title: Prognostic value of computed tomographic pulmonary angiography and the pulmonary embolism severity index in patients with acute pulmonary embolism.
abstract: Pulmonary embolism is a serious and potentially fatal disorder. Pulmonary embolism risk stratification may allow early hospital discharge and outpatient treatment for low-risk patients. Also, it may prevent death by early medical intervention in high-risk groups. We evaluated objectively confirmed pulmonary embolism in 126 patients by multidetector computed tomographic pulmonary angiography at a single center from January 2008 to January 2010. The Pulmonary Severity Embolism Index (PESI), the right ventricle (RV) to left ventricle (LV) diameter (RV/LV) ratio and the vascular obstruction index (VOI) were derived from data extracted from electronic hospital records and image database. A total of six out of 96 patients (6.3%) died during follow-up. There was an association between PESI and mortality (P-value < 0.001 χ² test). PESI class I-II had a 100% negative predictive value for death in 90 days. No association was found between the RV/LV ratio, the VOI and mortality (P-value > 0.05 χ² test). Also, no association was found between the RV/LV ratio and the VOI and PESI (P-value > 0.05 χ² test). PESI is an accurate tool for pulmonary embolism prognostic stratification. It safely discriminates low-risk from high-risk patients regarding death outcome. We were unable to demonstrate an association between image scores and mortality.
authors.affiliation: Hospital Mater Dei, Belo Horizonte, Minas Gerais, Brazil. hortasoares@gmail.com
authors.forename: Thiago Horta
authors.initials: TH
authors.lastname: Soares
authors.forename: Marcos
authors.initials: M
authors.lastname: de Bastos
authors.forename: Bruna Vilaça
authors.initials: BV
authors.lastname: de Carvalho
authors.forename: Wanderval
authors.initials: W
authors.lastname: Moreira
authors.forename: Cristiane Pena
authors.initials: CP
authors.lastname: Cabral
authors.forename: Luciano Fagundes
authors.initials: LF
authors.lastname: de Paula
authors.forename: Camila
authors.initials: C
authors.lastname: Caram
authors.forename: Suely Meireles
authors.initials: SM
authors.lastname: Rezende
mesh_terms: D000208:Acute Disease; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000792:Angiography; D005260:Female; D005500:Follow-Up Studies; D006352:Heart Ventricles / Q000473:pathology; D006753:Hospital Records; D006801:Humans; D008297:Male; D008875:Middle Aged; D061330:Multidetector Computed Tomography / Q000379:methods*; D009929:Organ Size; D011379:Prognosis; D011651:Pulmonary Artery / Q000000981:diagnostic imaging*; D011655:Pulmonary Embolism / Q000000981:diagnostic imaging* / Q000401:mortality; D018570:Risk Assessment; D012680:Sensitivity and Specificity; D012720:Severity of Illness Index; D055815:Young Adult