@article {Bova694, author = {Carlo Bova and Olivier Sanchez and Paolo Prandoni and Mareike Lankeit and Stavros Konstantinides and Simone Vanni and David Jim{\'e}nez}, title = {Identification of intermediate-risk patients with acute symptomatic pulmonary embolism}, volume = {44}, number = {3}, pages = {694--703}, year = {2014}, doi = {10.1183/09031936.00006114}, publisher = {European Respiratory Society}, abstract = {The identification of normotensive patients with acute pulmonary embolism (PE) at high risk of adverse PE-related clinical events (i.e. intermediate-risk group) is a major challenge. We combined individual patient data from six studies involving 2874 normotensive patients with PE. We developed a prognostic model for intermediate-risk PE based on the clinical presentation and the assessment of right ventricular dysfunction and myocardial injury. We used a composite of PE-related death, haemodynamic collapse or recurrent PE within 30 days of follow-up as the main outcome measure. The primary outcome occurred in 198 (6.9\%) patients. Predictors of complications included systolic blood pressure 90{\textendash}100 mmHg (adjusted odds ratio (aOR) 2.45, 95\% CI 1.50{\textendash}3.99), heart rate >=110 beats per min (aOR 1.87, 95\% CI 1.31{\textendash}2.69), elevated cardiac troponin (aOR 2.49, 95\% CI 1.71{\textendash}3.69) and right ventricular dysfunction (aOR 2.28, 95\% CI 1.58{\textendash}3.29). We used these variables to construct a multidimensional seven-point risk index; the odds ratio for complications per one-point increase in the score was 1.55 (95\% CI 1.43{\textendash}1.68; p\<0.001). The model identified three stages (I, II and III) with 30-day PE-related complication rates of 4.2\%, 10.8\% and 29.2\%, respectively. In conclusion, a simple grading system may assist clinicians in identifying intermediate-risk PE. A simple grading system to identify intermediate-risk pulmonary embolism http://ow.ly/uItnL}, issn = {0903-1936}, URL = {https://erj.ersjournals.com/content/44/3/694}, eprint = {https://erj.ersjournals.com/content/44/3/694.full.pdf}, journal = {European Respiratory Journal} }