Differences in risk factors between all-cause and pulmonary embolism-related death in acute pulmonary embolism: insights from the COMMAND VTE registry-2
Year: 2025
Type: article
Study design: Observational Study
Abstract: Background The accurate risk prediction of early mortality, particularly PE-related death, in patients with acute pulmonary embolism (PE) has become more important for selecting optimal management strategies. Objectives To evaluate the cumulative 30-day incidence of and risk factors for all-cause and PE-related death within 30 days. Patients/Methods In the COMMAND VTE Registry-2, which enrolled symptomatic patients with venous thromboembolism at 31 centers in Japan, we analyzed 2035 patients with acute PE. Results The cumulative 30-day incidence of all-cause and PE-related death were 6.4 and 3.4%, respectively. Independent risk factors for all-cause and PE-related death were age >80 years (HR, 2.43; 95%CI, 1.45–4.08; P <0.001), hypoxemia (HR, 3.36; 95%CI, 1.07–10.5; P =0.04), tachycardia (HR, 3.78; 95%CI, 2.20–6.50; P <0.001), hypotension (HR, 5.43; 95% CI, 3.17–9.29; P <0.001), an abnormal leukocyte count (HR, 1.78; 95%CI, 1.08–2.93; P =0.02), and the absence of proximal deep vein thrombosis (HR, 2.58; 95%CI, 1.51–4.39; P <0.001). Active cancer (HR, 2.59; 95%CI, 1.75–3.82; P <0.001) and male sex (HR, 1.56; 95%CI, 1.07–2.28; P =0.02) were independent risk factors for all-cause death, but not PE-related death. Chronic heart or lung disease (HR, 1.72; 95%CI, 1.02–2.90; P =0.04) and right ventricular dysfunction (HR, 2.61; 95%CI, 1.02–6.70; P =0.046) were independent risk factors for PE-related death, but not all-cause death. Conclusions We identified several independent risk factors for PE-related death within 30 days, which differed from those for all-cause death. Risk factors specifically for PE-related death may be useful in decision-making for optimal treatment strategies for acute PE.
Authors: Soichiro Kobayashi, Yoshito Ogihara, Yugo Yamashita, Takeshi Morimoto, Ryuki Chatani, Kazuhisa Kaneda, Yuji Nishimoto, Nobutaka Ikeda, Yohei Kobayashi, Satoshi Ikeda, Kitae Kim, Moriaki Inoko, Toru Takase, Shuhei Tsuji, Maki Oi, Takuma Takada, Kazunori Otsui, Jiro Sakamoto, Takeshi Inoue, Shunsuke Usami, Po-Min Chen, Kiyonori Togi, Norimichi Koitabashi, Seiichi Hiramori, Kosuke Doi, Hiroshi Mabuchi, Yoshiaki Tsuyuki, Koichiro Murata, Kensuke Takabayashi, Hisato Nakai, Daisuke Sueta, Wataru Shioyama, Tomohiro Dohke, Toru Sato, Ryusuke Nishikawa, Takeshi Kimura, Kaoru Dohi
Institutions: Mie University, Mie University Hospital, Kyoto University, Hyogo Medical University, Kurashiki Central Hospital, Toyonaka Municipal Hospital, Toho University Ohashi Medical Center, Osaka Red Cross Hospital, Nagasaki University, Kobe City Medical Center General Hospital, Kitano Hospital, Kindai University Hospital, Japanese Red Cross Society Wakayama Medical Center, Otsu Red Cross Hospital, Tokyo Women's Medical University, Kobe University Hospital, Tenri Hospital, Kansai Electric Power (Japan), Kansai Electric Power Hospital, Saiseikai Noe Hospital, Kindai University, Gunma University, Kokura Memorial Hospital, Kyoto Medical Center, Koto Memorial Hospital, Shimada Municipal Hospital, Shizuoka City Hospital, Hirakata Kohsai Hospital, Sugita Genpaku Memorial Obama Municipal Hospital, Kumamoto University, Shiga University of Medical Science, Kohka Public Hospital
Language: English
Subfield: Internal Medicine
Field: Medicine
Domain: Health Sciences
Open Access status: gold
Estimated APC paid: $2,250
OpenAlex ID: W4411992573