The Role of Euro SCORE and STS Prediction Systems in Prognosis of Candidates for Surgical Pulmonary Embolectomy at a Referral Hospital

Abstract

Background: Pulmonary embolism (PE) is the only preventable cause of death in hospitalized patients with 15% mortality rate, which is increased to 25% among hemodynamically instable cases. The current study, regarding new concepts and techniques of risk assessment in pulmonary embolism, aimed at evaluating the role of STS score and EuroSCORE in prognosis forecast among cases of surgical embolectomy in patients with pulmonary embolism in order to suggest an acceptable way to reduce mortality rate in addition to optimum case selection for embolectomy.Methods: Through a prospective cross-sectional study, 50 patients were recruited out of the total candidates for embolectomy at Massih Daneshvari hospital, during years 2016 and 2017. The participants were followed up for complications, morbidities, hospital stay, intensive care unit (ICU) admission and also mortality. Two scoring systems, as named before, were used and the results were compared considering the consequences of surgical embolectomy, such as hospital stay, morbidity and mortality, to finally suggest an association between the scores in each system and the outcomes.Results: Fifty patients with pulmonary embolism, who were candidates for surgical embolectomy, entered the study. The mean age ± SD was 65.8 ± 14.1 and males made up 54.2% of the participants. The mean scores were significantly higher in patients, who died, compared with alive participants. The mean STS score was doubled in people who died while the EuroSCORE showed almost three-folded values in that group compared to survived individuals (P value < 0.001 and 0.003, respectively). The APACHE II score was significantly higher in dead participants (P value = 0.04) and they spent most of their hospitalization time at the ICU (78.2% versus 15.6% of the survived group) (P value = 0.01). The survived participants had lower rate of kidney injury as well (17% versus 29%; P value = 0.009), while the overall rate of the problem was 24% in 50 participants. There was a reverse correlation between STS and EuroSCORE obtained score and the length of stay that is not too far from the fact that individuals with worse conditions usually obtain higher scores and die faster than others. Conclusions:To sum up, with a global acceptance in addition to ease of utilization, euroSCORE is approved by the clinicians disregarding the overall controversy between the two predicting systems that were studied in terms of calibration and discrimination.