Refinement of a modified simplified Pulmonary Embolism Severity Index for elderly patients with acute pulmonary embolism
Por:
Morillo, R, Jimenez, D, Bikdeli, B, Rodriguez, C, Tenes, A, Yamashita, Y, Morimoto, T, Kimura, T, Vidal, G, Ruiz-Gimenez, N, Espitia, O and Monreal, M
Publicada:
15 jul 2021
Ahead of Print:
1 jun 2021
Resumen:
Objective: To evaluate the utility of a modified (i.e., without the variable "Age >80 years") simplified Pulmonary Embolism Severity Index (sPESI) in elderly patients with acute symptomatic pulmonary embolism (PE), and to derive and validate a refined version of the sPESI for identification of elderly patients at low risk of adverse events.
Methods: The study included normotensive patients aged >80 years with acute PE enrolled in the RIETE registry. We used multivariable logistic regression analysis to create a new risk score to predict 30-day all-cause mortality. We externally validated the new risk score in elderly patients from the COMMAND VTE registry.
Results: Multivariable logistic regression identified four predictors for mortality: high-risk sPESI, immobilization, coexisting deep vein thrombosis (DVT), and plasma creatinine > 2 mg/dL. In the RIETE derivation cohort, the new model classified fewer patients as low risk (4.0% [401/10,106]) compared to the modified sPESI (35% [3522/10,106]). Low-risk patients based on the new model had a lower 30-day mortality than those based on the modified sPESI (1.2% [95% CI, 0.4-2.9%] versus 4.7% [95% CI, 4.0-5.4%]). In the COMMAND VTE validation cohort, 1.5% (3/206) of patients were classified as having low risk of death according to the new model, and the overall 30-day mortality of this group was 0% (95% CI, 0-71%), compared to 5.9% (95% CI, 3.1-10.1%) in the high-risk group.
Conclusions: For predicting short-term mortality among elderly patients with acute PE, this study suggests that the new model has a substantially higher sensitivity than the modified sPESI. A minority of these patients might benefit from safe outpatient therapy of their disease. (C) 2021 Published by Elsevier B.V.
Filiaciones:
Morillo, R:
Hosp Ramon Y Cajal IRYCIS, Resp Dept, Madrid, Spain
Jimenez, D:
Hosp Ramon Y Cajal IRYCIS, Resp Dept, Madrid, Spain
Univ Alcala IRYCS, Med Dept, Madrid, Spain
Inst Salud Carlos III, CIBER Enfermedades Resp CIBERES, Madrid, Spain
Bikdeli, B:
Harvard Med Sch, Cardiovasc Med Div, Brigham & Womens Hosp, Boston, MA 02115 USA
Rodriguez, C:
Hosp Ramon Y Cajal IRYCIS, Resp Dept, Madrid, Spain
Tenes, A:
Hosp Ramon Y Cajal IRYCIS, Resp Dept, Madrid, Spain
Yamashita, Y:
Kyoto Univ, Dept Cardiovasc Med, Grad Sch Med, Kyoto, Japan
Morimoto, T:
Hyogo Coll Med, Dept Clin Epidemiol, Nishinomiya, Hyogo, Japan
Kimura, T:
Kyoto Univ, Dept Cardiovasc Med, Grad Sch Med, Kyoto, Japan
Vidal, G:
Corp Sanitaria Parc Tauli, Dept Internal Med, Barcelona, Spain
Ruiz-Gimenez, N:
Hosp Univ La Princesa, Dept Internal Med, Madrid, Spain
Espitia, O:
CHU Nantes, Dept Internal Med, Nantes, France
:
Inst Salud Carlos III, CIBER Enfermedades Resp CIBERES, Madrid, Spain
Hosp Badalona Germans Trias & Pujol, Dept Internal Med, Barcelona, Spain
Univ Autonoma Barcelona, Barcelona, Spain
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