Simplification of the Pulmonary Embolism Severity Index for Prognostication in Patients With Acute Symptomatic Pulmonary Embolism
Por:
Jimenez, D, Aujesky, D, Moores, L, Gomez, V, Lobo, JL, Uresandi, F, Otero, R, Monreal, M, Muriel, A and Yusen, RD
Publicada:
9 ago 2010
Resumen:
Background: The Pulmonary Embolism Severity Index (PEST) estimates the risk of 30-day mortality in patients with acute pulmonary embolism (PE): We constructed a simplified version of the PESI.
Methods: The study retrospectively developed a simplified PESI clinical prediction rule for estimating the risk of 30-day mortality in a derivation cohort of Spanish outpatients. Simplified and original PEST performances were compared in the derivation cohort. The simplified PEST underwent retrospective external validation in an independent multinational cohort (Registro Informatizado de la Enfermedad Tromboembolica [RIETE] cohort) of outpatients.
Results: In the derivation data set, univariate logistic regression of the original 11 PEST variables led to the removal of variables that did not reach statistical significance and subsequently produced the simplified PESI that contained the variables of age, cancer, chronic cardiopulmonary disease, heart rate, systolic blood pressure, and oxyhemoglobin saturation levels. The prognostic accuracy of the original and simplified PESI scores did not differ (area under the curve, 0.75 [95% confidence interval (CI), 0.69-0.80]). The 305 of 995 patients (30.7%) who were classified as low risk by the simplified PESI had a 30-day mortality of 1.0% (95% CI, 0.0%-2.1%) compared with 10.9% (8.5%-13.2%) in the high-risk group. In the RIETE validation cohort, 2569 of 7106 patients (36.2%) who were classified as low risk by the simplified PESI had a 30-day mortality of 1.1% (95% CI, 0.7%-1.5%) compared with 8.9% (8.1%-9.8%) in the high-risk group.
Conclusion: The simplified PESI has similar prognostic accuracy and clinical utility and greater ease of use compared with the original PESI.
Filiaciones:
Jimenez, D:
Hosp Ramon & Cajal, Resp Dept, E-28034 Madrid, Spain
Univ Alcala de Henares, Madrid 28034, Spain
Aujesky, D:
Univ Lausanne, Div Gen Internal Med, Lausanne, Switzerland
Moores, L:
Uniformed Serv Univ Hlth Sci, F Edward Hebert Sch Med, Bethesda, MD 20814 USA
Gomez, V:
Hosp Ramon & Cajal, Resp Dept, E-28034 Madrid, Spain
Lobo, JL:
Txagorritxu Hosp, Vitoria, Spain
Uresandi, F:
Hosp Cruces, Vizcaya, Spain
Otero, R:
Hosp Univ Virgen Rocio, Seville, Spain
:
Hosp Badalona Germans Trias & Pujol, Dept Med, Badalona, Spain
Muriel, A:
Hosp Ramon & Cajal, Biostat Unit, E-28034 Madrid, Spain
Yusen, RD:
Washington Univ, Sch Med, Div Pulm & Crit Care Med, St Louis, MO USA
Washington Univ, Sch Med, Div Gen Med Sci, St Louis, MO USA
Green Published, Bronze
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