SIRENA score for in-hospital mortality risk assessment in patients with acute pulmonary embolism

Abstract

Aim . To create a new prognostic scale for in-hospital mortality risk assessment in patients with pulmonary embolism (PE). Material and methods . The study was carried out on the basis of Russian register of acute pulmonary embolism SIRENA. Results . Based on the Russian register of acute pulmonary embolism SIRENA (n=609; women — 50,7%; mean age — 63,0±1,5 years), independent predictors of in-hospital death were determined: left ventricular ejection fraction <40%, immobilization in the last 12 months, creatinine clearance <50 ml/min, syncope as a PE symptom, cyanosis at admission. Each of these factors with a value of 1 became a component of the novel SIRENA score. At the score of 0, 1, 2, 3 and more, in-hospital mortality was 3,1%, 7,0%, 16,7% and 40,0%, respectively. Mortality with a SIRENA score <2 (low risk) was 5,0%, and with a score ≥2 (high risk) — 24,3% (relative risk (RR), 4,87; 95% confidence interval (CI), 2,97-7,98; p<0,001). Predictive sensitivity and specificity for in-hospital mortality were 62,7% and 78,5%, respectively. The area under the ROC curve was 0,76 (95% CI, 0,690,83), which did not differ significantly from sPESI score — 0,73 (95% CI, 0,66-0,80). With a high risk for sPESI and SIRENA, the mortality was 27,1%, which was significantly higher compared to patients with a high risk only for sPESI — 13,9% (RR, 1,94; 95% CI, 1,36-2,82; p<0,001), but did not differ significantly compared with patients at high risk according to SIRENA score — 24,3% (RR, 1,11; 95% CI, 0,75-1,65; p=0,78). Conclusion . Based on the Russian register of acute pulmonary embolism, the SIRENA score was developed, which has a high accuracy (sensitivity, 62,7%; specificity, 78,5%) in predicting in-hospital mortality.