Relationship between pulmonary embolism severity index (PESI) score and unfavorable inpatient prognosis in non-high risk pulmonary embolism (PE)

Abstract

Background: PEITHO trial showed that non-high risk PE patients with hemodynamic instability had an increased mortality risk. Pulmonary Embolism Severity Index (PESI) score allow identification of those with low risk of 30 day mortality but may not be able to select those with intermediate-high risk that could require close surveillance. Objectives: To determine the relationship between PESI score and unfavorable outcomes (intensive care unit (ICU) admission, inotropics and death), as reported in PEITHO trial. Methods: A retrospective cohort study was performed on patients with PE. The relationship between PESI score and the composite outcome was analysed and odds ratios (OR) were calculated. Results: 227 patients with diagnosis of PE were collected; mean age was 57± 17 years (54.2% female), 49% had right/left ventricular dysfunction. Most frequent comorbidities were COPD, cancer and cardiac failure. ICU admission, need of inotropic therapy and/or death was present in 67 patients (29.5%). Patients with PESI score V had an OR=91 (IC 23.0-363; p=0.001) for UCI admission, an OR=6.3 (IC 4.6-8.6;p=0.001) for the need of inotropic theraphy and an OR=6.1 (IC 4.5-8.3;p=0.001) for death. Conclusions: PESI score can identify patients with non-high risk PE who are at increased risk for UCI admission/need for inotropics/death and are in need of a more intensive surveillance.