资料：由于静脉血栓栓塞（VTE）后报告的生存率差异很大，我们进行了一项基于人群的回顾性队列研究，以估计生存率，将观察到的生存率与预期生存率进行比较，并确定短期生存率的预测因素。静脉血栓栓塞（VTE）后的生存期（小于或等于7天）和长期生存期（>7天）。我们跟踪了25年来（1966-1990年）（n = 2218）来自明尼苏达州奥姆斯特德县，仅患有深静脉血栓形成（DVT）或肺栓塞伴或不伴深静脉血栓形成的患者结果：在14629人年的随访中，1333例患者死亡。7天、30天和1年VTE生存率分别为74.8%（DVT，96.2%; PE +/- DVT，59.1%）、72.0%（DVT，94.5%; PE +/- DVT，55.6%）和63.6%（DVT，85.4%; PE +/- DVT，47.7%）。对于年龄和性别相似的明尼苏达州白人，观察到的DVT、PE +/- DVT和总体生存率明显低于预期（P < .001）。三分之一以上的死亡发生在发病当天或在生命中未被识别的VTE之后。在25年的研究期间，短期生存率有所改善，而长期生存率没有变化。在调整了共病条件后，与单纯DVT相比，PE +/- DVT是发病后3个月内生存率降低的独立预测因素。短期和长期生存率的其他独立预测因素包括年龄、体重指数、患者发病部位、恶性肿瘤、充血性心力衰竭、神经系统疾病、慢性肺病、近期手术和激素治疗。长期生存的其他独立预测因素包括吸烟，其他心脏疾病，慢性肾脏疾病。结论：VTE后生存，特别是PE +/- DVT后，是比报道的更糟糕，并显着低于预期的生存。与单纯DVT相比，症状性PE +/- DVT是发病后3个月内生存率降低的独立预测因素，这意味着对这2种疾病的治疗应有所不同。
Background: Because reported survival after venous thromboembolism (VTE) varies widely, we performed a population-based retrospective cohort study to estimate survival, compare observed with expected survival, and determine predictors of short-term (less than or equal to 7 days) and long-term survival (>7 days) after VTE.Methods: We followed the 25-year (1966-1990) inception cohort (n = 2218) of Olmsted County, Minnesota, patients with deep vein thrombosis alone (DVT) or pulmonary embolism with or without deep vein thrombosis (PE +/- DVT) forward in time until death or the last clinical contact.Results: During 14629 person-years of follow-up, 1333 patients died. Seven-day, 30-day, and 1-year VTE survival rates were 74.8% (DVT, 96.2%; PE +/- DVT, 59.1%), 72.0% (DVT, 94.5%; PE +/- DVT, 55.6%), and 63.6% (DVT, 85.4%; PE +/- DVT, 47.7%), respectively. Observed survival after DVT, PE +/- DVT, and overall was significantly worse than expected for Minnesota whites of similar age and sex (P < .001). More than one third of deaths occurred on the date of onset or after VTE that was unrecognized during life. Short-term survival improved during the 25-year study period, while longterm survival was unchanged. After adjusting for comorbid conditions, PE +/- DVT was an independent predictor of reduced survival for up to 3 months after onset compared with DVT alone. Other independent predictors of both short- and long-term survival included age, body mass index, patient location at onset, malignancy, congestive heart failure, neurologic disease, chronic lung disease, recent surgery, and hormone therapy. Additional independent predictors of long-term survival included tobacco smoking, other cardiac disease, and chronic renal disease.Conclusions: Survival after VTE, and especially after PE +/- DVT, is much worse than reported, and significantly less than expected survival. Compared with DVT alone, symptomatic PE +/- DVT is an independent predictor of reduced survival for up to 3 months after onset, implying that treatment for the 2 disorders should be different.