Clinical predictors and outcomes of pulmonary infarction in patients with central pulmonary embolism

ABSTRACT

Background

Given the heterogeneity of predisposing factors associated with pulmonary infarction (PI) and the lack of clinically relevant outcomes among patients with acute pulmonary embolism (PE) complicated by PI, further investigation is required.

Methods

Retrospective study of patients with central PE in an 11-year period. Data were stratified according to the diagnosis of PI. Multivariable logistic regression analysis was used to analyze factors associated with PI development and determine if PI was associated with severe hypoxemic respiratory failure and mechanical ventilation use.

Results

Of 645 patients with central PE, 24% (n = 156) had PI. After adjusting for demographics, comorbidities, and clinical features on admission, only age (OR 0.98, CI 0.96–0.99; p = 0.008) was independently associated with PI. Regarding outcomes, 35% (n = 55) had severe hypoxemic respiratory failure, and 19% (n = 29) required mechanical ventilation. After adjusting for demographics, PE severity, and right ventricular dysfunction, PI was independently associated with severe hypoxemic respiratory failure (OR 1.78; CI 1.18–2.69, p = 0.005) and mechanical ventilation (OR 1.92; CI 1.14–3.22, p = 0.013).

Conclusions

Aging is a protective factor against PI. In acute central PE, subjects with PI had higher odds of developing severe hypoxemic respiratory failure and requiring mechanical ventilation.

KEYWORDS:

• Pulmonary infarction
• acute central pulmonary embolism
• severe hypoxemic respiratory failure
• mechanical ventilation
• Lung aging
• Pulmonary collateral circulation

Author contributions

Jose Manuel Martinez Manzano: Project conceptualization and design, Data acquisition, statistical analysis, data interpretation, Manuscript writing – original draft, Manuscript revision for intellectual content and final approval. Kevin Bryan Lo: Project conceptualization and design, Data acquisition, statistical analysis, data interpretation, Manuscript writing – original draft, Manuscript revision for intellectual content and final approval. Omar Cantu-Martinez: Project conceptualization and design, Data acquisition, statistical analysis, data interpretation, Manuscript writing – original draft, Manuscript revision for intellectual content and final approval. Long Nguyen: Project conceptualization, Data acquisition and data interpretation, Manuscript revision for intellectual content and final approval. Brenda Chiang: Project conceptualization, Data acquisition and data interpretation, Manuscript revision for intellectual content and final approval. Simone A. Jarrett: Project conceptualization, Data acquisition and data interpretation, Manuscript revision for intellectual content and final approval. Sahana Tito: Project conceptualization, Data acquisition and data interpretation, Manuscript revision for intellectual content and final approval. Alexander Prendergast: Project conceptualization, Data acquisition and data interpretation, Manuscript revision for intellectual content and final approval. Maria. A. Planchart Ferretto: Project conceptualization, Data acquisition and data interpretation, Manuscript revision for intellectual content and final approval. Willy Roque: Project conceptualization, Data acquisition and data interpretation, Manuscript revision for intellectual content and final approval. Ammaar Watoo: Project conceptualization, Data acquisition and data interpretation, Manuscript revision for intellectual content and final approval. Zurab Azmaiparashvili: Project conceptualization and design, Data acquisition and data interpretation. Manuscript revision for intellectual content and final approval. Sadia Benzaquen: Project conceptualization and design, Data acquisition and data interpretation. Manuscript revision for intellectual content and final approval. All authors agree to be accountable for all aspects of the work.

Declaration of interest

The authors have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.

Reviewer disclosures

Peer reviewers on this manuscript have no relevant financial or other relationships to disclose.

Supplementary material

Supplemental data for this article can be accessed online at https://doi.org/10.1080/17476348.2023.2263359.

Additional information

Funding

This paper was not funded.