Central clot score at computed tomography as a predictor of 30-day mortality after acute pulmonary embolism.
BACKGROUND
The severity of acute pulmonary embolism can be assessed with computed tomography (CT) using clot burden estimation. We compared the existing CT obstruction scores with an in-house developed central clot score for the prediction of 30-day pulmonary embolism (PE)-related mortality.


METHODS
In 125 consecutive patients [47 men, 78 women; mean age +/- standard deviation (SD, 60.4 years +/- 16.6] with acute PE, 2 readers in consensus assessed the severity of PE with 2 existing clot scoring systems (Mastora and Qanadli) and central clot score. The right ventricular dysfunction was assessed by right ventricular diameter (RVD), left ventricular diameter (LVD), ventricular ratio (VR) and septal deviation. Univariate and multivariate regression analysis were performed to correlate these parameters and 30-day PE-related mortality.


RESULTS
Ten patients (8%) died of PE within 30 days following CT and 115 patients did not have PE-related death outcome. There was a significant difference in all 3 clot scores, LVD and VR between patients with 30-day PE-related death and those without (P < or =0.001-0.02). Univariate regression analysis showed that all three clot scores and LVD were predictors of PE death, however with multivariate analysis, only central clot score showed significant correlation with 30-day PE death [Odds ratio (OR), 1.1; 96% CI, 1-1.16; P <0.003]. A central clot index of 53% had 100% sensitivity, 76.5% specificity, 23.5% positive predictive value and 98% negative predictive value for 30-day PE death.


CONCLUSIONS
Central clot score is a strong predictor of 30-day PE death and may therefore allow therapy and risk stratification in patients with acute PE.
Venkatesh
Sudhakar Kundapur
SK
Department of Diagnostic Radiology, National University Hospital, National University Health System, Singapore. Sudhakar_K_Venkatesh@nuhs.edu.sg
Wang
Shih Chang
SC
D000208:Acute Disease; D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001777:Blood Coagulation; D005260:Female; D005544:Forecasting; D006801:Humans; D008297:Male; D008875:Middle Aged; D011655:Pulmonary Embolism / Q000401:mortality*; D012720:Severity of Illness Index; D014057:Tomography, X-Ray Computed; D055815:Young Adult