Abstract
We compared the test characteristics of the Shock Index (SI) and the simplified Pulmonary Embolism Severity Index (sPESI) for predicting 30-day outcomes in a cohort of 1,206 patients with objectively confirmed pulmonary embolism (PE). The primary outcome of the study was all-cause mortality. The secondary outcome was non fatal symptomatic recurrent VTE or non fatal major bleeding. Overall, 119 out of 1,206 patients died (9.9%; 95% confidence interval [CI], 8.2% to 11.5%) during the first month of follow-up. The sPESI classified fewer patients as low risk (31% [369/1,206], 95% CI: 28% to 33%) compared to the SI (85% [1,024/1,206], 95% CI: 83% to 87%) (P<0.001). Low-risk patients based on the sPESI had a lower 30-day mortality than those based on the SI (1.6% [95% CI, 0.3–2.9] versus 8.3% [95% CI, 6.6–10.0]), while the 30-day rate of non fatal recurrent VTE or major bleeding was similar (2.2% [95%CI, 0.7% to 3.6%] versus 3.3% [95%CI, 2.2% to 4.4%]). The net reclassification improvement with the sPESI was 13.4% (P=0.07). The integrated discrimination improvement was estimated as 1.8% (P<0.001). The sPESI quantified the prognosis of patients with PE better than the SI.
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