Introduction
Materials and methods
Patients inclusion
Data collection
Risk stratification and management
Grouping, study outcomes and definitions
Statistical analysis
Results
Characteristics | Very old group (n = 609) | 65-79 years (n = 2734) | < 65 years (n = 4095) | P values |
---|---|---|---|---|
Age(years) | 83.9 ± 3.3 | 72.25 ± 4.18 | 50.53 ± 11.25 | |
Female n (%) | 354 (58.1%) | 1313 (48%) | 2272 (55.5%) | < 0.001 |
BMI | 23.1 ± 3.4 | 23.9 ± 3.6 | 24.03 ± 3.6 | < 0.001 |
Major comorbidity, n (%) | ||||
Cardiovascular disease n (%) | 436 (71.6%) | 1716 (62.9%) | 1291 (31.6%) | < 0.001 |
Hypertension n (%) | 352 (57.8%) | 1372 (50.3%) | 946 (23.1%) | < 0.001 |
Coronary heart disease n (%) | 185 (30.4%) | 567 (20.8%) | 252 (6.2%) | < 0.001 |
Rheumatic heart disease n (%) | 3 (0.5%) | 25 (0.9%) | 20 (0.5%) | 0.087 |
Cardiomyopathy n (%) | 4 (0.7%) | 15 (0.5%) | 26 (0.6%) | 0.896 |
Heart failure n (%) | 65 (10.7%) | 191 (7.0%) | 106 (2.6%) | < 0.001 |
Respiratory disease n (%) | 265 (43.5%) | 876 (32.1%) | 888 (21.7%) | < 0.001 |
Chronic obstructive pulmonary disease n (%) | 106 (17.4%) | 349 (12.8%) | 143 (3.5%) | < 0.001 |
Pulmonary infection n (%) | 114 (18.7%) | 346 (12.7%) | 400 (9.8%) | < 0.001 |
Pulmonary Tuberculosis n (%) | 44 (7.2%) | 99 (3.6%) | 83 (2.0%) | < 0.001 |
Asthma n (%) | 11 (1.8%) | 36 (1.3%) | 49 (1.2%) | 0.464 |
Interstitial lung disease n (%) | 25 (4.1%) | 69 (2.5%) | 36 (0.9%) | < 0.001 |
Cor pulmonale n (%) | 35 (5.7%) | 86 (8.2%) | 68 (1.7%) | < 0.001 |
Bronchiectasis n (%) | 14 (2.3%) | 35 (1.3%) | 42 (1.0%) | 0.026 |
Lung cancer n (%) | 14 (2.3%) | 99 (3.6%) | 160 (3.9%) | 0.137 |
Hyperlipidemia n (%) | 35 (5.7%) | 151 (5.5%) | 174 (4.3%) | 0.032 |
Diabetes n (%) | 111 (18.3%) | 383 (14.1%) | 301 (7.4%) | < 0.001 |
Neurological diseases n (%) | 150 (24.8%) | 449 (16.5%) | 337 (8.3%) | < 0.001 |
Ischemic stroke n (%) | 116 (19.2%) | 336 (12.4%) | 192 (4.7%) | < 0.001 |
Hemorrhagic stroke n (%) | 20 (3.3%) | 48 (1.8%) | 71 (1.7%) | 0.028 |
Malignancy n (%) | 71 (11.7%) | 354 (13%) | 476 (11.7%) | 0.224 |
Varicose n (%) | 35 (5.7%) | 207 (7.6%) | 299 (7.3%) | 0.278 |
DVT | 221 (37%) | 998 (36.9%) | 1729 (42.7%) | < 0.001 |
Liver and kidney disease n (%) | 24 (4.0%) | 92 (3.4%) | 194 (4.8%) | 0.021 |
Liver cirrhosis n (%) | 2 (0.3%) | 8 (0.3%) | 18 (0.4%) | 0.624 |
Chronic hepatitis n (%) | 6 (1.0%) | 34 (1.2%) | 87 (2.1%) | 0.009 |
Chronic nephritis n (%) | 11 (1.8%) | 26 (1.0%) | 33 (0.8%) | 0.056 |
Nephrotic syndrome n (%) | 4 (0.7%) | 26 (1.0%) | 55 (1.3%) | 0.171 |
Diuretics n (%) | 2 (0.3%) | 23 (0.9%) | 40 (1.0%) | 0.262 |
Central venous catheterization | 0 (0.0%) | 0 (0.0%) | 14 (0.4%) | 0.005 |
