急性肺栓塞（PE）可以作为潜在的肿瘤的表现形式，并具有副肿瘤性病因学。有时，在急性PE诊断之后，可以诊断出以前不知道的肿瘤。以前从未进行过患有潜在癌症的PE患者群体的识别。我们的目标是确定急性PE中潜在癌症的预测因子。我们的假设是D-二聚体水平将是癌症的预测因子。我们对一组住院急性PE患者进行了回顾性分析。排除条件包括年龄<18岁、静脉栓塞仅发生在肺以外的静脉、栓塞被认为是慢性的，以及没有急性PE的影像确认。根据癌症诊断的时间将患者分为三组：1）已知的同时存在的活动癌症；2）在急性PE住院期间或在随后的2年内被诊断出的癌症；3）在PE诊断后的2年随访期间未发现癌症。使用 logistic 回归分析确定了合并癌症的预测因子，并建立了多元模型。我们研究了562例患者，其中年龄中位数为72岁，219名（39.0%）为男性。在223例（39.7%）患者中，PE为中央动脉性，并且61.4%的患者表现为双侧PE。出院时，47.7%的PE被认为是无症状的。D-二聚体水平的中位数（四分位数范围）为7.98（3.30-14.99）μg/mL。共有126例（22.4%）患者属于第一组，第二组有47例（在急性PE诊断后至多两年内诊断出的癌症），第三组有389例患者。升高的 D-二聚体水平与已知癌症有独立关联。D-二聚体是未来癌症诊断的独立预测因子：对于每增加5 ng/mL，OR = 1.07（95% CI：1.01-1.14）；对于 D-二聚体 >15.0 μg/mL的患者，未来癌症的 OR 为 2.10（1.05-4.18）。如果只考虑入院时无症状的 PE 患者（n = 307），则考虑到 D-二聚体的结果相似；贫血也是未知癌症的预测因子 [OR = 2.13（1.08-4.16）]。D-二聚体 >15 μg/mL 的患者在今后 2 年被诊断为癌症的风险增加了 2 倍以上。D-二聚体可能有助于临床医生确定哪些患者有更高的潜在癌症风险。版权所有© 2023。Elsevier Ltd. 发表。

Acute pulmonary embolism (PE) can occur as a manifestation of an underlying cancer and be of paraneoplastic aetiology. A previously unknown cancer is sometimes diagnosed after the acute PE diagnosis. The identification of a group of patients with elevated probability of having an occult cancer underlying PE was never performed. We aimed to determine predictors of occult cancer in acute PE. Our hypothesis was that the D-dimer levels would be a predictor of cancer.We retrospectively analysed a cohort of patients hospitalized with acute PE.<18 years, venous embolism only of veins other than pulmonary territory or when the embolism was considered chronic, and no image confirmation of acute PE. Patients were grouped according to the timing of cancer diagnosis: 1) known concomitant active cancer, 2) cancer diagnosed during acute PE admission or in the following 2 years and, 3) no known cancer during the 2-year follow-up since PE diagnosis. Predictors of concomitant cancer were determined using a logistic regression analysis. Multivariate models were built.We studied 562 patients; median age was 72 years and 219 (39.0 %) were men. In 223 (39.7 %) of the patients the PE was of central arteries and 61.4 % presented with bilateral PE. PE was considered unprovoked at time of discharge in 47.7 %. Median (interquartile range) D-dimer level was 7.98 (3.30-14.99) μg/mL. A total of 126 (22.4 %) patients were in group 1, 47 in group 2 (cancer diagnosed after the diagnosis of acute PE and up to 2 years) and 389 patients were in group 3. Elevated D-dimer levels were independently associated with already known cancer. D-dimer were independent predictors of future cancer diagnosis: OR = 1.07 ((95 % CI: 1.01-1.14) per each 5 ng/mL increase; for patients with D-dimer >15.0 μg/mL the OR of future cancer was 2.10 (1.05-4.18). If only patients with unprovoked PE upon admission (n = 307) were to be considered results were similar considering D-dimer; anaemia also predicted unknown cancer [OR = 2.13 (1.08-4.16)].Patients with D-dimer >15 μg/mL presented a >2-fold higher risk of being diagnosed with a cancer condition in the upcoming 2 years. D-dimer may help clinicians in identifying which patients are at higher risk of occult cancer.Copyright © 2023. Published by Elsevier Ltd.