Download PDF
Thromb Haemost 2020; 120(07): 1025-1034
DOI: 10.1055/s-0040-1712459
Review Article
Georg Thieme Verlag KG Stuttgart · New York

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

Dingyi Wang
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
,
Guohui Fan
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
,
Xin Liu
3   Department of Nephrology, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing, China
,
Sinan Wu
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
,
Zhenguo Zhai
1   Institute of Clinical Medical Sciences, China-Japan Friendship Hospital, Beijing, China
4   Department of Pulmonary and Critical Care Medicine, Center of Respiratory Medicine, China-Japan Friendship Hospital, Beijing, China
› Author Affiliations Funding This study is funded by The National Key Research and Development Program of China (No. 2016YFC0905600; 2016YFC0901104); CAMS Innovation Fund for Medical Sciences (CIFMS) (No. 2018-I2M-1-003); National Natural Science Foundation of China (No. 81570049; 81970058); Beijing Natural Science Foundation (No. 7152062).
Further Information

Publication History

12 March 2020

16 April 2020

Publication Date:
11 June 2020 (online)

   Permissions and Reprints

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.

Keywords

pulmonary embolism - venous thromboembolism - renal insufficiency - acute kidney injury - mortality
 

  • References

  • 1 Konstantinides SV, Meyer G, Becattini C. , et al. ESC Scientific Document Group. 2019 ESC Guidelines for the diagnosis and management of acute pulmonary embolism developed in collaboration with the European Respiratory Society (ERS). Eur Heart J 2020; 41 (04) 543-603
    CrossrefPubMedGoogle Scholar
  • 2 Aujesky D, Obrosky DS, Stone RA. , et al. Derivation and validation of a prognostic model for pulmonary embolism. Am J Respir Crit Care Med 2005; 172 (08) 1041-1046
    CrossrefPubMedGoogle Scholar
  • 3 Becattini C, Agnelli G, Lankeit M. , et al. Acute pulmonary embolism: mortality prediction by the 2014 European Society of Cardiology risk stratification model. Eur Respir J 2016; 48 (03) 780-786
    CrossrefPubMedGoogle Scholar
  • 4 Vanni S, Nazerian P, Pepe G. , et al. Comparison of two prognostic models for acute pulmonary embolism: clinical vs. right ventricular dysfunction-guided approach. J Thromb Haemost 2011; 9 (10) 1916-1923
    CrossrefPubMedGoogle Scholar
  • 5 Jiménez D, Aujesky D, Moores L. , et al; RIETE Investigators. Simplification of the pulmonary embolism severity index for prognostication in patients with acute symptomatic pulmonary embolism. Arch Intern Med 2010; 170 (15) 1383-1389
    CrossrefPubMedGoogle Scholar
  • 6 Barco S, Mahmoudpour SH, Planquette B, Sanchez O, Konstantinides SV, Meyer G. Prognostic value of right ventricular dysfunction or elevated cardiac biomarkers in patients with low-risk pulmonary embolism: a systematic review and meta-analysis. Eur Heart J 2019; 40 (11) 902-910
    CrossrefPubMedGoogle Scholar
  • 7 Penaloza A, Roy PM, Kline J. Risk stratification and treatment strategy of pulmonary embolism. Curr Opin Crit Care 2012; 18 (04) 318-325
    CrossrefPubMedGoogle Scholar
  • 8 Goldhaber SZ, Visani L, De Rosa M. Acute pulmonary embolism: clinical outcomes in the International Cooperative Pulmonary Embolism Registry (ICOPER). Lancet 1999; 353 (9162): 1386-1389
    CrossrefPubMedGoogle Scholar
  • 9 Monreal M, Falgá C, Valle R. , et al; RIETE Investigators. Venous thromboembolism in patients with renal insufficiency: findings from the RIETE Registry. Am J Med 2006; 119 (12) 1073-1079
    CrossrefPubMedGoogle Scholar
