A Prediction Rule to Identify Low-Risk Patients With Pulmonary Embolism

Aujesky, Drahomir; Obrosky, D. Scott; Stone, Roslyn A.; Auble, Thomas E.; Perrier, Arnaud; Cornuz, Jacques; Roy, Pierre‐Marie; Fine, Michael J.

doi:10.1001/archinte.166.2.169

Cited by 165 publications

(129 citation statements)

References 48 publications

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“…The observation that haemodynamic instability at presentation predicts an adverse outcome in acute PE is certainly not new but confirms previous data from recent decades [3][4][5][6][7][8][9][10][11]. In the present authors' experience, the three shock parameters examined are equally good (or equally inadequate) in predicting an adverse outcome, since they all appear significant in the Cox model but do not possess high sensitivity or specificity.…”

Section: Discussionsupporting

confidence: 85%

“…The most important criterion to characterise acute PE as massive is systemic arterial hypotension [3]; however, this term is not clearly defined in the literature. Indeed, definitions for haemodynamic instability or massive PE varied among the studies: some used the criterion of a systolic blood pressure (SBP) value ,90 mmHg [4,5]; others used SBP ,100 mmHg [6][7][8][9][10]; and others used the shock index (cardiac frequency divided by SBP) [11]. In some studies no definition was provided.…”

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confidence: 99%

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Haemodynamically unstable pulmonary embolism in the RIETE Registry: systolic blood pressure or shock index?

Otero

Trujillo‐Santos²,

Cayuela³

et al. 2007

Eur Respir J

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Patients with acute pulmonary embolism (PE) presenting with haemodynamic instability have the worst prognosis. However, what is understood by haemodynamic instability has not been clearly defined.The Registro Informatizado de la Enfermedad Tromboembólica (RIETE) is an ongoing registry of consecutive patients with symptomatic, objectively confirmed, acute deep vein thrombosis or PE. The present authors compared the predictive value of a systolic blood pressure (SBP) value of ,100 mmHg and ,90 mmHg and the shock index (cardiac frequency divided by SBP) on 30-day mortality in consecutive patients with PE.As of May 2006, 6,599 patients with PE were enrolled in the study. Of these, 417 (6.3%) died within 30 days: 153 of the initial PE, 29 of recurrent PE and 235 due to other causes. Of the 417 individuals who died, 127 (30%) had a positive shock index, 60 (14%) had SBP ,100 mmHg and 33 (7.9%) had SBP ,90 mmHg. On multivariate analysis any of the three parameters were independently associated with an increased mortality. The shock index had a higher sensitivity (30.5 versus 14.4 and 7.9% for SBP ,100 mmHg and ,90 mmHg, respectively) but lower specificity (86.3 versus 93.0 and 96.6).All three measures of haemodynamic instability are independent predictors of 30-day mortality. However, while the shock index had the highest sensitivity, a systolic blood pressure value ,90 mmHg had the highest specificity.

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Section: Discussionsupporting

confidence: 85%

mentioning

confidence: 99%

Haemodynamically unstable pulmonary embolism in the RIETE Registry: systolic blood pressure or shock index?

Otero

Trujillo‐Santos²,

Cayuela³

et al. 2007

Eur Respir J

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“…Patients with acute PE who die have higher D-dimer levels compared to those who survive. 25,43,44 Acute RV failure is the main cause of death in acute PE, and RV dysfunction on echocardiography is associated with high mortality. 45 A recent meta-analysis has also confirmed this association.…”

Section: Risk Assessment and Stratificationmentioning

confidence: 99%

Diagnosis and Management of Acute Pulmonary Embolism

Dokwal¹

2014

PULSE

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“…High risk patients may potentially benefit from thrombolysis and intensive in-hospital surveillance, whereas low risk patients may be candidates for outpatient treatment using low-molecular-weight-heparin. Despite extensive research in this field in recent years, no explicit criteria exist for treatment of low risk PE-patients in an outpatient setting [1].…”

Section: Introductionmentioning

confidence: 99%

“…Risk stratification can be obtained using clinical variables, like the PE severity index or the Geneva prognostic index [1,2]. Besides clinical variables, echocardiographic detection of right ventricular (RV) overload and the degree of obstruction of the pulmonary arteries on computed tomography (CT) are useful in risk stratification in patients with PE [3][4][5][6][7][8][9].…”

Section: Introductionmentioning

confidence: 99%

A prognostic model for short term adverse events in normotensive patients with pulmonary embolism

et al. 2011

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Risk stratification of patients with PE has gained interest in terms of the identification of patients in whom treatment on an outpatient base can be considered. Previous studies are of limited value due to their focus on adverse clinical events within several months after diagnosis of PE. We developed a prognostic model, based on easily accessible, clinical, and laboratory parameters, to predict adverse events during the first 10 days after the diagnosis of acute PE. We have analyzed the data of 210 outpatients with confirmed PE. Collected data included medical history, pulse rate, blood pressure, NT-proBNP, and D-dimer concentrations. The primary outcome was the occurrence of adverse clinical events in a 10 day follow-up period. Our final prognostic model to predict short-term adverse events consists of NT-proBNP levels, D-dimer concentrations, pulse rate, and the occurrence of active malignancy; the total score ranges from 0 to 37 points. Patients with a low score (no active malignancy, pulse rate <90 bpm, NT-proBNP <500 pg/ml, and D-dimer <3,000 lg/l FEU) have a 10-day adverse event risk <1.5%. This risk increases to over 30% in patients with a maximum score, based on high pulse rate, D-dimer concentrations, and NT-proBNP levels. Our prognostic model, once prospectively validated in an independent sample of patients, can be used in the early risk stratification of PE to estimate the risk of adverse events and to differentiate between candidates for in-or out-hospital treatment. Am. J. Hematol. 86:646-649, 2011. V

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A Prediction Rule to Identify Low-Risk Patients With Pulmonary Embolism

Abstract: This simple prediction rule accurately identifies patients with pulmonary embolism who are at low risk of short-term mortality and other adverse medical outcomes. Prospective validation of this rule is important before its implementation as a decision aid for outpatient treatment.

Cited by 165 publications

References 48 publications

Haemodynamically unstable pulmonary embolism in the RIETE Registry: systolic blood pressure or shock index?

Haemodynamically unstable pulmonary embolism in the RIETE Registry: systolic blood pressure or shock index?

Diagnosis and Management of Acute Pulmonary Embolism

A prognostic model for short term adverse events in normotensive patients with pulmonary embolism

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