Validation of the 2019 European Society of Cardiology Risk Stratification Algorithm for Pulmonary Embolism in Normotensive Elderly Patients

Moor, Jeanne; Baumgartner, Christine; Méan, Marie; Stalder, Odile; Limacher, Andreas; Rodondi, Nicolas; Aujesky, Drahomir

doi:10.1055/a-1475-2263

Cited by 6 publications

(9 citation statements)

References 29 publications

(43 reference statements)

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“…One meta-analysis published in 2016 also showed the overall 30-day mortality of 11.4% (9.9–13.1%) in the high-risk PESI group [ 24 ]. These findings can be explained form the higher proportion of patients with active malignancy in our study (55%) than in the previous studies (9–21%); in addition, the proportions of active DVT and recent surgery were higher than in the previous reports [ 6 , 23 ]. Nevertheless, the data on the actual prevalence of venous thromboembolism including DVT and APE in the Southeast Asian population including Thailand are lacking.…”

Section: Discussioncontrasting

confidence: 72%

“…The 30-day all-cause mortality of patients with APE in our study (19.1%) was higher than previous reports (5.9%), and for the patients with PESI class V, it was 38% vs. 17.9% [ 6 ]. Another recent study in normotensive elderly patients showed overall mortality of less than 5% [ 23 ]. One meta-analysis published in 2016 also showed the overall 30-day mortality of 11.4% (9.9–13.1%) in the high-risk PESI group [ 24 ].…”

Section: Discussionmentioning

confidence: 99%

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Predictive Ability of the National Early Warning Score in Mortality Prediction of Acute Pulmonary Embolism in the Southeast Asian Population

Bumroongkit

Tajarernmuang

Trongtrakul

et al. 2023

JCDD

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Background: The National Early Warning Scores (NEWS) easily and objectively measures acute clinical deterioration. However, the performance of NEWS to predict mortality in patients with acute pulmonary embolism (APE) is still required. Therefore, the objective of this study was to evaluate the performance of the NEWS in predicting the mortality of patients with APE. Methods: NEWS and Pulmonary Embolism Severity Index (PESI) at diagnosis time were calculated. Risk regression analysis was performed to identify the NEWS and PESI risk classification as a predictor for 30 days all-cause mortality and PE-related mortality. Results: NEWS was significantly higher in non-survivors compared to survivors (median (IQR) was 10 (7, 11) vs. 7 (2, 9), respectively, p < 0.001). The best cut-off point of NEWS in discriminating APE patients who non-survived from those who survived at 30 days was ≥9, with a sensitivity and specificity of 66.9% and 66.3%, respectively. The adjusted risk ratio of 30-day all-cause mortality in patients with initial NEWS ≥ 9 was 2.96 (95% CI; 2.13, 4.12, p < 0.001). Conclusions: The NEWS can be used for mortality prediction in patients with APE. APE patients with NEWS ≥ 9 are associated with a high risk of mortality and should be closely monitored.

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Section: Discussioncontrasting

confidence: 72%

Section: Discussionmentioning

confidence: 99%

Predictive Ability of the National Early Warning Score in Mortality Prediction of Acute Pulmonary Embolism in the Southeast Asian Population

Bumroongkit

Tajarernmuang

Trongtrakul

et al. 2023

JCDD

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“…The ESC prognostic algorithm was developed for the early risk assessment of patients with APE, which represented an important step in therapeutic decision making [ 8 ]. Moor et al reported that the area under the receiver operating characteristic curve (AUC) predictive value of the 2019 ESC algorithm for 30-day mortality was 0.636 [ 18 ]. In a prospective cohort study, the risk of death in patients at “intermediate-high” and “intermediate-low” risk according to the ESC model was similar, and risk stratification in patients at intermediate risk requires further improvement [ 19 ].…”

