Abstract
Objectives: Hemodynamic status, cardiac enzymes, and imaging-based risk stratification are frequently used to evaluate a pulmonary embolism (PE). This study investigated the prognostic role of a simplified Pulmonary Embolism Severity Index (sPESI) score and the European Society of Cardiology (ESC) model. Methods : The study included 50 patients from the emergency and pulmonology department of one medical center between October 2005 and June 2006. The ability of the sPESI and ESC model to predict short-term (in-hospital) and long-term (6-month and 6-year) overall mortality was assessed, in addition to the accurancy of the sPESI and ESC model in predicting short-term adverse events, such as cardiopulmonary resuscitation, or major bleeding. Results : Of the 50 patients, the in-hospital and 6-year mortality rates were 14% and 46%, respectively. Fifteen (30%) of these experienced adverse events during hospitalization. Importantly, patients classified as low-risk according to the sPESI had no short-term adverse events as opposed to 4.8 % in the ESC low-risk group. They also had no in-hospital, 6-month, or 6-year mortality compared to 4.8%, %14.3, and %23.8, respectively, in the ESC low-risk group. Conclusions: The sPESI predicted short-term and long-term survival. The exclusion of short-term adverse events does not appear to require imaging and laboratory testing.
Highlights
Acute pulmonary embolism (PE) is related to high (4 to 13%) short-term mortality rates.[1,2] Recent, studies have revealed that PE heralds an increased long-term risk of adverse outcomes after hospital discharge with 1-year mortality rates as high as 25%.3-6 Early PE-related mortality is associated with clinical results and underlying disease.[2]
Study design: Prospective baseline data collected from the time of PE diagnosis and outcome data from the same cohort were used to determine the ability of the simplified Pulmonary Embolism Severity Index (PESI) (sPESI) and European Society of Cardiology (ESC) prognostic model to predict in-hospital adverse events, 6-month and 6-year overall mortality
In the ESC prognostic model, high-risk patients were identified by the presence of shock or persistent arterial hypotension; intermediate-risk patients were classified according to the presence of right ventricular dysfunction (RVD) based on echocardiography and/or elevated Cardiac TroponinI levels; and low-risk patients were categorized as those having none of the aforementioned sign and symptoms.[6]
Summary
Acute pulmonary embolism (PE) is related to high (4 to 13%) short-term (in-hospital or 30-day) mortality rates.[1,2] Recent, studies have revealed that PE heralds an increased long-term risk of adverse outcomes after hospital discharge with 1-year mortality rates as high as 25%.3-6 Early PE-related mortality is associated with clinical results and underlying disease.[2]. Acute pulmonary embolism (PE) is related to high (4 to 13%) short-term (in-hospital or 30-day) mortality rates.[1,2] Recent, studies have revealed that PE heralds an increased long-term risk of adverse outcomes after hospital discharge with 1-year mortality rates as high as 25%.3-6. PE-related mortality is associated with clinical results and underlying disease.[2] As several prognostic models have limitations in daily clinical practice, a few have been recommended for risk stratification in acute PE.[7,8,9,10,11] The Pulmonary Embolism Severity Index (PESI) is one of the most widely validated prognostic models for 30-day mortality.[9] Studies have demonstrated that this model can identify patients with a low mortality risk who may be treated as outpatient.[12,13] the PESI may not be suitable for routine clinical practice in busy emergency or pulmonology departments, as it requires the calculation of a score based on many different variables, and each parameter has a diverse value. The sPESI had similar accuracy in predicting short-term mortality in PE patients and offered great ease of use.[14]
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