[Prognostic factors for patients with pulmonary thromboembolism after orthopaedic surgery].

OBJECTIVE: To investigate the changes of serum enzymes and their prognostic value in patients with pulmonary thromboembolism after orthopaedic surgery.

METHODS: Clinical data of 134 cases of confirmed pulmonary thromboembolism after orthopaedic surgery from 1997 to 2010 were reviewed.The 134 cases were divided into dead group (n=28) and survival group (n=106). The clinical presentation, electrocardiogram, arterial oxygen pressure (PaO2), chest X-ray, echocardiography,and serum enzymes including alanine transaminase (ALT), aspartate aminotransferase (AST), gamma-glutamyl transpeptidase (γ-GT), lactate dehydrogenase (LDH), creatine kinase (CK) and creatine kinase isoenzyme (CK-MB) were analyzed. And multivariable Logistic regression was conducted to identify the risk factors of in-hospital death.

RESULTS: The average age of dead patients was higher than that of survival patients (P=0.043), while the P(O2) of dead patients was much lower than that of survival patients (P=0.035). The percentage of syncope, hypotension, right bundle-branch block and SIQIIITIII, pulmonary hypertension and right ventricular dysfunction in dead patients were higher than those in survival patients (P=0.009, P=0.041, P=0.018, P=0.030, P=0.042 and P=0.038), respectively. There were significant differences of elevated serum ALT, LDH and CK-MB levels between dead patients and survival patients (P=0.042, P=0.035 and P=0.017). Logistic regression indicated that the risk factors for death of patients with PTE after orthopaedic surgery were age (OR, 1.182; 95% CI, 1.010-1.383; P=0.036), hypoxemia (OR, 1.128; 95% CI, 1.018-1.249; P=0.022), hypotension (OR, 3.346; 95% CI, 1.116-10.031; P=0.031), right ventricular dysfunction (OR, 4.083; 95% CI, 1.040- 16.035; P=0.044) and elevated serum CK-MB levels (OR, 3.466; 95% CI, 1.054-11.400; P=0.041).

CONCLUSION: The incidence rate of elevated serum ALT, LDH and CK-MB levels in patients who died of pulmonary thromboembolism after orthopaedic surgery was higher than that of survival patients; Age, hypoxemia, hypotension and right ventricular dysfunction were independent risk factors of in-hospital death; The CK-MB might be a useful biomarker for risk stratification of acute PTE.