Derivation and Validation of a Novel Prediction Model to Identify Low-Risk Patients With Acute Pulmonary Embolism

Subramanian, Muthiah; Gopalan, Sowmya; Ramadurai, Srinivasan; Arthur, Preetam; Prabhu, Mukund A.; Thachathodiyl, Rajesh; Natarajan, K

doi:10.1016/j.amjcard.2017.05.043

Cited by 4 publications

(10 citation statements)

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“…The modified HOPPE and sPESI scores share three key variables—pulse rate, systolic blood pressure and oxygen saturation. All have high face validity and have been shown to be associated with outcome [ 2 , 9 ]. A potential criticism of the HOPPE score is that it does not take into account co-morbidities which may be an important factor in physician decision-making.…”

Section: Discussionmentioning

confidence: 99%

“…All analyses were performed using Analyse-It for Excel ( https://analyse-it.com ; Analyse-it Software, Leeds, UK). The previous study [ 2 ] reported NPV for 30-day mortality of 95% to 96%. Based on this, 160 patients were required to give a confidence interval +/- 5% for NPV of the outcome in-hospital mortality or composite mortality or MACE.…”

Section: Methodsmentioning

confidence: 99%

“…Pulmonary embolism (PE) is an uncommon condition in emergency departments (ED) accounting for approximately 1.2% of ED presentations for shortness of breath [ 1 ]. It carries a mortality of approximately 4% and a risk of serious non-fatal major adverse clinical events (MACE) of approximately a further 2.5% [ 2 ].…”

Section: Introductionmentioning

confidence: 99%

“…Recently a new score has been derived, the HOPPE score—an acronym derived from its elements heart rate, oxygenation, systolic and diastolic blood pressure and electrocardiogram (ECG) features [ 2 ]. Its components are shown in Table 1 .…”

Section: Introductionmentioning

confidence: 99%

“…Its components are shown in Table 1 . In internal and a small external validation, low risk patients (score ≤6) had no 30-day mortality or non-fatal MACE [ 2 ].0 External validation to date has been small (total of 82 patients, only 27 low risk). To be clinically acceptable, further external validation is required.…”

Section: Introductionmentioning

confidence: 99%

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External validation of the modified HOPPE score to predict low risk pulmonary embolism suitable for early discharge

et al. 2020

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Objective Recently, a novel score for risk stratification of patients with pulmonary embolism (PE)the HOPPE score-was derived. We aimed to externally validate the HOPPE score in emergency department-diagnosed PE, using SpO2 as a surrogate for PaO2-the modified HOPPE score. Methods Retrospective observational study of adult patients with an emergency department diagnosis of PE was performed. Data collected included demographics, co-morbidities, clinical features, electrocardiogram and test results, in-hospital mortality and non-fatal major adverse clinical events (MACE; survived cardiac arrest, cardiogenic shock or thrombolysis administration). The primary outcome of interest was clinical performance of the modified HOPPE score for inhospital mortality and the composite outcome of in-hospital death and MACE. A secondary outcome was comparison of predictive performance between the modified HOPPE score and the simplified Pulmonary Embolism Severity Index score. Results Two hundred and six patients were studied (median age 61, 55% female). There were no deaths or MACE in patients with a low risk modified HOPPE score of 0 to 6 (0%; 95% confidence interval, 0% to 1.8%). Negative predictive value of a low risk score was 100% (95% confidence interval, 92.2% to 100%) for in-hospital mortality and for the composite of in-hospital mortality or MACE. The modified HOPPE score had similar predictive performance to the simplified Pulmonary Embolism Severity Index score with an area under the curve of 0.88 vs. 0.80 for the composite outcome of in-hospital mortality or MACE (P = 0.052). Twenty-eight percent of the patients were classified as low risk and potentially suitable for management as outpatients. Conclusion The modified HOPPE score showed good clinical performance. Prospective validation is warranted.

