Thrombosis research · 2026
Temporal trends and risk factors of extracranial major bleeding in patients with acute pulmonary embolism.
СтатьяНазвание и аннотация: Перевод в очереди
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Christodoulou Konstantinos C, Hobohm Lukas, Mohr Katharina, Farmakis Ioannis T, Sivanathan Visvakanth, Espinola-Klein Christine, Moehler Markus, Konstantinides Stavros V, Keller Karsten
Аннотация
BACKGROUND: Major bleeding is a crucial event in patients with pulmonary embolism (PE) accompanied by high morbidity and mortality. While the major bleeding research focus primarily on intracranial bleeding, research regarding extracranial major bleeding (ECB) is largely underrepresented.
METHODS: We used the German nationwide inpatient statistics including all hospitalizations of patients admitted due to PE 2016-2020. Hospitalizations were stratified for occurrence of ECB and risk factors for ECB were investigated.
RESULTS: Overall, 283,263 patients were admitted due to PE 2016-2020 in Germany; among them 9378 (3.3%) suffered from ECB. PE patients with ECB were older, more often female, revealed a higher Charlson comorbidity index (CCI; 5.0 [4.0-7.0] vs. 4.0 [2.0-5.0], P < 0.001), were afflicted by prolonged in-hospital stay (13.0 [7.0-22.0] vs 7.0 [4.0-9.0] days, P < 0.001) and higher in-hospital mortality rate (28.3% vs. 7.4%, P < 0.001). ECB was associated with increased in-hospital mortality rate (OR 7.76 [95%CI 7.31-8.24], P < 0.001) and hospitalization costs >20,000€ (OR 24.46 [95%CI 22.25-26.89], P < 0.001). Hospitalization costs were higher in PE with than without ECB (mean: 12.795 vs. 3637€, P < 0.001). Female sex (OR 1.35 [95%CI 1.28-1.42], P < 0.001), higher CCI score (OR 1.25 [95%CI 1.24-1.26], P < 0.001), kidney disease (OR 2.47 [95%CI 2.35-2.60], P < 0.001), heart failure (OR 1.65 [95%CI 1.57-1.73], P < 0.001), cancer (OR 2.01 [95%CI 1.97-2.22], P < 0.001) and hemodynamic instability (OR 12.08 [95%CI 11.38-12.82], P < 0.001) were associated with ECB.
CONCLUSIONS: ECB occurred in 3.3% of the PE hospitalizations and is independently associated with 7.8-fold increased in-hospital mortality rate. Independent risk factors for ECB comprise female sex, hemodynamic status and comorbidity burden.
METHODS: We used the German nationwide inpatient statistics including all hospitalizations of patients admitted due to PE 2016-2020. Hospitalizations were stratified for occurrence of ECB and risk factors for ECB were investigated.
RESULTS: Overall, 283,263 patients were admitted due to PE 2016-2020 in Germany; among them 9378 (3.3%) suffered from ECB. PE patients with ECB were older, more often female, revealed a higher Charlson comorbidity index (CCI; 5.0 [4.0-7.0] vs. 4.0 [2.0-5.0], P < 0.001), were afflicted by prolonged in-hospital stay (13.0 [7.0-22.0] vs 7.0 [4.0-9.0] days, P < 0.001) and higher in-hospital mortality rate (28.3% vs. 7.4%, P < 0.001). ECB was associated with increased in-hospital mortality rate (OR 7.76 [95%CI 7.31-8.24], P < 0.001) and hospitalization costs >20,000€ (OR 24.46 [95%CI 22.25-26.89], P < 0.001). Hospitalization costs were higher in PE with than without ECB (mean: 12.795 vs. 3637€, P < 0.001). Female sex (OR 1.35 [95%CI 1.28-1.42], P < 0.001), higher CCI score (OR 1.25 [95%CI 1.24-1.26], P < 0.001), kidney disease (OR 2.47 [95%CI 2.35-2.60], P < 0.001), heart failure (OR 1.65 [95%CI 1.57-1.73], P < 0.001), cancer (OR 2.01 [95%CI 1.97-2.22], P < 0.001) and hemodynamic instability (OR 12.08 [95%CI 11.38-12.82], P < 0.001) were associated with ECB.
CONCLUSIONS: ECB occurred in 3.3% of the PE hospitalizations and is independently associated with 7.8-fold increased in-hospital mortality rate. Independent risk factors for ECB comprise female sex, hemodynamic status and comorbidity burden.