Who Is at Low Risk for Death After Acute Pulmonary Embolism?

Summary and Comment |
February 17, 2012

Who Is at Low Risk for Death After Acute Pulmonary Embolism?

  1. Neil H. Winawer, MD, SFHM

A simplified risk-assessment tool performed well in predicting 30-day and 90-day mortality in patients with acute pulmonary embolism.

  1. Neil H. Winawer, MD, SFHM

Acute pulmonary embolism (PE) confers high risk for morbidity and mortality. Researchers compared two risk-stratification scoring systems for predicting death in a retrospective cohort of 302 patients with acute PE.

The PE severity index (PESI) score, which has been shown to predict 30-day and 90-day mortality accurately after acute PE, comprises 11 clinical variables. In the present study, patients were subcategorized by their raw PESI scores into a low-risk class (levels I and II) and a high-risk class (levels III through V). The recently proposed prognosis in pulmonary embolism (PREP) score, an abridged version of the PESI score, comprises only three clinical variables: presence of altered mental status, cardiogenic shock, and cancer (Am J Respir Crit Care Med 2010; 181:168). Patients were categorized as being at low or high risk for death according to their raw PREP score.

The cohort's mortality rates were 3% at 30 days and 4% at 90 days. Both risk scores performed similarly well, according to their negative predictive values (NPVs), in predicting death at 30 days and 90 days: For both time junctures, the PESI's NPV was 100% and the PREP's NPV was 99%. Patient risk category did not affect the usefulness of either score.

Comment

Both the PESI and the PREP scoring tools accurately predicted 30-day and 90-day outcomes. The simplicity of the PREP makes it more practical to use at the bedside. Additionally, better identification of which PE patients belong at home instead of in the hospital will improve quality of care, increase patient satisfaction, and reduce healthcare utilization and costs. Further prospective trials of these two PE risk-stratification tools will help to confirm the current findings.

Citation(s):

Reader Comments (1)

Norman M. Canter, M.D.

It would seem of prognostic and therapeutic value to identify coagulopathies that represent a greater tendency for clotting and to address treatment specifically toward those coagulopathies.

Competing interests: None declared

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