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

Abstract

This article evaluates the association between renal insufficiency and short-term outcomes among patients with acute pulmonary embolism. 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. 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. 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.