The value of sPESI for risk stratification in patients with pulmonary embolism

Wells, Phillip S.; Peacock, W. Frank; Fermann, Gregory J.; Coleman, Craig I.; Wang, Li; Başer, Onur; Schein, Jeff; Crivera, Concetta

doi:10.1007/s11239-019-01814-z

Cited by 19 publications

(8 citation statements)

References 27 publications

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“… 19 , 22 Conversely, the 48% rate of patients with an sPESI of 0 points was higher than the 28% rate in two other recent studies. 19 , 23 Possible reasons for these discrepancies are differences in hospital settings and patient characteristics as well as the way the triaging tools are used. Indeed, both tools include measurements of three vital signs: systolic blood pressure, pulse rate, and oxygen saturation.…”

Section: Discussionmentioning

confidence: 99%

Triaging acute pulmonary embolism for home treatment by Hestia or simplified PESI criteria: the HOME-PE randomized trial

Roy

Penaloza

Hügli

et al. 2021

European Heart Journal

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Aims The aim of this study is to compare the Hestia rule vs. the simplified Pulmonary Embolism Severity Index (sPESI) for triaging patients with acute pulmonary embolism (PE) for home treatment. Methods and results Normotensive patients with PE of 26 hospitals from France, Belgium, the Netherlands, and Switzerland were randomized to either triaging with Hestia or sPESI. They were designated for home treatment if the triaging tool was negative and if the physician-in-charge, taking into account the patient’s opinion, did not consider that hospitalization was required. The main outcomes were the 30-day composite of recurrent venous thrombo-embolism, major bleeding or all-cause death (non-inferiority analysis with 2.5% absolute risk difference as margin), and the rate of patients discharged home within 24 h after randomization (NCT02811237). From January 2017 through July 2019, 1975 patients were included. In the per-protocol population, the primary outcome occurred in 3.82% (34/891) in the Hestia arm and 3.57% (32/896) in the sPESI arm (P = 0.004 for non-inferiority). In the intention-to-treat population, 38.4% of the Hestia patients (378/984) were treated at home vs. 36.6% (361/986) of the sPESI patients (P = 0.41 for superiority), with a 30-day composite outcome rate of 1.33% (5/375) and 1.11% (4/359), respectively. No recurrent or fatal PE occurred in either home treatment arm. Conclusions For triaging PE patients, the strategy based on the Hestia rule and the strategy based on sPESI had similar safety and effectiveness. With either tool complemented by the overruling of the physician-in-charge, more than a third of patients were treated at home with a low incidence of complications.

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Section: Discussionmentioning

confidence: 99%

Triaging acute pulmonary embolism for home treatment by Hestia or simplified PESI criteria: the HOME-PE randomized trial

Roy

Penaloza

Hügli

et al. 2021

European Heart Journal

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“…The presence of increased mortality in patients with hypocalcemia may suggest that hypocalcemia may be a useful prognostic tool in PE patients. There are several prognostic assessment tools that exist for PE patients, including the pulmonary embolism severity index (PESI) and the simplified PESI (sPESI) [ 15 , 16 ]. Moreover, imaging and cardiac biomarkers are also used to stratify patients with an intermediate and high risk of PE [ 17 ].…”

Section: Discussionmentioning

confidence: 99%

Association of hypocalcemia with in-hospital mortality and complications in patients with acute pulmonary embolism: results from the 2017 Nationwide Inpatient Sample

et al. 2021

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Background Acute pulmonary embolism (PE) is a common cause for hospitalization associated with significant mortality and morbidity. Disorders of calcium metabolism are a frequently encountered medical problem. The effect of hypocalcemia is not well defined on the outcomes of patients with PE. We aimed to identify the prognostic value of hypocalcemia in hospitalized PE patients utilizing the 2017 Nationwide Inpatient Sample (NIS). Methods In this retrospective study, we selected patients with a primary diagnosis of Acute PE using ICD 10 codes. They were further stratified based on the presence of hypocalcemia. We primarily aimed to compare in-hospital mortality for PE patients with and without hypocalcemia. We performed multivariate logistic regression analysis to adjust for potential confounders. We also used propensity‐matched cohort of patients to compare mortality. Results In the 2017 NIS, 187,989 patients had a principal diagnosis of acute PE. Among the above study group, 1565 (0.8%) had an additional diagnosis of hypocalcemia. 12.4% of PE patients with hypocalcemia died in the hospital in comparison to 2.95% without hypocalcemia. On multivariate regression analysis, PE and hypocalcemia patients had 4 times higher odds (aOR-4.03, 95% CI 2.78–5.84, p < 0.001) of in-hospital mortality compared to those with only PE. We observed a similarly high odds of mortality (aOR = 4.4) on 1:1 propensity-matched analysis. The incidence of acute kidney injury (aOR = 2.62, CI 1.95–3.52, p < 0.001), acute respiratory failure (a0R = 1.84, CI 1.42–2.38, p < 0.001), sepsis (aOR = 4.99, CI 3.08–8.11, p < 0.001) and arrhythmias (aOR = 2.63, CI 1.99–3.48, p < 0.001) were also higher for PE patients with hypocalcemia. Conclusion PE patients with hypocalcemia have higher in-hospital mortality than those without hypocalcemia. The in-hospital complications were also higher, along with longer length of stay.