Section: Discussionmentioning

confidence: 99%

Additive prognostic value of serum calcium to the ESC risk stratification in patients with acute pulmonary embolism

et al. 2023

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Background Hypocalcemia has been shown to be involved in the adverse outcomes of acute pulmonary embolism (APE). We aimed to determine the incremental value of adding hypocalcemia, defined as serum calcium level ≤ 2.12 mmol/L, on top of the European Society of Cardiology (ESC) prognostic algorithm, for the prediction of in-hospital mortality in APE patients, which in turn could lead to the optimization of APE management. Methods This study was conducted at West China Hospital of Sichuan University from January 2016 to December 2019. Patients with APE were retrospectively analyzed and divided into 2 groups based on serum calcium levels. Associations between hypocalcemia and adverse outcomes were assessed by Cox analysis. The accuracy of risk stratification for in-hospital mortality was assessed with the addition of serum calcium to the current ESC prognostic algorithm. Results Among 803 patients diagnosed with APE, 338 (42.1%) patients had serum calcium levels ≤ 2.12 mmol/L. Hypocalcemia was significantly associated with higher in-hospital and 2-year all-cause mortality compared to the control group. The addition of serum calcium to ESC risk stratification enhanced net reclassification improvement. Low-risk group with serum calcium level > 2.12 mmol/L had a 0% mortality rate, improving the negative predictive value up to 100%, while high-risk group with serum calcium level ≤ 2.12 mmol/L indicated a higher mortality of 25%. Conclusion Our study identified serum calcium as a novel predictor of mortality in patients with APE. In the future, serum calcium may be added to the commonly used ESC prognostic algorithm for better risk stratification of patients suffering from APE.

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“…The ESC prognostic algorithm was developed for the early risk assessment of patients with APE, which represented an important step in therapeutic decision making[8]. Moor et al reported that the area under the receiver operating characteristic curve (AUC) predictive value of the 2019 ESC algorithm for 30-day mortality was 0.636 [17]. In a prospective cohort study, the risk of death in patients at "intermediate-high" and "intermediate-low" risk according to the ESC model was similar, and risk strati cation in patients at intermediate risk requires further improvement [18].…”

Section: Discussionmentioning

confidence: 99%

Additive prognostic value of serum calcium to the ESC risk stratification in patients with acute pulmonary embolism

Zhang

Ali

Liu

et al. 2022

Preprint

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Background Hypocalcemia has been shown to be involved in the adverse outcomes of acute pulmonary embolism (APE). We aimed to determine the incremental value of adding hypocalcemia, defined as serum calcium level ≤ 2.12 mmol/L, on top of the European Society of Cardiology (ESC) prognostic algorithm, for the prediction of in-hospital mortality in APE patients, which in turn could lead to the optimization of APE management. Methods This study was conducted at West China Hospital of Sichuan University from January 2016 to December 2019. Patients with APE were retrospectively analyzed and divided into 2 groups based on serum calcium levels. Associations between hypocalcemia and adverse outcomes were assessed by Cox analysis. The accuracy of risk stratification for in-hospital mortality was assessed with the addition of serum calcium to the current ESC prognostic algorithm. Results Among 803 patients diagnosed with APE, 338 (42.1%) patients had serum calcium levels ≤ 2.12 mmol/L. Hypocalcemia was significantly associated with higher in-hospital and 2-year all-cause mortality compared to the control group. A serum calcium level ≤ 2.12 mmol/L in patients with ESC-defined low risk identified a group with a mortality of 2.5%, improving the negative predictive value up to 100%, while in high-risk patients, it indicated a group of high early mortality of 25%. Conclusion Our study identified serum calcium as a novel predictor of mortality in patients with APE. In the future, serum calcium may be added to the commonly used ESC prognostic algorithm for better risk stratification of patients suffering from APE.

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Validation of the 2019 European Society of Cardiology Risk Stratification Algorithm for Pulmonary Embolism in Normotensive Elderly Patients

Cited by 6 publications

References 29 publications

Predictive Ability of the National Early Warning Score in Mortality Prediction of Acute Pulmonary Embolism in the Southeast Asian Population

Predictive Ability of the National Early Warning Score in Mortality Prediction of Acute Pulmonary Embolism in the Southeast Asian Population

Additive prognostic value of serum calcium to the ESC risk stratification in patients with acute pulmonary embolism

Additive prognostic value of serum calcium to the ESC risk stratification in patients with acute pulmonary embolism

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