Smoking n (%) | 195 (36.7%) | 795 (35.3%) | 1269 (37.9%) | 0.284 |
Surgery, trauma, immobilization n (%) | 474 (78.0%) | 2357 (86.2%) | 3567 (87.1%) | < 0.001 |
Laboratory examination | ||||
Platelet count (× 109/L) | 195.1 ± 75.2 | 201.5 ± 77.1 | 218.9 ± 87.2 | < 0.001 |
Hemoglobin (g/L) | 123.3 ± 20.7 | 126.5 ± 20.0 | 129.9 ± 22.4 | < 0.001 |
White blood cell > 10*109/L | 125 (20.8%) | 595 (22.1%) | 1215 (30.2%) | < 0.001 |
PaO2 < 60 mmHg n (%) | 114 (21.3%) | 578 (24%) | 623 (18%) | < 0.001 |
eGFR < 60 mL/min/1.73m2 n (%) | 209 (35.9%) | 505 (19.4%) | 242 (6.2%) | < 0.001 |
Elevated BNP or NT-proBNP n (%) | 385 (63.2%) | 1638 (59.9%) | 2296 (56.1%) | < 0.001 |
Elevated CTN n (%) | 357 (58.6%) | 1549 (56.7%) | 2241 (54.7%) | 0.096 |
Symptoms and signs | ||||
Cough n (%) | 295 (48.5%) | 1172 (43%) | 1641 (40.2%) | < 0.001 |
Sputum n (%) | 258 (42.5%) | 946 (34.7%) | 1189 (29.1%) | < 0.001 |
Dyspnea n (%) | 385 (63.3%) | 1862 (68.3%) | 2746 (67.2%) | 0.062 |
Chest pain n (%) | 158 (26.0%) | 895 (32.8%) | 1798 (44.0%) | < 0.001 |
Hemoptysis n (%) | 34 (5.6%) | 223 (8.2%) | 748 (18.3%) | < 0.001 |
Palpitation n (%) | 62 (10.2%) | 378 (13.9%) | 560 (13.7%) | 0.047 |
Syncope n (%) | 50 (8.2%) | 274 (10.0%) | 453 (11.1%) | 0.065 |
Physical examinations | ||||
Temperature > 37.3◦C n (%) | 45 (7.4%) | 224 (8.2%) | 531 (13.0%) | < 0.001 |
Pulse > 110/min n (%) | 42 (7.0%) | 227 (8.4%) | 469 (11.5%) | < 0.001 |
SBP < 100 mmHg n (%) | 12 (2.0%) | 107 (3.9%) | 249 (6.1%) | < 0.001 |
DBP < 60 mmHg n (%) | 30 (5.0%) | 103 (3.8%) | 153 (3.8%) | 0.351 |
Respiratory rate > 20/min n (%) | 189 (31.2%) | 959 (35.2%) | 1530 ( 37.5%) | 0.005 |
Cyanosis n (%) | 86 (14.3%) | 431 (15.8%) | 527 (12.9%) | 0.003 |
Moist crackle n (%) | 213 (35.3%) | 784 (28.8%) | 835 (20.5%) | < 0.001 |
Wheezing n (%) | 85 (14.1%) | 242 (8.9%) | 184 (4.5%) | < 0.001 |
Vascular murmur n (%) | 3 (0.5%) | 6 (0.2%) | 19 (0.5%) | 0.240 |
Pleural rub n (%) | 1 (0.2%) | 15 (0.6%) | 29 (0.7%) | 0.247 |
Jugular venous distention n (%) | 48 (8.0%) | 189 (6.9%) | 231 (5.7%) | 0.024 |
Cardiomegaly n (%) | 57 (9.5%) | 223 (8.2%) | 256 (6.3%) | 0.001 |
Tricuspid area murmur n (%) | 14 (2.3%) | 93 (3.4%) | 147 (3.6%) | 0.266 |
P2 increase n (%) | 81 (13.4%) | 367 (13.5%) | 700 (17.2%) | < 0.001 |
Heart beats under the xiphoid process n (%) | 8 (1.3%) | 40 (1.5%) | 82 (2.0%) | 0.172 |
Abdominal signs n (%) | 17 (2.8%) | 112 (4.1%) | 155 (3.8%) | 0.326 |
Limb sighs n (%) | 258 (42.6%) | 1030 (37.9%) | 1557 (38.4%) | 0.093 |
Leg edema n (%) | 243 (40.2%) | 913 (33.6%) | 1355 (33.4%) | 0.004 |
Arm edema n (%) | 5 (0.8%) | 31 (1.1%) | 44 (1.1%) | 808 |
Leg varicose n (%) | 32 (5.3%) | 176 (6.5%) | 267 (6.6%) | 0.482 |
