Outcome of patients with different clinical presentations of high-risk pulmonary embolism

Ebner, Matthias; Sentler, Carmen; Harjola, Veli‐Pekka; Bueno, Héctor; Lerchbaumer, Markus Herbert; Hasenfuß, Gerd; Eckardt, Kai Uwe; Konstantinides, Stavros; Lankeit, Mareike

doi:10.1093/ehjacc/zuab038

Cited by 13 publications

(6 citation statements)

References 24 publications

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“… 3 , 21 Furthermore, altered mental status was an independent predictor [OR 9.1] of a life-threatening adverse outcomes in PE patients. 22 Using this information, we proposed a new ICU-sPESI mortality prediction score by adding these clinical variables to the original sPESI score. This novel score demonstrated improved discrimination of mortality risk compared to PESI and sPESI.…”

Section: Discussionmentioning

confidence: 99%

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Predicting Hospital Survival in Patients Admitted to ICU with Pulmonary Embolism

Ryll,

Zodl,

Weingarten

et al. 2023

J Intensive Care Med

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Objective The Pulmonary Embolism Severity Index (PESI) and simplified PESI (sPESI) predict mortality for patients with PE. We compared PESI/sPESI to the Acute Physiology and Chronic Health Evaluation IV (APACHE-IV) in predicting mortality in patients with PE admitted to the intensive care unit (ICU). Additionally, we assessed the performance of a novel ICU-sPESI score created by adding three clinical variables associated with acuity of PE presentation (intubation, confusion [altered mental status], use of vasoactive infusions) to sPESI. Materials and Methods Using the eICU Collaborative Research Database from 2014 to 2015, we conducted a large retrospective cohort study of adult patients admitted to the ICU with a primary diagnosis of PE. We calculated APACHE-IV, PESI, sPESI, and ICU-sPESI scores and compared their performance for predicting in-hospital mortality using area under the receiver operating characteristic (AUROC) curve. Score thresholds for >99% negative predictive values (NPV) were calculated for each score. Survival was estimated using the Kaplan–Meier method. Results We included 1424 PE cases. In-hospital mortality was 6.3% [95% CI: 5.1%-7.6%]. AUROC for APACHE-IV, PESI, and sPESI were 0.870, 0.848, and 0.777, respectively. APACHE-IV and PESI outperformed sPESI (P < 0.01 for both comparisons), while APACHE-IV and PESI demonstrated similar performance (P = 0.322). The ICU-sPESI performance was similar to APACHE-IV and PESI (AUROC = 0.847; AUROC comparison: APACHE-IV vs ICU-sPESI: P = 0.396; PESI vs ICU-sPESI: P = 0.945). Hospital mortality for ICU-sPESI scores 0-2 was 1.1%, and for scores 3, 4, 5, 6, and ≥7 was 8.6%, 11.7%, 29.2%, 37.5%, and 76.9%, respectively. Score thresholds for >99% NPV were ≤48 for APACHE-IV, ≤115 for PESI, and 0 points for sPESI and ICU-sPESI. Conclusions By accounting for severity of PE presentation, our newly proposed ICU-sPESI score provided improved PE mortality prediction compared to the original sPESI score and offered excellent discrimination of mortality risk.

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Section: Discussionmentioning

confidence: 99%

“…These markers were chosen based on prior studies showing their independent association with PE mortality. 3 , 21 , 22 …”

Section: Methodsmentioning

confidence: 99%

Predicting Hospital Survival in Patients Admitted to ICU with Pulmonary Embolism

Ryll,

Zodl,

Weingarten

et al. 2023

J Intensive Care Med

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“…від вихідного рівня без причин, яке триває понад 15 хв, і є основою стратифікації пацієнтів з гострою ТЕЛА до групи високого ризику розвитку несприятливих подій згідно із сучасними рекомендаціями [1]. Наразі встановлено, що клінічний перебіг ТЕЛА у групі високого ризику є найтяжчим, а прогноз вкрай несприятливим, госпітальна летальність, за даними різних досліджень, серед цих пацієнтів може становити від 25,4 до 70 % [3,4]. Проте залишається недостатньо вивченим питання щодо додаткових клініко-анамнестичних та інструментальних чинників, які можуть бути пов'язані з прогнозом у хворих на ТЕЛА високого ризику.…”

Section: оригінальні дослідження / Original Researchesunclassified

Risk stratification of poor short-term prognosis in patients with high-risk pulmonary embolism