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“…The majority of patients with acute PE are hemodynamically stable and have 30‐day mortality rates of approximately 4.7% to 5.4% 3,4 . Risk assessment models such as the Pulmonary Embolism Severity Index (PESI) score, the simplified PESI (sPESI) score, and the Hestia criteria can identify subsets of hemodynamically stable patients with acute PE whose risk of short‐term mortality is even lower (0.5%–2.5%) 5–10 . Data from multiple cohorts suggest that approximately 22% to 47% of hemodynamically stable patients with acute PE have a low risk using these validated rules or criteria 9–12 …”

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confidence: 99%

Outpatient Treatment of Low‐risk Pulmonary Embolism in the Era of Direct Oral Anticoagulants: A Systematic Review

Maughan

Frueh

McDonagh

et al. 2020

Academic Emergency Medicine

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Background Clinical guidelines have supported outpatient treatment of low‐risk pulmonary embolism (PE) since 2014, but adoption of this practice has been slow. Direct oral anticoagulant (DOAC) therapy for venous thromboembolism (VTE) is now as common as vitamin K antagonist treatment, but data are sparse regarding outcomes for patients with low‐risk PE treated with DOACs as outpatients. We conducted a systematic review of literature on outcomes of outpatient management for PE, including comparisons to inpatient treatment and differences by anticoagulant class. Methods We searched Medline, Embase, PubMed, CENTRAL, clinicaltrials.gov, and ICTRN for studies published from January 1980 through February 2019 using a predefined strategy developed with a medical librarian. We included English‐language randomized controlled trials (RCTs) and prospective nonrandomized trials (NRTs) of adult patients diagnosed with acute, symptomatic PE, and discharged from the emergency department or within 48 hours. Our primary outcome included four major adverse outcomes (all‐cause mortality, PE‐related mortality, recurrent VTE, and major bleeding) within 30 and 90 days. A preplanned subanalysis of high‐quality studies assessed outcomes associated with different anticoagulation treatment classes. Results Our initial search identified 6,818 records, of which 12 studies (four RCT, eight NRT) with a total of 3,191 patients were included in the review. All RCTs and six NRTs were determined to have low to moderate risk of bias and were classified as high quality. Outpatients in these studies (n = 1,814) had rates of 90‐day major adverse outcomes below 1%, including all‐cause mortality (0.7%, 95% confidence interval [CI] = 0.4% to 1.2%), PE‐related mortality (0.06%, 95% CI = 0.01% to 0.3%), recurrent VTE (0.8%, 95% CI = 0.5% to 1.4%), and major bleeding (0.8%, 95% CI = 0.5% to 1.4%). Exploratory analysis revealed no association between anticoagulant treatment class and rates of major adverse outcomes. Conclusion Among patients with low‐risk PE treated as outpatients, few patients experienced major adverse outcomes such as mortality, recurrent VTE, or major bleeding within 90 days.

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The value of sPESI for risk stratification in patients with pulmonary embolism

Cited by 19 publications

References 27 publications

Triaging acute pulmonary embolism for home treatment by Hestia or simplified PESI criteria: the HOME-PE randomized trial

Triaging acute pulmonary embolism for home treatment by Hestia or simplified PESI criteria: the HOME-PE randomized trial

Association of hypocalcemia with in-hospital mortality and complications in patients with acute pulmonary embolism: results from the 2017 Nationwide Inpatient Sample

Outpatient Treatment of Low‐risk Pulmonary Embolism in the Era of Direct Oral Anticoagulants: A Systematic Review

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