Risk Factors for Mortality in Patients with Pulmonary Embolism-A Meta-Analysis

BackgroundIn recent years, although there have been many domestic and international reports on risk factors for pulmonary embolism (PE), there has not yet been a comprehensive and systematic analysis of risk factors for death from PE In this study, we conducted a meta-analysis of the research literature on PE published from June 2012 to January 2024.AimThe aim of this study was to systematically and comprehensively assess the risk factors, association strength, and quality of evidence for death in patients with pulmonary embolism.MethodsThe search strategy was developed in accordance with the PICOS principles (P: Participant, ie, study subject; I: Intervention, ie, intervention; C: Comparison, ie, control group; O: ie, Outcome study endpoints; S: Study design, ie, study design), and the search strategy was developed through computerized searches of English databases (including PubMed, Web of Science, Cochrane Library,EMbase) and Chinese databases, including China Biomedical Literature Database (CBM), Wanfang Data Medical Journals Repository, Wipo Database and China Knowledge Network. The search period was from the construction of the database to January 2024.ResultsTwenty-four papers met the nadir criteria, and the total number of cases and controls were 8769 and 8,830, respectively. Meta-analysis showed that the Odds ratio (OR) for the risk of death from PE were: age >70 years (1.65, 95% confidence interval 1.62 to 1.68), hyponatremia (2.68, 2.25 to 3.19), D-dimer(1.51, 1.38 to 1.67), Troponin I (3.56, 1.83 to 6.90), Malignancy (3.67, 3.01 to 4.48), Diabetes mellitus (1.58, 1.33 to 1.88), and S protein factor activity (0.72, 0.65 to 0.81). (See Table 3).ConclusionThe results of this study showed that age over 70, hyponatremia, D-dimer, troponin I, malignancy, diabetes, and decreased protein S activity are independent risk factors for acute death in patients with pulmonary embolism. However, controlling certain risk factors alone may not reduce the mortality of PE. First, many of the risk factors for PE death are not modifiable (age, diabetes, malignancy). Secondly, the association between a risk factor and mortality is not always causal. Efforts to address a risk factor may not result in improved outcomes if there is no causal link. Therefore, these risk factors can be tracked in future randomized controlled trial studies.