  • 10 Moher D, Liberati A, Tetzlaff J, Altman DG. ; PRISMA Group. Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. PLoS Med 2009; 6 (07) e1000097
    CrossrefPubMedGoogle Scholar
  • 11 Kellum JA, Lameire N, Aspelin P. , et al. KDIGO clinical practice guideline for acute kidney injury. Official J Int Society Nephrology 2012; 2 (01) 124-138
    PubMedGoogle Scholar
  • 12 Wells GA, Shea B, O’Connell D, et al. The Newcastle-Ottawa Scale (NOS) for assessing the quality of nonrandomised studies in meta-analyses. Available at: http://www.ohri.ca/programs/clinical_epidemiology/oxford.asp . Accessed May 24, 2020
    PubMed
  • 13 Schulman S, Angerås U, Bergqvist D, Eriksson B, Lassen MR, Fisher W. ; Subcommittee on Control of Anticoagulation of the Scientific and Standardization Committee of the International Society on Thrombosis and Haemostasis. Definition of major bleeding in clinical investigations of antihemostatic medicinal products in surgical patients. J Thromb Haemost 2010; 8 (01) 202-204
    CrossrefPubMedGoogle Scholar
  • 14 Kostrubiec M, Pływaczewska M, Jiménez D. , et al. The prognostic value of renal function in acute pulmonary embolism-a multi-centre cohort study. Thromb Haemost 2019; 119 (01) 140-148
    Article in Thieme ConnectPubMedGoogle Scholar
  • 15 Trimaille A, Marchandot B, Girardey M. , et al. Assessment of renal dysfunction improves the simplified Pulmonary Embolism Severity Index (sPESI) for risk stratification in patients with acute pulmonary embolism. J Clin Med 2019; 8 (02) E160
    CrossrefPubMedGoogle Scholar
  • 16 Almeida S, Neiva JP, Bico P. , et al. Renal function at admission as a prognostic marker in patients admitted for pulmonary embolism. Eur Heart J Acute Cardiovasc Care 2015; 4: 67
    PubMedGoogle Scholar
  • 17 Salinger-Martinovic S, Dimitrijevic Z, Stanojevic D. , et al. Are we calculated enough? Glomerular filtration rate as a predictor of intra-hospital prognosis in patients with pulmonary embolism. Eur Heart J 2019; 40: 4063
    PubMedGoogle Scholar
  • 18 Kostrubiec M, Łabyk A, Pedowska-Włoszek J. , et al. Assessment of renal dysfunction improves troponin-based short-term prognosis in patients with acute symptomatic pulmonary embolism. J Thromb Haemost 2010; 8 (04) 651-658
    CrossrefPubMedGoogle Scholar
  • 19 Berghaus TM, Behr W, von Scheidt W, Schwaiblmair M. The N-terminal pro-brain-type natriuretic peptide based short-term prognosis in patients with acute pulmonary embolism according to renal function. J Thromb Thrombolysis 2012; 33 (01) 58-63
    CrossrefPubMedGoogle Scholar
  • 20 Altınsoy B, Öz İİ, Örnek T. , et al. Prognostic value of renal dysfunction indicators in normotensive patients with acute pulmonary embolism. Clin Appl Thromb Hemost 2017; 23 (06) 554-561
    CrossrefPubMedGoogle Scholar
  • 21 Kresoja KP, Ebner M, Rogge NIJ. , et al. Prediction and prognostic importance of in-hospital major bleeding in a real-world cohort of patients with pulmonary embolism. Int J Cardiol 2019; 290: 144-149
    CrossrefPubMedGoogle Scholar
  • 22 Jo JY, Lee MY, Lee JW, Rho BH, Choi WI. Leukocytes and systemic inflammatory response syndrome as prognostic factors in pulmonary embolism patients. BMC Pulm Med 2013; 13: 74
    CrossrefPubMedGoogle Scholar
  • 23 Keller K, Beule J, Balzer JO, Dippold W. Renal function as a cofactor for risk stratification and short-term outcome in acute pulmonary embolism. Exp Gerontol 2017; 100: 11-16
    CrossrefPubMedGoogle Scholar
  • 24 Agrawal N, Ramegowda RT, Patra S. , et al. Predictors of inhospital prognosis in acute pulmonary embolism: keeping it simple and effective!. Blood Coagul Fibrinolysis 2014; 25 (05) 492-500
    CrossrefPubMedGoogle Scholar
