• Solange Aparecida Petilo Carvalho Bricola, Edison Ferreira Paiva, Arnaldo Lichtenstein, Reinaldo José Gianini, Jurandir Godoy Duarte, Samuel Katsuyuki Shinjo, Jose Eluf-Neto, and Arruda MartinsMiltonM.
• Faculdade de Medicina da Universidade de São Paulo, Department of Medicine, São Paulo/SP, Brazil.
• Clinics (Sao Paulo). 2013 May 1; 68 (5): 679685679-85.

ObjectivePulmonary embolism is an underdiagnosed major cause of death for hospitalized patients. The objective of this study was to identify the conditions associated with fatal pulmonary embolism in this population.MethodsA total of 13,074 autopsy records were evaluated in a case-control study. Patients were matched by age, sex, and year of death, and factors potentially associated with fatal pulmonary embolism were analyzed using univariate and multivariate conditional logistic regression.ResultsPulmonary embolism was considered fatal in 328 (2.5%) patients. In the multivariate analysis, conditions that were more common in patients who died of pulmonary embolism were atherosclerosis, congestive heart failure, and neurological surgery. Some conditions were negatively associated with fatal pulmonary embolism, including hemorrhagic stroke, aortic aneurism, cirrhosis, acquired immune deficiency syndrome, and pneumonia. In the control group, patients with hemorrhagic stroke and aortic aneurism had short hospital stays (8.5 and 8.8 days, respectively), and the hemorrhage itself was the main cause of death in most of them (90.6% and 68.4%, respectively), which may have prevented the development of pulmonary embolism. Cirrhotic patients in the control group also had short hospital stays (7 days), and 50% died from bleeding complications.ConclusionsIn this large autopsy study, atherosclerosis, congestive heart failure, and neurological surgery were diagnoses associated with fatal pulmonary embolism.

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