Homan sigh n (%) | 7 (1.2%) | 25 (0.9%) | 97 (2.4%) | < 0.001 |
Gastrocnemius tenderness n (%) | 5 (0.8%) | 58 (2.1%) | 187 (4.6%) | < 0.001 |
Items | ≥ 80 years (n = 609) | 65-79 years (n = 2734) | < 65 years (n = 4095) | P values |
---|---|---|---|---|
High risk n (%) | 15 ( 2.5%) | 110 (4.0%) | 185 (4.5%) | 0.155 |
Thrombolytic therapy as initial treatment n (%) | 13 (2.2%) | 286 (10.7%) | 607 (15.1%) | < 0.001 |
Anticoagulation as initial treatment n (%) | 524 (86%) | 2304 (84.3%) | 3395 (82.9%) | 0.083 |
Surgery thrombectomy n (%) | 1 (0.2%) | 19 (0.7%) | 31 (0.8%) | 0.258 |
Interventional thrombectomy n (%) | 0 (0.0%) | 13 (0.5%) | 13 (0.3%) | 0.153 |
IVC filter n (%) | 26 (4.4%) | 112 (4.2%) | 248% (6.2) | 0.001 |
INR up to the standard when discharge n (%) | 276 (73.2%) | 1470 (75%) | 2282 (76.9%) | 0.233 |
All cause death n (%) | 45 (7.4%) | 115 (4.2%) | 93 (2.3%) | < 0.001 |
Bleeding n (%) | 32 (7.1%) | 127 (6.4%) | 176 (6.2%) | 0.723 |
Major bleeding n (%) | 10 (2.2%) | 40 (2.0%) | 63 (2.2%) | 0.901 |
Days of stay (day) | 15 (11, 21) | 14 (10, 20) | 15 (10, 20) | 0.072 |
Treatment interval (day) | 8 (4,14) | 8 (4,14) | 7 (3,13) | 0.107 |
Comparison between survival and death groups in very old patients
Characteristics | Survival (n = 654) | Death (n = 45) | P values |
---|---|---|---|
Age (years) | 83.9 ± 3.3 | 85.6 ± 3.8 | 0.001 |
Female n (%) | 329 (58.3%) | 25 (55.6%) | 0.716 |
BMI | 23.2 ± 3.4 | 21.6 ± 2.8 | 0.002 |
Major comorbidity, n (%) | |||
Cardiovascular disease n (%) | 400 (70.9%) | 36 (80%) | 0.194 |
Respiratory disease n (%) | 243 (43.1%) | 22 (48.9%) | 0.450 |
Neurological diseases n (%) | 137 (24.5%) | 13 (28.9%) | 0.508 |
Malignancy n (%) | 36 (6.4%) | 7 (15.6%) | 0.021 |
Varicose n (%) | 34 (6.0%) | 1 (2.2%) | 0.291 |
Liver and kidney disease n (%) | 20 (3.6%) | 4 (8.9%) | 0.077 |
Surgery in 3 months n (%) | 42 (7.4%) | 4 (8.9%) | 0.725 |
Trauma in 3 months n (%) | 49 ( 8.7%) | 4 (8.9%) | 0.966 |
Central venous catheterization | 0 (0.0%) | 0 (0.0%) | - |
Smoking n (%) | 182 (37.1%) | 13 (31.7%) | 0.494 |
Immobilization more than 3 days n (%) | 400 (73.9%) | 27 (62.8%) | 0.113 |
Laboratory examination | |||
Anemia | 152 (27.8%) | 20 (46.5%) | 0.009 |
Thrombocytopenia | 37 (6.7%) | 6 (13.6%) | 0.086 |
White blood cell > 10*109/L | 112 (20.1%) | 13 (30.2%) | 0.115 |
PaO2 < 60 mmHg n (%) | 97 (19.5%) | 17 (47.2%) | < 0.001 |
eGFR < 60 mL/min/1.73m2 n (%) | 186 (34.4%) | 23 (56.1%) | 0.005 |
Elevated cardiac biomarkers n (%) | 266 (47.2%) | 25 (55.6) | 0.278 |
Elevated BNP or NT-proBNP n (%) | 35 (63.1%) | 29 (64.4%) | 0.859 |
Elevated CTN n (%) | 327 (58%) | 30 (66.7%) | 0.255 |
Symptoms and signs | |||
Cough n (%) | 273 (48.5%) | 22 (48.9%) | 0.959 |
