title: Changes in PESI scores predict mortality in intermediate-risk patients with acute pulmonary embolism.
abstract: Although the Pulmonary Embolism Severity Index (PESI) accurately identifies 35% of patients with acute pulmonary embolism (PE) as being low risk, some patients deemed high risk by the PESI on admission might be treated safely in the outpatient environment. This retrospective cohort study included a total of 304 consecutive patients with acute PE, classified at the time of hospital admission into PESI class III. The PESI was recalculated 48 h after admission (PESI(48)) and each patient reclassified into the corresponding risk category. The primary outcome of the study was all-cause mortality between day 2 and day 30 after PE diagnosis. 26 (8.5%) patients (95% CI 5.4-11.7%) died between day 2 and day 30 after PE diagnosis. Investigators reclassified 83 (27.3%) patients (95% CI 22.3-32.3%) as low risk (classes I and II) at 48 h. 30-day mortality in these patients was 1.2% (95% CI 0-3.5%) as opposed to 11.3% (95% CI 7.1-15.5%) in those who remained high risk. The net improvement in reclassification was estimated at 54% (p<0.001). In a cohort of intermediate-risk patients with acute PE, calculation of the PESI(48) allows identification of those patients at very low risk of dying during the first month of follow-up.
authors: F. Edward Hebert School of Medicine, Uniformed Services University, Bethesda, MD, USA.
authors: Lisa
authors: L
authors: Moores
authors: Celia
authors: C
authors: Zamarro
authors: Vicente
authors: V
authors: Gómez
authors: Drahomir
authors: D
authors: Aujesky
authors: Leticia
authors: L
authors: García
authors: Rosa
authors: R
authors: Nieto
authors: Roger
authors: R
authors: Yusen
authors: David
authors: D
authors: Jiménez
mesh_terms: D000368:Aged; D000553:Ambulatory Care; D015331:Cohort Studies; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010343:Patient Admission; D011379:Prognosis; D011446:Prospective Studies; D011655:Pulmonary Embolism / Q000145:classification* / Q000175:diagnosis* / Q000401:mortality; D015272:Pulmonary Medicine / Q000379:methods / Q000592:standards*; D012042:Registries; D018570:Risk Assessment; D012307:Risk Factors; D012720:Severity of Illness Index; D016896:Treatment Outcome