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Section: Discussionmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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External validation of the modified HOPPE score to predict low risk pulmonary embolism suitable for early discharge

et al. 2020

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Comparison of seven prognostic tools to identify low-risk pulmonary embolism in patients aged <50 years

Jara‐Palomares¹,

Maria

Jiménez

et al. 2019

Sci Rep

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In young patients with acute pulmonary embolism (PE), the predictive value of currently available prognostic tools has not been evaluated. Our objective was to compare prognostic value of 7 available tools (GPS, PESI, sPESI, Prognostic Algorithm, PREP, shock index and RIETE) in patients aged <50 years. We used the RIETE database, including PE patients from 2001 to 2017. The major outcome was 30-day all-cause mortality. Of 34,651 patients with acute PE, 5,822 (17%) were aged <50 years. Of these, 83 (1.4%) died during the first 30 days. Number of patients deemed low risk with tools was: PREP (95.9%), GPS (89.6%), PESI (87.2%), Shock index (70.9%), sPESI (59.4%), Prognostic algorithm (58%) and RIETE score (48.6%). The tools with a highest sensitivity were: Prognostic Algorithm (91.6%; 95% CI: 85.6–97.5), RIETE score (90.4%; 95%CI: 84.0–96.7) and sPESI (88%; 95% CI: 81–95). The RIETE, Prognostic Algorithm and sPESI scores obtained the highest overall sensitivity estimates for also predicting 7- and 90-day all-cause mortality, 30-day PE-related mortality, 30-day major bleeding and 30-day VTE recurrences. The proportion of low-risk patients who died within the first 30 days was lowest using the Prognostic Algorithm (0.2%), RIETE (0.3%) or sPESI (0.3%) scores. In PE patients less 50 years, 30-day mortality was low. Although sPESI, RIETE and Prognostic Algorithm scores were the most sensitive tools to identify patients at low risk to die, other tools should be evaluated in this population to obtain more efficient results.

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Validation of the Predictive Model of the European Society of Cardiology for Early Mortality in Acute Pulmonary Embolism

Cugno

Depetri

Gnocchi

et al. 2018

TH Open

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Background Acute pulmonary embolism (PE) is burdened by high mortality, especially within 30 days from the diagnosis. The development and the validation of predictive models for the risk of early mortality allow to differentiate patients who can undergo home treatment from those who need admission into intensive care units. Methods To validate the prognostic model for early mortality after PE diagnosis proposed by the European Society of Cardiology (ESC) in 2014, we analyzed data of a cohort of 272 consecutive patients with acute PE, observed in our hospital during a 10-year period. Moreover, we evaluated the additional contribution of D-dimer, measured at PE diagnosis, in improving the prognostic ability of the model. All cases of PE were objectively diagnosed by angiography chest CT scan or perfusion lung scan. Results The overall mortality rate within 30 days from PE diagnosis was 10% (95% confidence interval [CI]: 6.4–13.5%). According to the ESC prognostic model, the risk of death increased 3.23 times in the intermediate-low-risk category, 5.55 times in the intermediate-high-risk category, and 23.78 times in the high-risk category, as compared with the low-risk category. The receiver operating characteristic analysis showed a good discriminatory power of the model (area under the curve [AUC] = 0.77 [95% CI: 0.67–0.87]), which further increased when D-dimer was added (AUC = 0.85 [95% CI: 0.73–0.96]). Conclusion This study represents a good validation of the ESC predictive model whose performance can be further improved by adding D-dimer plasma levels measured at PE diagnosis.

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Derivation and Validation of a Novel Prediction Model to Identify Low-Risk Patients With Acute Pulmonary Embolism

Cited by 4 publications

References 30 publications

External validation of the modified HOPPE score to predict low risk pulmonary embolism suitable for early discharge

External validation of the modified HOPPE score to predict low risk pulmonary embolism suitable for early discharge

Comparison of seven prognostic tools to identify low-risk pulmonary embolism in patients aged <50 years

Validation of the Predictive Model of the European Society of Cardiology for Early Mortality in Acute Pulmonary Embolism

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