Risk Stratification of Patients With Acute Symptomatic Pulmonary Embolism Based on Presence or Absence of Lower Extremity DVT : Systematic Review and Meta-analysis

BACKGROUND: For patients diagnosed with acute pulmonary embolism (PE), the prognostic significance of concomitant deep vein thrombosis (DVT) lacks clarity. METHODS: We performed a meta-analysis of studies that enrolled patients with acute PE to assess the prognostic value of concomitant DVT for the primary outcome of 30-day all-cause mortality, and the secondary outcome of 90-day PE-related adverse events. We conducted unrestricted searches of Pubmed and Embase from 1980 through September 30, 2014 and used the terms "deep vein thrombosis", "pulmonary embolism", and "prognos*". We used a random-effects model to pool study results; Begg rank correlation method to evaluate for publication bias; and I2 testing to assess for heterogeneity. RESULTS: The meta-analysis included a total of 9 studies (10 cohorts, as one study had 2 cohorts) with 8,859 patients. Of the 7 cohorts with 7,868 participants that had PE and provided results on the primary outcome, 4,379 (56%) had concomitant DVT; 272 of 4,379 (6.2%) patients with concomitant DVT died 30-days after the diagnosis of PE compared with 133 of 3,489 (3.8%) without DVT. Concomitant DVT had a significant association with 30-day all-cause mortality in all patients (7 cohorts; odds ratio [OR], 1.9; 95% CI, 1.5 to 2.4; I2 = 0%). Concomitant DVT was not significantly associated with 90-day PE-related adverse outcomes (5 cohorts; OR, 1.6; 95% CI, 0.8 to 3.4; I2 = 75%). CONCLUSIONS: In patients diagnosed with acute symptomatic PE, concomitant DVT was significantly associated with an increased risk of death within 30 days of PE diagnosis.