Contribution of Quick Sequential Organ Failure Assessment Score Combined with Electrocardiography in Risk Stratification of Patients with Acute Pulmonary Embolism

Abstract

Background:The quick Sequential Organ Failure Assessment (qSOFA) score emerged recently. We investigated its contribution to risk stratification in acute pulmonary embolism (PE) by combining with electrocardiography (ECG).Methods:Acute PE patients diagnosed in Beijing Chao-Yang Hospital, Capital Medical University, from 2008 to 2018 were retrospectively studied and divided into high- and low - risk groups by imaging and biomarkers. The ECG scores consisted of tachycardia, McGinn-White sign (S1Q3T3), right bundle branch block, and T-wave inversion of leads V1–V3. A new combination of qSOFA scores and ECG scores by logistic regression for predicting high-risk stratification patients with acute PE was evaluated by a receiver operating characteristic curve.Results:Totally 1318 patients were enrolled, including 271 in the high-risk group and 1047 in the low-risk group. A combination predictive scoring system named qSOFA-ECG = qSOFA score + ECG score was created. The optimal cutoff value for qSOFA-ECG was 2, and the sensitivity, specificity, positive predictive value, and negative predictive value were 81.5%, 72.3%, 43.2%, and 93.8%, respectively. For predicting high-risk stratification and reperfusion therapy, the qSOFA-ECG is superior to PE Severity Index (PESI) and simplified PESI.Conclusions:The qSOFA score contributes to identify acute PE patients with potentially hemodynamic decompensation that need monitoring and possible reperfusion therapy at the emergency department arrival when used in combination with ECG score.

Prediction of prognosis and outcome of patients with pulmonary embolism in the emergency department using early warning scores and qSOFA score

“…The authors concluded that the qSOFA score contributes to the identification of patients with acute PE who are at risk of hemodynamic decompensation and thus require monitoring and possible reperfusion therapy upon ED arrival when used in combination with the ECG score. 20 In our study, the qSOFA score showed worse performance than the NEWS2.…”

“…19 A 10-year study from China combined the qSOFA score with electrocardiography (ECG) findings to determine the risk stratification in patients with acute PE. 20 The study involved 1318 patients (271 in the high-risk group, 1047 in the low-risk group). The authors established a combination predictive scoring system called the qSOFA-ECG score, which was obtained by adding the qSOFA score and the ECG score.…”

Early Predictive Value of the Electrocardiogram Combined with Q-SOFA Score for the Prognosis of Acute Poisoning Patients: A Retrospective Analysis

“…Compared to ECG indicators (AUC 0.777,95%CI 0.728 ~ 0.827), the q-SOFA score has a high sensitivity, but lower speci city. One study demonstrated that ECG combined with q-SOFA score improved risk strati cation for patients with acute pulmonary embolism [30]. Moreover, several reports indicate that combining heart rate variability with q-SOFA can effectively improve predictive ability for mortality in patients with sepsis [31,32].…”

The risk factors for all-cause in-hospital death in patients with acute pulmonary embolism

“…Such tools include: (a) calculation of Pulmonary Embolism Severity Index (PESI) or simplified PESI (sPESI) scores and the patient's qualification to one of five PESI risk classes or to one of two sPESI classes; (b) ESC classification of pulmonary embolism severity and the risk of early death (low/intermediate-low/intermediate-high/high); (c) determination of blood high-sensitivity troponin I (hs-TNI) or high-sensitivity troponin T (hs-TNT) concentration cut-offs (standard and age-adjusted); (d) assessment for signs of right ventricular (RV) pressure overload in transthoracic echocardiography (TTE) or RV enlargement in CTPA; and, in some cases, (e) determination of blood N-terminal proBtype natriuretic peptide (NT-proBNP) concentration cut-off (mostly ≥ 600 pg/ml) [2,3]. Researchers have also suggested using the following stratifying tools: the presence of coexisting DVT in patients at intermediate-low risk of short-term complications [5]; (b) selected parameters of CTPA imaging [6][7][8], as well as various combinations of the parameters, some of which are mentioned above, such as (i) D-dimer cut-off with sPESI [9], (ii) PESI with NT-proBNP, hs-TNT, and high-sensitivity C-reactive protein cut-offs [10] and (iii) PESI, sPESI and Bova scores with additional patient stratification on the basis of systolic blood pressure [11]; and (c) a combination of a quick Sequential Organ Failure Assessment (qSOFA) score with particular ECG signs [12].…”