title: Comparison of clinical scores for identification of patients with pulmonary embolism at intermediate-high risk of adverse clinical outcome: the prognostic role of plasma lactate.
abstract: To compare the prognostic accuracy of the 2014 risk model of the European Society of Cardiology (ESC) and of Bova and TELOS scores for identification of normotensive patients with pulmonary embolism (PE) at high risk for short-term adverse events (i.e., intermediate-high risk patients), we retrospectively applied these tests to a prospective cohort of 994 normotensive patients with objectively confirmed PE. Sixty-three (6.3 %) patients reached the primary outcome, a composite of hemodynamic collapse and death within 7 days from diagnosis. The Bova and TELOS scores classified the same proportion of patients in intermediate-high risk category (5.9 and 5.7 %, respectively), with a similar primary outcome rate (18.6 and 21.1 %, respectively). The 2014 ESC model classified in the intermediate-high risk category the largest proportion of patients (12.5 %, p < 0.001 vs Bova and TELOS), with the lowest primary outcome rate (13 %, p = ns vs Bova and TELOS). When lactate determination was added to the Bova score, 112 patients (11.2 %) were classified in the intermediate-high risk category (p < 0.05 vs Bova and TELOS), with a slight increase in the primary outcome rate (25.9 %, p = 0.014 vs 2014 ESC model), allowing the recognition of a twofold higher number of patients reaching the primary outcome (29 vs 15, 11 and 12 patients in the 2014 ESC model, Bova and TELOS scores, respectively, p < 0.01 for all). The 2014 ESC model, Bova and TELOS scores identify a small number of intermediate-high risk patients with PE, without differences among tests. Adding plasma lactate to the Bova score significantly improves the identification of intermediate-high risk patients.
authors.affiliation: Emergency Department, Azienda Ospedaliero-Universitaria Careggi, Largo Brambilla 3, 50139, Florence, Italy. simonevanni@alice.it.
authors.forename: Simone
authors.initials: S
authors.lastname: Vanni
authors.affiliation: Emergency Department, Azienda Ospedaliero-Universitaria Careggi, Largo Brambilla 3, 50139, Florence, Italy.
authors.forename: Peiman
authors.initials: P
authors.lastname: Nazerian
authors.affiliation: Department of Medicine, University Hospital of Cosenza, Cosenza, Italy.
authors.forename: Carlo
authors.initials: C
authors.lastname: Bova
authors.affiliation: Emergency Department, Azienda Ospedaliero-Universitaria Careggi, Largo Brambilla 3, 50139, Florence, Italy.
authors.forename: Ernesta
authors.initials: E
authors.lastname: Bondi
authors.affiliation: Emergency Department, A.O.U. Città della Salute e della Scienza di Torino, Ospedale Molinette, Turin, Italy.
authors.forename: Fulvio
authors.initials: F
authors.lastname: Morello
authors.affiliation: Emergency Department, Azienda Ospedaliero-Universitaria Careggi, Largo Brambilla 3, 50139, Florence, Italy.
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Pepe
authors.affiliation: Emergency Department, Azienda Ospedaliero-Universitaria Careggi, Largo Brambilla 3, 50139, Florence, Italy.
authors.forename: Barbara
authors.initials: B
authors.lastname: Paladini
authors.affiliation: Emergency Department, Azienda Ospedaliero-Universitaria Careggi, Largo Brambilla 3, 50139, Florence, Italy.
authors.forename: Giovanni
authors.initials: G
authors.lastname: Liedl
authors.affiliation: Emergency Department, Azienda Ospedaliero-Universitaria Careggi, Largo Brambilla 3, 50139, Florence, Italy.
authors.forename: Elisabetta
authors.initials: E
authors.lastname: Cangioli
authors.affiliation: Emergency Department, Azienda Ospedaliero-Universitaria Careggi, Largo Brambilla 3, 50139, Florence, Italy.
authors.forename: Stefano
authors.initials: S
authors.lastname: Grifoni
authors.affiliation: Respiratory Department, Ramón y Cajal Hospital, IRYCIS, Alcalá de Henares University, Madrid, Spain.
authors.forename: David
authors.initials: D
authors.lastname: Jiménez
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D015415:Biomarkers / Q000032:analysis / Q000097:blood; D016009:Chi-Square Distribution; D015331:Cohort Studies; D003661:Decision Support Techniques; D004452:Echocardiography / Q000379:methods; D005260:Female; D006801:Humans; D019344:Lactic Acid / Q000032:analysis* / Q000097:blood; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D011655:Pulmonary Embolism / Q000175:diagnosis*; D012189:Retrospective Studies; D018570:Risk Assessment / Q000379:methods*; D014336:Troponin / Q000032:analysis / Q000097:blood
chemical_list: D015415:Biomarkers; D014336:Troponin; D019344:Lactic Acid
keywords: Lactate; Prognosis; Pulmonary embolism; Right ventricular dysfunction; Troponin