Sputum n (%) | 237 (42.1%) | 21 (46.7%) | 0.551 |
Dyspnea n (%) | 357 (63.4%) | 28 (62.2%) | 0.874 |
Chest pain n (%) | 145 (25.8%) | 13 (28.9%) | 0.645 |
Hemoptysis n (%) | 30 (5.3%) | 4 (8.9%) | 0.317 |
Palpitation n (%) | 57 (10.1%) | 5 (11.1%) | 0.833 |
Syncope n (%) | 47 (8.3%) | 3 (6.7%) | 0.693 |
Temperature > 37.3◦C n (%) | 42 (7.5%) | 3 (6.7%) | 0.842 |
Pulse > 110/min n (%) | 35 (6.3%) | 7 (15.9%) | 0.016 |
SBP < 100 mmHg n (%) | 6 (1.6%) | 3 (6.7%) | 0.019 |
DBP < 60 mmHg n (%) | 24 (4.3%) | 6 (13.3%) | 0.007 |
Respiratory rate > 20/min n (%) | 174 (31.0%) | 15 (34.1%) | 0.672 |
Items | Survival (n = 564) | Death (n = 45) | P values |
---|---|---|---|
High risk n (%) | 8 (53.3%) | 7 (46.7%) | < 0.001 |
Intermediate-high risk n (%) | 249 (92.2%) | 21 (7.8%) | < 0.001 |
Intermediate-low risk n (%) | 307 (94.8%) | 17 (5.2%) | < 0.001 |
Initial thrombolytic therapy n (%) | 6 (1.1%) | 2 (4.4%) | 0.055 |
Initial anticoagulation n (%) | 495 (87.8%) | 29 (64.4%) | < 0.001 |
Surgery thrombectomy n (%) | 1 (0.2%) | 0 (0.0%) | 0.775 |
Interventional thrombectomy n (%) | 0 (0.0%) | 0 (0.0%) | - |
IVC filter n (%) | 25 (4.6%) | 1 (2.3%) | 0.467 |
Bleeding n (%) | 28 (6.6%) | 4 (15.4%) | 0.092 |
Major bleeding n (%) | 7 (1.6%) | 3 (11.5%) | 0.001 |
≥ 3 comorbidities n (%) | 134 (23.8%) | 19 (42.2%) | 0.006 |
Variables | Univariate Logistic-regression Analysis | Multivariate Logistic-regression Analysis | ||||||
---|---|---|---|---|---|---|---|---|
P | OR | 95% C.I | P | OR | 95% C.I | |||
Lower | Upper | Lower | Upper | |||||
Age | 0.024 | 0.34 | 0.133 | 0.869 | 0.470 | 0.576 | 0.129 | 2.567 |
BMI < 18 | 0.138 | 0.498 | 0.198 | 1.251 | ||||
Malignancy, n (%) | 0.000 | 3.537 | 1.757 | 7.120 | 0.005 | 0.245 | 0.091 | 0.658 |
Liver and kidney disease, n (%) | 0.060 | 2.949 | 0.953 | 9.118 | 0.317 | 0.463 | 0.103 | 2.089 |
Anamia, n (%) | 0.011 | 2.260 | 1.206 | 4.233 | 0.080 | 0.483 | 0.214 | 1.092 |
Platelet < 100 × 109/L, n (%) | 0.094 | 2.202 | 0.875 | 5.544 | ||||
PaO2 < 60 mmHg, n (%) | 0.000 | 3.699 | 1.854 | 7.381 | 0.000 | 0.216 | 0.094 | 0.497 |
eGFR < 60 mL/min/1.73m2, n (%) | 0.006 | 2.439 | 1.284 | 4.633 | 0.014 | 0.361 | 0.160 | 0.814 |
Pulse ≥ 110Bpm, n (%) | 0.020 | 2.827 | 1.176 | 6.797 | 0.393 | 0.580 | 0.167 | 2.021 |
SBP < 100 mmHg, n (%) | 0.031 | 4.389 | 1.145 | 16.825 | 0.931 | 0.912 | 0.115 | 7.243 |
DBP < 60 mmHg, n (%) | 0.011 | 3.442 | 1.329 | 8.917 | 0.094 | 0.281 | 0.063 | 1.242 |
Thrombolysis as initial therapy, n (%) | 0.078 | 4.326 | 0.847 | 22.079 | ||||
Anticoagulation as initial therapy, n (%) | 0.000 | 0.253 | 0.131 | 0.489 | 0.005 | 3.826 | 1.511 | 9.688 |
≥ 3 comorbidities n (%) | 0.007 | 2.345 | 1.258 | 4.370 | 0.179 | 0.547 | 0.227 | 1.318 |