Tseluyko,

Yakovleva,

Askierov

et al. 2023

ЕМ

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Background. Pulmonary embolism (PE) is the third leading cause of cardiovascular mortality. High-risk PE patients have more severe course of disease and poor prognosis. The question of additional factors which may be associated with prognosis in such patients remains poorly understood. The aim is to identify factors associated with mortality in high-risk PE patients and to determine contribution of these factors to the risk stratification of death. Materials and methods. A retrospective analysis of 635 medical cards of patients with PE diagnosis hospitalized in Kharkiv City Clinical Hospital 8 from January 1, 2017 to January 1, 2023 was conducted. The diagnosis was verified by multispiral computed tomography pulmonary angiography (CTPA) and/or by autopsy. Patients were divided into groups: group І — high-risk (113 — 17.8 %); group II — low-risk (522 — 82.2 %). Group I was divided into subgroups: IA — 63 (55.8 %) individuals, who were discharged from the hospital with improved status, IB — 50 (44.2 %) people, who died in hospital. Clinical, anamnestic, laboratory and instrumental parameters were measured. Statistical analysis was performed. Results. Patients from group I were older, there were more women among them. In subgroup ІВ, there are more women, more cases of obesity and deep vein thrombosis. Patients from group IB had lower blood oxygen saturation (SpO2) and systolic blood pressure (SBP), lower left ventricular ejection fraction (LVEF) measured by echocardiography. Bilateral segmental pulmonary embolism according to CTPA was more common in IB group. According to uni- and multivariate analysis, independent factors affecting in-hospital mortality in patients with high-risk PE were determined, among them: female gender, presence of bifurcation thrombus, lower SBP, SpO2, LVEF. Using the additional regression analysis, the formula for individual prediction of the risk of in-hospital mortality in high-risk PE patients was created. According to the receiver operating characteristic analysis, the sensitivity of the formula is 64.0 %, specificity is 92.1 %. The SBAFS (S — SpO2, B — Bifurcation thrombus, A — Arterial hypotension, F — left ventricular ejection Fraction, S — female Sex) score was formed, where the score of 2 or more indicates additional high risk of in-hospital mortality in high-risk PE patients. Conclusion. The high-risk PE patients who died during hospitalization had more cases of obesity, hypertension, lower SpO2, SBP, and LVEF, and there were more women among them. According to the multivariate logistic regression analysis, additional independent factors associated with in-hospital mortality in high-risk PE patients are female sex, thrombus in bifurcation of the pulmonary trunk, SpO2, SBP, LVEF. The formula for risk stratification of in-hospital death in high-risk PE patients was created and validated. The SBAFS score was formed to indicate additional high risk of in-hospital mortality in high-risk PE patients.

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“…Recent data suggest that early risk stratification of acute PE could be improved by taking account of additional covariates, especially in high-risk PE. Data from 784 consecutive PE patients prospectively enrolled in a single-center registry suggested that the use of an optimized venous lactate cut-off value (i.e., 3.8 mmol/L vs. 2.3 mmol/L with the current definition) to diagnose obstructive shock made it possible to distinguish risk of in-hospital adverse outcomes between patients with shock and persistent hypotension (21.4% vs. 9.5%, respectively), resulting in a net reclassification improvement (0.24 ± 0.08; p = 0.002) [ 78 ]. Moreover, we previously demonstrated that the addition of renal dysfunction on top of the current ESC risk stratification improved overall model performance, yielding 18% reclassification of overall predicted mortality, including reclassification across intermediate–high-risk to high-risk PE in 15.8% of eligible patients [ 79 ].…”

Section: Current Controversies Warranting Further Researchmentioning

confidence: 99%

An Update on the Management of Acute High-Risk Pulmonary Embolism

Chopard

Behr

Vidoni

et al. 2022

JCM

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Hemodynamic instability and right ventricular (RV) dysfunction are the key determinants of short-term prognosis in patients with acute pulmonary embolism (PE). High-risk PE encompasses a wide spectrum of clinical situations from sustained hypotension to cardiac arrest. Early recognition and treatment tailored to each individual are crucial. Systemic fibrinolysis is the first-line pulmonary reperfusion therapy to rapidly reverse RV overload and hemodynamic collapse, at the cost of a significant rate of bleeding. Catheter-directed pharmacological and mechanical techniques ensure swift recovery of echocardiographic parameters and may possess a better safety profile than systemic thrombolysis. Further clinical studies are mandatory to clarify which pulmonary reperfusion strategy may improve early clinical outcomes and fill existing gaps in the evidence.

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Outcome of patients with different clinical presentations of high-risk pulmonary embolism

Cited by 13 publications

References 24 publications

Predicting Hospital Survival in Patients Admitted to ICU with Pulmonary Embolism

Predicting Hospital Survival in Patients Admitted to ICU with Pulmonary Embolism

Risk stratification of poor short-term prognosis in patients with high-risk pulmonary embolism

An Update on the Management of Acute High-Risk Pulmonary Embolism

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