Analysis of the Occurrence of Acute Pulmonary Embolism in the ICU Ward and Related Risk Factors Predicting Its Severity

Abstract

Objective: To investigate the occurrence of acute pulmonary embolism in the intensive care unit (ICU) and analyze the related risk factors for predicting its severity. Methods: From January 2016 to December 2020, 83 patients with acute pulmonary embolism in the intensive care unit of Peking University People's Hospital were selected as the research subjects, including 34 males (40.96%) and 49 females (59.04%), with an average age of 62.06±16.83 years. The patients were divided into a high-risk group (N = 31), medium-risk group (N = 32), and low-risk group (N = 20), according to the guidelines for diagnosis and treatment of acute pulmonary embolism issued by ASH in 2020. The clinical characteristics, treatment, and prognosis of the three groups were summarized, and the severity of the patients could be predicted and the related risk factors affecting prognosis were analyzed. Results: There were significant statistical differences in respiratory rate, syncope as the first symptom, bilateral pulmonary embolism, and APACHE-II score among the three groups (P < 0.05). There were significant statistical differences in the laboratory indexes, such as BNP, cTnI and D-dimer before and immediately after APE among the three groups (P < 0.05). There were significant statistical differences in cTnI and D-dimer among the three groups (P < 0.05). By pairwise comparison, it was found that there were significant statistical differences between the high-risk and low-risk groups in the immediate test indexes of APE, such as BNP, D-dimer, lower extremity vascular ultrasound abnormalities, and ECG abnormalities (P < 0.05), while there was no significant statistical difference between the medium-risk and low-risk groups in the immediate test indexes of APE (P > 0.05). However, in the medium-risk group, the laboratory indexes tended to increase, in terms of treatment and outcome, thrombolysis rate, and inferior vena cava filter implantation rate. ICU stay (> 2 weeks) of the high-risk group was significantly higher than those of the other two groups, with significant statistical difference (P < 0.05). Logistic regression analysis showed that respiratory rate (or = 1.778,95% CI 1.043-3.032, P = 0.034), D-Dimer (or = 1,95% CI 1.0-1.0, P = 0.006), and APACHE-II score (or = 1.879,95% CI 1.398-2.527, P = 0.000) were independent risk factors for predicting the severity of APE patients in the ICU ward. Conclusion: Acute pulmonary embolism (APE) is a critical disease in ICU. By monitoring BNP, cTnI and D-dimer, we can identify critical patients with APE early. In addition, we found that respiratory rate, D-dimer, and APACHE-II score were independent risk factors for predicting the severity of APE patients in the ICU. Clinically, APE can be identified early. The diagnosis, treatment rate, and prognosis can be improved by monitoring these indicators.