[Prognostic analysis of acute pulmonary thromboembolism with newly diagnosed atrial fibrillation].

Objective: To analyze the clinical characteristics and to explore the prognostic factors of acute pulmonary embolism(APE) with newly diagnosed atrial fibrillation(AF). Methods: The medical records of inpatients with APE discharged from Beijing Anzhen Hospital between January 1, 2008, and December 31, 2021 were retrospectively reviewed. The clinical symptoms, complications, laboratory results, echocardiographic parameters, simplified pulmonary embolism severity index (sPESI) and adverse in-hospital outcome were compared between the newly diagnosed AF group and the sinus rhythm group. Logistic regression analysis was used to evaluate the risk factors of adverse in-hospital outcome with APE. Results: Fifty-one patients were included in newly diagnosed AF group and 102 cases in the sinus rhythm group. The patients in newly diagnosed AF group had greater sPESI scores, higher proportion of sPESI≥2 scores, higher incidence of adverse in-hospital outcome as well as longer hospital stay days. Newly diagnosed AF and sPESI≥2 scores were independent predictors affecting adverse in-hospital outcome. The area under ROC curve in newly diagnosed AF combined with sPESI≥2 scores was largest. Conclusions: The APE patients with newly diagnosed AF were more severely ill and prone to in-hospital adverse outcome. Newly diagnosed AF was an independent predictor affecting adverse in-hospital outcome. sPESI≥2 combined with newly diagnosed AF scores had a high predictive value for the occurrence of in-hospital adverse outcome.目的： 探讨合并新诊断心房颤动的急性肺血栓栓塞症（APE）患者的临床特点和院内不良事件的预测因素。 方法： 回顾性分析首都医科大学附属北京安贞医院2008年1月1日到2021年12月31日住院的APE患者153例，根据是否新诊断心房颤动分为房颤组51例，其中男23例，女28例，年龄（70.9±9.8）岁；窦性心律组102例，其中男44例，女58例，年龄（70.6±7.2）岁。比较两组间合并症、症状及体征、实验室检查和超声心动图指标、简化肺栓塞严重指数（sPESI）评分和院内不良事件。采用logistic回归分析发生院内不良事件的危险因素。 结果： 房颤组患者sPESI评分更高、sPESI评分≥2分患者比例更高，发生单项院内不良事件和发生院内不良事件的总病例数更多、住院时间更长。logistic多因素回归分析发现sPESI≥2分和新诊断心房颤动是发生院内不良事件的独立危险因素。sPESI≥2分联合新诊断心房颤动的ROC曲线下面积最大。 结论： 合并新诊断心房颤动的APE患者病情更为严重，容易发生院内不良事件。新诊断心房颤动是发生院内不良事件的独立危险预测因素，sPESI≥2分联合新诊断心房颤动对院内不良事件的发生有较高的预测价值。.