A Statewide Analysis on the Origins of de Novo Pulmonary Embolism: Does the Liver Play a Role?
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Pulmonary, Research, 2022
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INTRODUCTION: Over the last decade the concept of de novo pulmonary embolism (DNPE), or pulmonary embolism (PE) independent of a deep vein thrombosis (DVT), has been realized as a unique phenomenon, especially in trauma patients. Although the pathophysiology of DNPE remains unclear, most surmise that it stems from local inflammatory changes in the lungs. Considering the anatomic relationship between the liver and the pulmonary vasculature, we hypothesize that liver injury may play an important role in DNPE formation. The purpose of our study was to compare the relationship between hepatic and lung injury to DNPE. METHODS: A retrospective chart review from January 2010 to December 2019 identified all blunt and penetrating trauma patients in the Pennsylvania Trauma Outcome Study (PTOS) database. Patients were divided and compared based on whether or not they suffered a liver or lung injury. Our primary outcome was the incidence of DNPE, defined as the incidence of PE without DVT. DVT and PE were diagnosed based on requirements set by PTOS and the National Trauma Data Standard. In a separate analysis, multivariate regression was used to identify independent risk factors for DNPE formation. RESULTS: In total, we identified 381,676 patients. Compared to non-liver injury patients, liver-injury patients had a higher incidence of DNPE (1.3% vs. 0.3%, P < .05). Compared to non-lung injury patients, lung-injury patients had a higher incidence of DNPE (1.0% vs 0.3%, P < .05). Compared to non-DNPE patients, DNPE patients had a higher incidence of liver injury (8.9% vs. 2.4%, P < .05) and lung injury (18.5% vs. 6.4%, P < .05). On multivariate analysis, Injury Severity Score > 25 (OR 3.3), liver injury (OR 1.7), lung injury (OR 1.6), and male gender (OR 1.2), were all independent predictors of DNPE. CONCLUSIONS: Our data suggests that both liver injury and lung injury are independently associated with DNPE formation. We propose a novel theory, expanding on the lung-centered hypothesis for the pathophysiology of DNPE. Considering the direct anatomic relationship of the liver to the pulmonary vasculature, the local hypercoagulable, inflammatory, and thromboembolic effects of liver trauma may also promote DNPE formation. Our findings could have widespread implications on the diagnosis, prevention, and management of PE.
Meta Tag
Content Type Presentation
Knowledge Area Pulmonary
Knowledge Area Research
Knowledge Level Advanced
Membership Level Select
Tag Pulmonary Embolism
Tag Outcomes Research
Year 2022
de novo pulmonary embolism
liver injury
trauma patients


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