Abstract
Although the Pulmonary Embolism Severity Index (PESI) accurately identifies 35% of patients with acute pulmonary embolism (PE) as being low risk, some patients deemed high risk by the PESI on admission might be treated safely in the outpatient environment.
This retrospective cohort study included a total of 304 consecutive patients with acute PE, classified at the time of hospital admission into PESI class III. The PESI was recalculated 48 h after admission (PESI48) and each patient reclassified into the corresponding risk category. The primary outcome of the study was all-cause mortality between day 2 and day 30 after PE diagnosis.
26 (8.5%) patients (95% CI 5.4–11.7%) died between day 2 and day 30 after PE diagnosis. Investigators reclassified 83 (27.3%) patients (95% CI 22.3–32.3%) as low risk (classes I and II) at 48 h. 30-day mortality in these patients was 1.2% (95% CI 0–3.5%) as opposed to 11.3% (95% CI 7.1–15.5%) in those who remained high risk. The net improvement in reclassification was estimated at 54% (p<0.001).
In a cohort of intermediate-risk patients with acute PE, calculation of the PESI48 allows identification of those patients at very low risk of dying during the first month of follow-up.
Footnotes
Earn CME accreditation by answering questions about this article. You will find these at the back of the printed copy of this journal or online at www.ersjournals.com/misc/cmeinfo.xhtml
Support Statement
This work has been supported in part by grants from FIS (08/0200), SEPAR 2008, and NEUMOMADRID 2010.
Statement of Interest
A statement of interest for R. Yusen can be found at www.erj.ersjournals.com/site/misc/statements.xhtml
- Received December 22, 2011.
- Accepted April 2, 2012.
- ©ERS 2013