The shock index and the simplified PESI for identification of low-risk patients with acute pulmonary embolism.
We compared the test characteristics of the shock index (SI) and the simplified pulmonary embolism severity index (sPESI) for predicting 30-day outcomes in a cohort of 1,206 patients with objectively confirmed pulmonary embolism (PE). The primary outcome of the study was all-cause mortality. The secondary outcome was nonfatal symptomatic recurrent venous thromboembolism (VTE) or nonfatal major bleeding. Overall, 119 (9.9%) out of 1,206 patients died (95% CI 8.2-11.5%) during the first month of follow-up. The sPESI classified fewer patients as low-risk (369 (31%) out of 1,206 patients, 95% CI 28-33%) compared to the SI (1,024 (85%) out of 1,206 patients, 95% CI 83-87%) (p<0.001). Low-risk patients based on the sPESI had a lower 30-day mortality than those based on the SI (1.6% (95% CI 0.3-2.9%) versus 8.3% (95% CI 6.6-10.0%)), while the 30-day rate of nonfatal recurrent VTE or major bleeding was similar (2.2% (95%CI 0.7-3.6%) versus 3.3% (95%CI 2.2-4.4%)). The net reclassification improvement with the sPESI was 13.4% (p = 0.07). The integrated discrimination improvement was estimated as 1.8% (p<0.001). The sPESI quantified the prognosis of patients with PE better than the SI.
Sam
A
A
Respiratory Dept and Medicine Dept, Ramón y Cajal Hospital and Alcalá de Henares University, 28034 Madrid, Spain.
Sánchez
D
D
Gómez
V
V
Wagner
C
C
Kopecna
D
D
Zamarro
C
C
Moores
L
L
Aujesky
D
D
Yusen
R
R
Jiménez Castro
D
D
D000368:Aged; D000369:Aged, 80 and over; D000925:Anticoagulants / Q000494:pharmacology; D015331:Cohort Studies; D005260:Female; D006305:Health Status Indicators; D006470:Hemorrhage; D006801:Humans; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D011446:Prospective Studies; D011655:Pulmonary Embolism / Q000175:diagnosis* / Q000401:mortality; D012008:Recurrence; D012189:Retrospective Studies; D012306:Risk; D018570:Risk Assessment; D016896:Treatment Outcome; D054556:Venous Thromboembolism / Q000473:pathology
D000925:Anticoagulants