title: Risk factors for intracranial haemorrhage in patients with pulmonary embolism treated with thrombolytic therapy Development of the PE-CH Score.
abstract: Pulmonary embolism (PE) is a major cause of morbidity and mortality world-wide, and the use of thrombolytic therapy has been associated with favourable clinical outcomes in certain patient subsets. These potential benefits are counterbalanced by the risk of bleeding complications, the most devastating of which is intracranial haemorrhage (ICH). We retrospectively evaluated 9703 patients from the 2003-2012 nationwide in-patient sample database (NIS) who received thrombolytics for PE. All patients with ICH during the PE hospitalisation were identified and a clinical risk score model was developed utilizing demographics and comorbidities. The dataset was divided 1:1 into derivation and validation cohorts. During 2003-2012, 176/9705 (1.8 %) patients with PE experienced ICH after thrombolytic use. Four independent prognostic factors were identified in a backward logistic regression model, and each was assigned a number of points proportional to its regression coefficient: pre-existing Peripheral vascular disease (1 point), age greater than 65 years (Elderly) (1 point), prior Cerebrovascular accident with residual deficit (5 points), and prior myocardial infarction (Heart attack) (1 point). In the derivation cohort, scores of 0, 1, 2 and ≥ 5 points were associated with ICH risks of 1.2 %, 1.9 %, 2.4 % and 17.8 %, respectively. Rates of ICH were similar in the validation cohort. The C-statistic for the risk score was 0.65 (0.61-0.70) in the derivation cohort and 0.66 (0.60-0.72) in the validation cohort. A novel risk score, derived from simple clinical historical elements was developed to predict ICH in PE patients treated with thrombolytics.
authors.affiliation: Saurav Chatterjee MD, Cardiovascular Medicine Division, Mount Sinai St Luke's-West Hospitals, 1111 Amsterdam Avenue, 3rd Floor Clark Building, New York, NY 10025, USA, Tel.: +1 212 523 4008, Fax: +1 347 244 7148, E-mail: sauravchatterjeemd@gmail.com.
authors.forename: Saurav
authors.initials: S
authors.lastname: Chatterjee
authors.forename: Ido
authors.initials: I
authors.lastname: Weinberg
authors.forename: Robert W
authors.initials: RW
authors.lastname: Yeh
authors.forename: Anasua
authors.initials: A
authors.lastname: Chakraborty
authors.forename: Partha
authors.initials: P
authors.lastname: Sardar
authors.forename: Mitchell D
authors.initials: MD
authors.lastname: Weinberg
authors.forename: Christopher
authors.initials: C
authors.lastname: Kabrhel
authors.forename: Geoffrey D
authors.initials: GD
authors.lastname: Barnes
authors.forename: Debabrata
authors.initials: D
authors.lastname: Mukherjee
authors.forename: Dharam
authors.initials: D
authors.lastname: Kumbhani
authors.forename: Riyaz
authors.initials: R
authors.lastname: Bashir
authors.forename: Anjali
authors.initials: A
authors.lastname: Vaidya
authors.forename: Akaya
authors.initials: A
authors.lastname: Smith
authors.forename: Barry
authors.initials: B
authors.lastname: Fuchs
authors.forename: Peter
authors.initials: P
authors.lastname: Groeneveld
authors.forename: Jay
authors.initials: J
authors.lastname: Giri
mesh_terms: D000367:Age Factors; D000368:Aged; D019540:Area Under Curve; D002561:Cerebrovascular Disorders / Q000175:diagnosis / Q000453:epidemiology; D016009:Chi-Square Distribution; D015897:Comorbidity; D016208:Databases, Factual; D003661:Decision Support Techniques; D005260:Female; D005343:Fibrinolytic Agents / Q000009:adverse effects*; D006801:Humans; D020300:Intracranial Hemorrhages / Q000139:chemically induced* / Q000175:diagnosis; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009203:Myocardial Infarction / Q000175:diagnosis / Q000453:epidemiology; D016491:Peripheral Vascular Diseases / Q000175:diagnosis / Q000453:epidemiology; D011237:Predictive Value of Tests; D011655:Pulmonary Embolism / Q000175:diagnosis / Q000188:drug therapy* / Q000453:epidemiology; D012372:ROC Curve; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D015912:Thrombolytic Therapy / Q000009:adverse effects*; D013997:Time Factors; D016896:Treatment Outcome; D014481:United States / Q000453:epidemiology
chemical_list: D005343:Fibrinolytic Agents
keywords: (intracranial) haemorrhage; Embolism; thrombolysis