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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)

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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
 

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