Validation of the Pulmonary Embolism Severity Index for risk stratification after acute pulmonary embolism in a cohort of patients in Brazil

Abstract

Objective: To validate the Pulmonary Embolism Severity Index (PESI), which was developed for risk stratification after acute pulmonary embolism (PE), for use in Brazil. Methods: This was a single-center retrospective study involving patients admitted to the emergency department with acute PE. The original and simplified versions of the PESI were calculated using hospital admission data from medical records. The outcome measure was the overall 30-day mortality rate. Results: We included 123 patients. The mean age was 57 ± 17 years, and there was a predominance of females, who accounted for 60% of the cohort. There were 28 deaths, translating to an overall 30-day mortality rate of 23%. In the cluster analysis by risk class, overall 30-day mortality was 2.40% for classes I-II, compared with 20.00% for classes III-IV-V (relative risk [RR] = 5.9; 95% CI: 1.88-18.51; p = 0.0002). When we calculated overall 30-day mortality using the simplified version (0 points vs. ≥ 1 point), we found it to be 3.25% for 0 points and 19.51% for ≥ 1 point (RR = 2.38; 95% CI: 0.89-6.38; p = 0.06). Using the original version, a survival analysis showed that risk classes I and II presented similar Kaplan-Meier curves (p = 0.59), as did risk classes III, IV, and V (p = 0.25). However, the curve of the clusters based on the original version, showed significantly higher mortality in the III-IV-V classes than in the I-II classes (RR = 7.63; 95% CI: 2.29-25.21; p = 0.0001). The cluster analysis based on the original version showed a greater area under the ROC curve than did the analysis based on the simplified version (0.70; 95% CI: 0.62-0.77 vs. 0.60; 95% CI: 0.51-0.67; p = 0.05). Conclusions: The PESI adequately predicted the prognosis after acute PE in this sample of the population of Brazil. The cluster analysis based on the original version is the most appropriate analysis in this setting.

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

“…However, multivariate analysis showed only that age-adjusted hs-TNI cut-off and PESI score (likely) were independent factors influencing the risk of in-hospital death. The strength of these relationships in our study, expressed by OR values, was similar to that reported by Darwish et al [15] for hs-TNI, by Barco et al [13] for NT-proBNP, and by Soriano et al [20] for PESI score. However, it should be underlined that in our study group, even among patients with APE confirmed in CTPA, APE was documented as the final cause of death in only 37.5% of patients.…”

“…For example a 1.2% mortality rate among low-risk APE patients classified using PESI and sPESI score [10], a 6.4% 30-day adverse outcome rate among normotensive (non-high-risk) patients [16], a 7.7-10% 30-day mortality rate in the overall group [17,18], and a 2.1% and 23.0% mortality rate for low-and high-risk APE patients [7]. Ebner et al [19] and Soriano et al [20] showed similar rates to those observed by us for in-hospital all-cause mortality, which in their studies amounted to 12.2% for the overall patient cohort [19], 3.25% for an sPESI score of 0 and 19.51% for an sPESI score ≥ 1, and 20% among those with a high-risk PESI score (classes III-V) [20].…”

Should we use prognostic scores for acute pulmonary thromboembolism in clinical practice?

“…In the current issue of the JBP, Soriano et al 12 published a single-center study aimed at validating the original and simplified versions of the PESI in a historical cohort of patients in Brazil in order to predict 30-day mortality following acute PTE. The authors retrospectively evaluated 123 patients admitted to the emergency department of a public, tertiary referral hospital that exclusively serves patients requiring acute care.…”

“…Despite the limitations inherent to studies of historical data conducted at highly specialized centers, the study by Soriano et al 12 is relevant and provides national data that can bridge the gap between clinical studies and the daily practice of pulmonology in Brazil. In patients with an established diagnosis of acute PTE, it is important to stratify the risk of poor outcome, clinical prognostic scores being useful for this purpose.…”

Impacto da informatização do processo de alta hospitalar em um hospital público terciário

“…Dentre as múltiplas causas, três principais situações guardam maior relação com este risco: erros de prescrição médica, tromboembolismo venoso desencadeado pela imobilização ao leito e a ocorrência de infecções hospitalares. Enquanto os erros de prescrição sejam os mais relacionados à internação tanto precoce como tardia, o tromboembolismo e a infecção hospitalar são grandes causas de complicações mais tardias (3)(4)(5) .…”