Renal Insufficiency and Short-Term Outcomes of Acute Pulmonary Embolism: A Systemic Review and Meta-Analysis

Author:

Wang Dingyi12,Fan Guohui12,Liu Xin3,Wu Sinan12,Zhai Zhenguo14

Affiliation:

1. Institute of Clinical Medical Sciences, China-Japan Friendship Hospital, Beijing, China

2. Institute of Respiratory Medicine, National Clinical Research Center for Respiratory Disease, Chinese Academy of Medical Sciences, Beijing, China

3. Department of Nephrology, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing, China

4. Department of Pulmonary and Critical Care Medicine, Center of Respiratory Medicine, China-Japan Friendship Hospital, Beijing, China

Abstract

Abstract Background This article evaluates the association between renal insufficiency and short-term outcomes among patients with acute pulmonary embolism. Methods The literature search was completed on December 31, 2019 and data were contracted from 13 cohort studies. Diagnosis of renal insufficiency was based on estimated glomerular filtration rate (eGFR), serum creatinine level, or self-report. The primary outcome was all-cause mortality of 30 days or during hospitalization. The pooled risk ratios (RRs), pooled mortality rates, and between-study heterogeneity were estimated by random-effect models. All the statistical analyses were performed using STATA/SE software. Results We included 13 studies (N = 35,662) in the meta-analysis, including two focused on acute kidney injury (AKI). Early all-cause mortality in patients with versus without renal insufficiency were 15% (95% confidence interval [CI] 9–22%) and 5% (95% CI 3–8%), respectively (RR 1.76, 95% CI 1.61–1.92). For patients with eGFR < 30 mL/min·1.73m−2, rates were 30% (95% CI 11–75%) versus 10% (95% CI 5–14%) (RR 3.32, 95% CI 1.53–6.70). For patients with AKI during hospitalization, rates were 32% (95% CI 11–75%) versus 13% (95% CI 4–29%) (RR 2.69, 95% CI 1.24–5.84). Pulmonary embolism (PE)-related death and fatal bleeding were significantly higher in patients with renal insufficiency. Conclusion Renal insufficiency, especially AKI and severe renal insufficiency, was associated with early mortality in acute PE patients. Our results may escalate vigilance in risk stratification and management of PE patients with renal insufficiency in clinical practice.

Funder

The National Key Research and Development Program of China

CAMS Innovation Fund for Medical Sciences

National Natural Science Foundation of China

Beijing Natural Science Foundation

Publisher

Georg Thieme Verlag KG

Subject

Hematology

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