  • 25 Verschuren F, Bonnet M, Benoit M-O. , et al. The prognostic value of pro-B-Type natriuretic peptide in acute pulmonary embolism. Thromb Res 2013; 131 (06) e235-e239
    CrossrefPubMedGoogle Scholar
  • 26 Murgier M, Bertoletti L, Darmon M. , et al; RIETE Investigators. Frequency and prognostic impact of acute kidney injury in patients with acute pulmonary embolism. Data from the RIETE registry. Int J Cardiol 2019; 291: 121-126
    CrossrefPubMedGoogle Scholar
  • 27 Chang CH, Fu CM, Fan PC. , et al. Acute kidney injury in patients with pulmonary embolism: a population-based cohort study. Medicine (Baltimore) 2017; 96 (09) e5822
    PubMedGoogle Scholar
  • 28 Wang IK, Shen TC, Muo CH, Yen TH, Sung FC. Risk of pulmonary embolism in patients with end-stage renal disease receiving long-term dialysis. Nephrol Dial Transplant 2017; 32 (08) 1386-1393
    PubMedGoogle Scholar
  • 29 Kumar G, Sakhuja A, Taneja A. , et al; Milwaukee Initiative in Critical Care Outcomes Research (MICCOR) Group of Investigators. Pulmonary embolism in patients with CKD and ESRD. Clin J Am Soc Nephrol 2012; 7 (10) 1584-1590
    CrossrefPubMedGoogle Scholar
  • 30 Janus N, Mahé I, Launay-Vacher V, Laroche JP, Deray G. Renal function and venous thromboembolic diseases. J Mal Vasc 2016; 41 (06) 389-395
    CrossrefPubMedGoogle Scholar
  • 31 Berghaus TM, Schwaiblmair M, von Scheidt W. Renal biomarkers and prognosis in acute pulmonary embolism. Heart 2012; 98 (16) 1185-1186
    PubMedGoogle Scholar
  • 32 Grams ME, Estrella MM, Coresh J, Brower RG, Liu KD. ; National Heart, Lung, and Blood Institute Acute Respiratory Distress Syndrome Network. Fluid balance, diuretic use, and mortality in acute kidney injury. Clin J Am Soc Nephrol 2011; 6 (05) 966-973
    CrossrefPubMedGoogle Scholar
  • 33 Siniscalchi C, Quintavalla R, Rocci A. , et al; RIETE Investigators. Statin and all-cause mortality in patients receiving anticoagulant therapy for venous thromboembolism. Data from the RIETE registry. Eur J Intern Med 2019; 68: 30-35
    CrossrefPubMedGoogle Scholar
  • 34 Goto S, Turpie AGG, Zaghdoun A. , et al. The influence of renal impairment on clinical outcomes in venous thromboembolism patients enrolled in GARFIELD- VTE. Research and Practice in Thrombosis and Haemostasis 2019; 3: 205-206
    PubMedGoogle Scholar
  • 35 Lin MC, Streja E, Soohoo M. , et al. Warfarin use and increased mortality in end-stage renal disease. Am J Nephrol 2017; 46 (04) 249-256
    CrossrefPubMedGoogle Scholar
  • 36 Ageno W, Casella IB, Han CK. , et al. Baseline profile of patients treated for acute venous thromboembolism in routine clinical practice according to age and renal function in the RE-COVERY DVT_PE global cohort study. ESC Congress 2019 together with World Congress of Cardiology; 2019: 2435
    PubMedGoogle Scholar
  • 37 Levey AS, Coresh J, Balk E. , et al; National Kidney Foundation. National Kidney Foundation practice guidelines for chronic kidney disease: evaluation, classification, and stratification. Ann Intern Med 2003; 139 (02) 137-147
    PubMedGoogle Scholar
  • 38 Levey AS, Stevens LA. Estimating GFR using the CKD Epidemiology Collaboration (CKD-EPI) creatinine equation: more accurate GFR estimates, lower CKD prevalence estimates, and better risk predictions. Am J Kidney Dis 2010; 55 (04) 622-627
    CrossrefPubMedGoogle Scholar
  • 39 Fabbian F, Gallerani M, Pala M. , et al. In-hospital mortality for pulmonary embolism: relationship with chronic kidney disease and end-stage renal disease. The hospital admission and discharge database of the Emilia Romagna region of Italy. Intern Emerg Med 2013; 8 (08) 735-740
    CrossrefPubMedGoogle Scholar