Ana Maestre1, Javier Trujillo-Santos2, Antoni Riera-Mestre3, David Jiménez4, Pierpaolo Di Micco5, José Bascuñana6, Jerónimo Ramón Vela7, Luísa Peris8, Pablo César Malfante9, Manuel Monreal10. 1. 1 Department of Internal Medicine, Hospital Universitario del Vinalopo, Elche, Alicante, Spain. 2. 2 Department of Internal Medicine, Hospital General Universitario Santa Lucía, Murcia, Spain. 3. 3 Department of Internal Medicine, Hospital Universitario de Bellvitge, Barcelona, Spain. 4. 4 Department of Pneumology, Hospital Ramón y Cajal, Madrid, Spain. 5. 5 Department of Internal Medicine and Emergency Room, Ospedale Buonconsiglio Fatebenefratelli, Naples, Italy. 6. 6 Department of Internal Medicine, Hospital Infanta Leonor, Madrid, Spain. 7. 7 Department of Internal Medicine, Hospital Universitario Miguel Servet, Zaragoza, Spain. 8. 8 Department of Internal Medicine, Consorcio Hospitalario Provincial de Castellón, Castellón, Spain. 9. 9 Department of Internal Medicine, Hospital Privado de Comunidad, Buenos Aires, Argentina; and. 10. 10 Department of Internal Medicine, Hospital Universitari Germans Trias i Pujol, Badalona, Universidad Católica de Murcia, Spain.
Abstract
RATIONALE: Patients with acute symptomatic pulmonary embolism (PE) deemed to be at low risk for early complications might be candidates for partial or complete outpatient treatment. OBJECTIVES: To develop and validate a clinical prediction rule that accurately identifies patients with PE and low risk of short-term complications and to compare its prognostic ability with two previously validated models (i.e., the Pulmonary Embolism Severity Index [PESI] and the Simplified PESI [sPESI]) METHODS: Multivariable logistic regression of a large international cohort of patients with PE prospectively enrolled in the RIETE (Registro Informatizado de la Enfermedad TromboEmbólica) registry. MEASUREMENTS AND MAIN RESULTS: All-cause mortality, recurrent PE, and major bleeding up to 10 days after PE diagnosis were determined. Of 18,707 eligible patients with acute symptomatic PE, 46 (0.25%) developed recurrent PE, 203 (1.09%) bled, and 471 (2.51%) died. Predictors included in the final model were chronic heart failure, recent immobilization, recent major bleeding, cancer, hypotension, tachycardia, hypoxemia, renal insufficiency, and abnormal platelet count. The area under receiver-operating characteristic curve was 0.77 (95% confidence interval [CI], 0.75-0.78) for the RIETE score, 0.72 (95% CI, 0.70-0.73) for PESI (P < 0.05), and 0.71 (95% CI, 0.69-0.73) for sPESI (P < 0.05). Our RIETE score outperformed the prognostic value of PESI in terms of net reclassification improvement (P < 0.001), integrated discrimination improvement (P < 0.001), and sPESI (net reclassification improvement, P < 0.001; integrated discrimination improvement, P < 0.001). CONCLUSIONS: We built a new score, based on widely available variables, that can be used to identify patients with PE at low risk of short-term complications, assisting in triage and potentially shortening duration of hospital stay.
RATIONALE: Patients with acute symptomatic pulmonary embolism (PE) deemed to be at low risk for early complications might be candidates for partial or complete outpatient treatment. OBJECTIVES: To develop and validate a clinical prediction rule that accurately identifies patients with PE and low risk of short-term complications and to compare its prognostic ability with two previously validated models (i.e., the Pulmonary Embolism Severity Index [PESI] and the Simplified PESI [sPESI]) METHODS: Multivariable logistic regression of a large international cohort of patients with PE prospectively enrolled in the RIETE (Registro Informatizado de la Enfermedad TromboEmbólica) registry. MEASUREMENTS AND MAIN RESULTS: All-cause mortality, recurrent PE, and major bleeding up to 10 days after PE diagnosis were determined. Of 18,707 eligible patients with acute symptomatic PE, 46 (0.25%) developed recurrent PE, 203 (1.09%) bled, and 471 (2.51%) died. Predictors included in the final model were chronic heart failure, recent immobilization, recent major bleeding, cancer, hypotension, tachycardia, hypoxemia, renal insufficiency, and abnormal platelet count. The area under receiver-operating characteristic curve was 0.77 (95% confidence interval [CI], 0.75-0.78) for the RIETE score, 0.72 (95% CI, 0.70-0.73) for PESI (P < 0.05), and 0.71 (95% CI, 0.69-0.73) for sPESI (P < 0.05). Our RIETE score outperformed the prognostic value of PESI in terms of net reclassification improvement (P < 0.001), integrated discrimination improvement (P < 0.001), and sPESI (net reclassification improvement, P < 0.001; integrated discrimination improvement, P < 0.001). CONCLUSIONS: We built a new score, based on widely available variables, that can be used to identify patients with PE at low risk of short-term complications, assisting in triage and potentially shortening duration of hospital stay.
Authors: Federico Angriman; Fernando J Vazquez; Pierre Marie Roy; Gregoire Le Gal; Marc Carrier; Esteban Gandara Journal: J Thromb Thrombolysis Date: 2017-04 Impact factor: 2.300
Authors: Laura E Simon; Hilary R Iskin; Ridhima Vemula; Jie Huang; Adina S Rauchwerger; Mary E Reed; Dustin W Ballard; David R Vinson Journal: West J Emerg Med Date: 2018-10-18
Authors: Lauren M Westafer; Meng-Shiou Shieh; Penelope S Pekow; Mihaela S Stefan; Peter K Lindenauer Journal: Acad Emerg Med Date: 2020-12-19 Impact factor: 3.451
Authors: Luis Jara-Palomares; Maria Alfonso; Ana Maestre; David Jimenez; Fernando Garcia-Bragado; Carme Font; Raquel Lopez Reyes; Luis Hernandez Blasco; Gemma Vidal; Remedios Otero; Manuel Monreal Journal: Sci Rep Date: 2019-12-27 Impact factor: 4.379