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Changes in PESI scores predict mortality in intermediate-risk patients with acute pulmonary embolism

Lisa Moores, Celia Zamarro, Vicente Gómez, Drahomir Aujesky, Leticia García, Rosa Nieto, Roger Yusen, David Jiménez on behalf of the Instituto Ramón y Cajal de Investigación Sanitaria Pulmonary Embolism Study Group
European Respiratory Journal 2013 41: 354-359; DOI: 10.1183/09031936.00225011
Lisa Moores
F. Edward Hebert School of Medicine, Uniformed Services University, Bethesda, MD
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Celia Zamarro
Respiratory Dept, Ramón y Cajal Hospital
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Vicente Gómez
Medicine Dept, Ramón y Cajal Hospital, Madrid, Spain
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Drahomir Aujesky
Division of General Internal Medicine, Bern University Hospital, Bern, Switzerland
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Leticia García
Respiratory Dept, Ramón y Cajal Hospital
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Rosa Nieto
Respiratory Dept, Ramón y Cajal Hospital
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Roger Yusen
Divisions of Pulmonary and Critical Care Medicine and General Medical Sciences, Washington University School of Medicine, St Louis, MO, USA
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David Jiménez
Respiratory Dept, Ramón y Cajal Hospital
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  • For correspondence: djc_69_98@yahoo.com
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    Figure 1–

    Flow diagram of patient enrolment and outcomes. PE: pulmonary embolism; PESI: Pulmonary Embolism Severity Index; PESI48: Pulmonary Embolism Severity Index 48 h after admission; sPESI: simplified Pulmonary Embolism Severity Index.

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  • Table 1– The Pulmonary Embolism Severity Index (PESI)
    MeasureScore
    Patient age yrs
    Male patient+10
    History of cancer+30
    History of heart failure+10
    History of chronic lung disease+10
    Heart rate ≥110 beats·min−1+20
    Systolic blood pressure <100 mmHg+30
    Respiratory rate ≥30 breaths·min−1+20
    Temperature <36°C/96.8°F+20
    Altered mental status+60
    O2 saturation <90%+20
    • The PESI risk score is calculated by starting with the patient’s age and adding additional points for any factors present as noted above. The patients are divided into five risk classes based upon the point total as follows: class I, <65 points; class II, 66–85 points; class III, 86–105 points; class IV, 106–125 points; class V, >126 points. Reproduced and modified from [5] with permission from the publisher.

  • Table 2– The Simplified Pulmonary Embolism Severity Index
    Age >80 yrs
    History of cancer
    History of heart failure or chronic lung disease
    Heart rate ≥110 beats·min−1
    Systolic blood pressure <100 mmHg
    O2 saturation <90%
    • Patients receive a point for each item present. Patients with 0 points are low risk and patients with ≥1 points are high risk. Reproduced and modified from [6] with permission from the publisher.

  • Table 3– Baseline characteristics of 304 study patients
    Patients n (%)
    Clinical characteristics
     Age >65 yrs235 (77)
     Male139 (46)
    Risk factors for VTE
     Cancer63 (21)
     Surgery27 (8.9)
     Immobility for ≥4 days71 (23)
     Previous VTE36 (12)
    Comorbid diseases
     Chronic lung disease21 (6.9)
     Congestive heart failure20 (6.6)
    Clinical presentation at admission
     Syncope43 (14)
     Chest pain120 (39)
     Dyspnoea225 (74)
     Altered mental status0 (0)
     Heart rate ≥110 beats·min−146 (15)
     Arterial oxyhaemoglobin saturation <90%64 (21)
     Respiratory rate ≥30 breaths·min−119 (6.2)
     SBP <100 mmHg5 (1.6)
    sPESI risk classes
     Low risk54 (18)
     High risk250 (82)
    • Patients were classified as Pulmonary Embolism Severity Index (PESI) risk class III at the time of hospital admission. VTE: venous thromboembolism; SBP: systolic blood pressure; sPESI: simplified PESI.

  • Table 4– Test characteristics of Pulmonary Embolism Severity Index 48 h after admission for predicting 30-day all-cause mortality and adverse outcomes
    30-day mortalityAdverse outcomes
    Sensitivity %96.1 (88.8–100)71.4 (38.0–100)
    Specificity %29.5 (24.1–34.9)27.3 (22.2–32.3)
    Positive predictive value %11.3 (7.1–15.5)2.3 (0.3–4.2)
    Negative predictive value %98.8 (96.4–100)97.6 (94.3–100)
    Positive likelihood ratio1.4 (1.2–1.5)1.0 (0.6–1.6)
    Negative likelihood ratio0.1 (0.02–0.9)1.0 (0.3–3.4)
    • Data are presented with 95% confidence intervals.

  • Table 5– Test characteristics of Simplified Pulmonary Embolism Severity Index 48 h after admission for predicting 30-day all-cause mortality and adverse outcomes
    30-day mortalityAdverse outcomes
    Sensitivity %100 (100–100)42.9 (6.2–79.5)
    Specificity %30.2 (24.8–35.6)26.9 (21.9–32.0)
    Positive predictive value %11.8 (7.5–16.1)1.4 (0–2.9)
    Negative predictive value %100 (100–100)95.2 (90.7–99.8)
    Positive likelihood ratio1.4 (1.3–1.5)0.6 (0.2–1.4)
    Negative likelihood ratio02.1 (1.1–4.1)
    • Data are presented with 95% confidence intervals.

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Changes in PESI scores predict mortality in intermediate-risk patients with acute pulmonary embolism
Lisa Moores, Celia Zamarro, Vicente Gómez, Drahomir Aujesky, Leticia García, Rosa Nieto, Roger Yusen, David Jiménez
European Respiratory Journal Feb 2013, 41 (2) 354-359; DOI: 10.1183/09031936.00225011

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Changes in PESI scores predict mortality in intermediate-risk patients with acute pulmonary embolism
Lisa Moores, Celia Zamarro, Vicente Gómez, Drahomir Aujesky, Leticia García, Rosa Nieto, Roger Yusen, David Jiménez
European Respiratory Journal Feb 2013, 41 (2) 354-359; DOI: 10.1183/09031936.00225011
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