Clinical characteristics and mortality predictors among very old patients with pulmonary thromboembolism: a multicenter study report
Authors: Zhou Xia , Yang Yuanhua , Zhai Zhenguo , Wang Dingyi , Lei Jieping , Xu Xiaomao , Ji Yingqun , Yi Qun , Chen Hong , Hu Xiaoyun , Liu Zhihong , Mao Yimin , Zhang Jie , Shi Juhong , Zhang Zhu , Wu Sinan , Gao Qian , Tao Xincao , Xie Wanmu , Wan Jun , Zhang Yunxia , Zhang Shuai , Zhen Kaiyuan , Zhang Zhonghe , Fang Baomin , Wang Chen ,   on behalf of the China pUlmonary thromboembolism REgistry Study (CURES) investigators, Li Jifeng , Yang He , Wang Lan , Zhou Haixia , Wang Maoyun , Wang Xiaohui , Luo Qin , Fan Junping , An Jun , Zeng Mian , Li Xia , Zhu Ling , Liu Yi , Ying Kejing , Ma Guofeng , Yan Chao , Dong Lixia , Zhou Wei , Bai Chong , Zhang Wei , Wang Liangxing , Xie Yupeng , Huang Xiaoying , Qiu Chen , Li Yazhen , Fu Yingyun , Liu Shengguo , Li Shengqing , Zhang Jian , Han Xinpeng , Xu Qixia , Li Xiaoqing , Pang Yingying , Gong Beilei , Huang Ping , Chen Yanwei , Chen Jiming , Shi Guochao , Ding Yongjie , Cheng Zhaozhong , Tong Li , Ma Zhuang , Liu Lei , Jiang Luning , Liang Zhijun , Deng Chaosheng , Yang Minxia , Wu Dawen , Zhang Shudong , Kang Lijun , Yu Fangfei , Chen Xuewei , Han Dan , Shen Shasha , Sun Guohua , Hou Yutao , Liu Baoliang , Fan Xiaohong , Zhang Ping , Xu Ruhong , Wang Zaiyi , Yan Cunzi , Yu Chunxiao , Lu Zhenfang , Hua Jing , Xu Zhenyang , Zhang Hongxia , Wang Jinxiang , Yang Xiaohong , Chen Ying , Tang Yongjun , Yang Wei , Zhang Nuofu , Duan Linli , Qing Simin , Liu Chunli , Jiang Lian , Zhao Hongda , Liu Chengying , Yuan Yadong , Gong Xiaowei , Zhang Xinhong , Zhang Chunyang , Xia Shuyue , Jia Hui , Liu Yunxia , Zhang Dongmei , Ma Yuntian , Guo Lu , Zhang Jing , Han Lina , Bai Xiaomin , Yang Guoru , Yu Guohua , Yang Ruian , Fan Jingyuan , Zhang Aizhen , Jiang Rui , Li Xueshuang , Wu Yuzhi , Han Jun , Yang Jingping , Xu Xiyuan , Bu Baoying , Cui Chaobo , Wang Ning , Zhang Yonghai , Duo Jie , Tuo Yajun , Ding Yipeng , Xu Heping , Sun Dingwei , Zhang Xiangyan , Liu Weijia , Wang Hongyang , Wang Yuan , Fu Aishuang , Huang Songping , Xu Qinghua , Chai Wenshu , Li Jing , Ye Yanping , Hu Wei , Chen Jin , Liu Bo , Suo Lijun , Guo Changcheng , Wang Ping , Liu Jinming , Zhao Qinhua , Kang Le , Xu Jianying , Zhao Lifen , Cheng Mengyu , Duan Wei , Wu Qi , Li Li , He Xiuqing , Li Yueyue , Chen Gang , Zhao Yunxia , Liu Zixiao , Xia Guoguang , Li Tianshui , Chen Nan , Liu Xiaoyang , Bian Tao , Wu Yan , Yang Huiqin , Tang Xiaoli , Zhang Yiwen , Jin Faguang , Chen Yanli , Li Yanyan , Lao Miaochan , Dong Liang , Zhu Guangfa , Zhang Wenmei , Chen Liangan , Liang Zhixin , Cui Liping , Xia Cenfeng , Zhang Jin , Zhang Peng , Guo Lianxiang , Niu Sha , Yu Sichong , Liu Guangjie , Wang Xinmao , Lv Yanhua , Liang Zhenyu , Cai Shaoxi , Yang Shuang , Zhang Xinyi , Kuang Jiulong , Ding Yanyan , Zhang Yongxiang , Guo Xuejun , Wang Yanmin , Wang Jialie , Hu Ruimin , Ma Lin , Gao Yuan , Zheng Rui , Shi Zhihong , Li Hong , Zhang Yingqi , Su Guanli , Qin Zhiqiang , Chen Guirong , Chen Xisheng , Niu Zhiwei , Jiang Jinjun , Chen Shujing , Zhang Tiantuo , Li Hongtao , Zhu Jiaxin , Zhou Yuqi , Yang Yinlou , Cheng Jiangtao , Sun Jie , Jiang Yanwen , Liu Jianhua , Wang Yujun , Yin Ju , Chen Lanqin , Yang Min , Jiang Ping , Liu Hongbo , Zhen Guohua , Zhang Kan , Wan Yixin , Tao Hongyan 
Published: January 2024

Abstract
Background
Clinical characteristics of patients with pulmonary thromboembolism have been described in previous studies. Although very old patients with pulmonary thromboembolism are a special group based on comorbidities and age, they do not receive special attention.

Objective
This study aims to explore the clinical characteristics and mortality predictors among very old patients with pulmonary thromboembolism in a relatively large population.

Design and participants
The study included a total of 7438 patients from a national, multicenter, registry study, the China pUlmonary thromboembolism REgistry Study (CURES). Consecutive patients with acute pulmonary thromboembolism were enrolled and were divided into three groups. Comparisons were performed between these three groups in terms of clinical characteristics, comorbidities and in-hospital prognosis. Mortality predictors were analyzed in very old patients with pulmonary embolism.

Key results
In 7,438 patients with acute pulmonary thromboembolism, 609 patients aged equal to or greater than 80 years (male 354 (58.1%)). There were 2743 patients aged between 65 and 79 years (male 1313 (48%)) and 4095 patients aged younger than 65 years (male 2272 (55.5%)). Patients with advanced age had significantly more comorbidities and worse condition, however, some predisposing factors were more obvious in younger patients with pulmonary thromboembolism. PaO2 < 60 mmHg, eGFR < 60 mL/min/1.73m2, malignancy, anticoagulation as first therapy were mortality predictors for all-cause death in very old patients with pulmonary thromboembolism. The analysis found that younger patients were more likely to have chest pain, hemoptysis (the difference was statistically significant) and dyspnea triad.

Conclusion
In very old population diagnosed with pulmonary thromboembolism, worse laboratory results, atypical symptoms and physical signs were common. Mortality was very high and comorbid conditions were their features compared to younger patients. PaO2 < 60 mmHg, eGFR < 60 mL/min/1.73m2 and malignancy were positive mortality predictors for all-cause death in very old patients with pulmonary thromboembolism while anticoagulation as first therapy was negative mortality predictors.