RT Journal Article
SR Electronic
T1 Changes in pesi score predict mortality in intermediate-risk patients with acute pe
JF European Respiratory Journal
JO Eur Respir J
FD European Respiratory Society
SP erj02250-2011
DO 10.1183/09031936.00225011
A1 Lisa Moores
A1 Celia Zamarro
A1 Vicente Gómez
A1 D. Aujesky
A1 Leticia García
A1 Rosa Nieto
A1 R. Yusen
A1 David Jiménez
A1 on behalf of the IRYCIS Pulmonary Embolism Study Group
YR 2012
UL http://erj.ersjournals.com/content/early/2012/07/11/09031936.00225011.abstract
AB 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 hours after admission (PESI48) and reclassified each patient into the corresponding risk category. The primary outcome of the study was all-cause mortality between day 2 and day 30 after PE diagnosis.Twenty-six patients (8.5%; 95% CI, 5.4%–11.7%) died between day 2 and day 30 after PE diagnosis. Investigators reclassified 83 patients (27.3%; 95% CI, 22.3%–32.3%) as low-risk (classes I and II) at 48 hrs. Thirty-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.