Outcomes in acute pulmonary embolism and their association with adherence to international recommendations around COVID-19 pandemic-induced hospital-strain: The experience in a Mexican tertiary care center.
不遵守国际建议会导致更差的结局。在COVID-19大流行期间，住院患者的总数和比例增加，从而给医院诊疗带来压力并妨碍了依从性。为了评估本中心在COVID-19大流行引起的医院压力之前、期间和之后不久对临床指南的依从性及其与临床结局的关联，采用随机、平衡的回顾性队列。从电子病历中抽取2019年至2022年间每年50例患者的平衡随机样本，并使用多变量和逻辑回归模型进行分析。主要结局是院内死亡、最初7天内血流动力学失代偿和院内出血的复合结局。我们研究中的总体不依从率为45.4%。不依从的主要危险因素为任何高于低危肺栓塞（PE）的死亡风险分类以及不同于I级的PESI分级，其OR分别为3.47（95% CI 2.07-5.82）和1.57（95% CI 1.04-2.37）。在两个时期（COVID-19季节和非COVID-19季节），不依从的管理均与复合结局密切相关，OR = 2.36（95% CI，1.23-4.54）。不依从还与更差的院内结局相关，复合结局的发生率为每1000人日21.08例（95% CI 10.97-40.51）和每1000人日47.7例（95% CI 33.39-67.50），归因风险为1.09%（95% CI -8.47%-10.64%）。总体而言，我们的研究结果强调需要优先配置人力和物力资源，以确保PE患者遵守诊疗标准。
Lack of adherence to international recommendations leads to worse outcomes. During the COVID-19 pandemic, the total number and proportion of hospitalized patients increased, consequently straining hospital care and hindering adherence. To evaluate adherence to clinical guidelines at our center, before, during, and shortly after the COVID-19 pandemic-induced hospital strain, and its association with clinical outcomes, using a random, balanced retrospective cohort. A balanced and randomized sample of 50 patients per year between 2019 and 2022 was drawn from electronic medical records and analyzed with multivariable and logistic regression models. The primary outcome was a composite of in-hospital death, hemodynamic decompensation within the first 7 days, and in-hospital bleeding. The global non-adherence in our study was 45.4%. The main risk factors for non-adherence were any mortality risk classification above low-risk PE and a PESI class different from class I, with ORs of 3.47 (95% CI 2.07-5.82) and 1.57 (95% CI 1.04-2.37), respectively. In both periods (COVID-19 season and non-COVID-19 season), non-adherent management strongly correlated with the composite outcome, OR = 2.36 (95% CI, 1.23-4.54). Non-adherence was also associated with worse in-hospital outcomes, with an incidence rate of the composite outcome of 21.08 per 1000 days/person (95% CI 10.97-40.51) and 47.7 per 1000 days/person (95% CI 33.39-67.50), and an attributable risk of 1.09% (95% CI -8.47%-10.64%). Overall, our findings highlight the need to prioritize human and material resources to ensure adherence to the standards of care for PE patients.
Juan José Rodríguez-Crespo, Eduardo Gutiérrez-León, Pedro Dammann-Beltrán, Jurhiat Alejandro Seaman-Gómez, Sergio Contreras-Garduño, Erick Yasar Zúñiga-González, et al. Outcomes in acute pulmonary embolism and their association with adherence to international recommendations around COVID-19 pandemic-induced hospital-strain: The experience in a Mexican tertiary care center.. PloS one. 2026; doi:10.1371/journal.pone.0347761.
Juan José Rodríguez-Crespo, Eduardo Gutiérrez-León, Pedro Dammann-Beltrán, Jurhiat Alejandro Seaman-Gómez, Sergio Contreras-Garduño, Erick Yasar Zúñiga-González, et al (2026). Outcomes in acute pulmonary embolism and their association with adherence to international recommendations around COVID-19 pandemic-induced hospital-strain: The experience in a Mexican tertiary care center.. PloS one. https://doi.org/10.1371/journal.pone.0347761
Juan José Rodríguez-Crespo, Eduardo Gutiérrez-León, Pedro Dammann-Beltrán, Jurhiat Alejandro Seaman-Gómez, Sergio Contreras-Garduño, Erick Yasar Zúñiga-González, et al. Outcomes in acute pulmonary embolism and their association with adherence to international recommendations around COVID-19 pandemic-induced hospital-strain: The experience in a Mexican tertiary care center.[J]. PloS one, 2026 doi:10.1371/journal.pone.0347761.
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