Clinical

Comparing pulmonary embolism mortality risk scores 


 

Background: Though most PEs do not have significant complications, 15% may be associated with risk of death or hemodynamic compromise. Retrospectively derived risk scores are used to risk-stratify patients and guide acute treatment strategies. It is unclear how well existing risk scores estimate mortality outcomes in patients with acute PE. 

Dr. Sophia Korovaichuk, Division of Hospital Medicine, Northwestern University, Chicago

Dr. Sophia Korovaichuk

Study design: Multicenter cohort study.

Setting: Eight hospitals participating in Pulmonary Embolism Response Team (PERT) consortium registry.

Synopsis: The study included 416 patients with radiographically confirmed acute PE, baseline data for risk calculations, and PERT consultation to consider advanced therapies. Four risk scores (PESI, simplified PESI, BOVA, and European Society of Cardiology) were calculated for each patient independently of clinical care. Patients were assigned into lower- and higher-­risk groups. All-cause mortality was assessed on days 7 and 30. The discrimination of each risk score was measured using area under the curve (AUC). Seven-day mortality ranged 1.3%-3.1% in the lower-risk group, and 7%-16.3% in the high-risk group. Thirty-day mortality in the low-risk group ranged 2.6%-10.2% and 14.4%-26.3% in the high-risk group. PE risk scores have only moderate discrimination for mortality at 7 days (AUC range, 0.616-0.666) and less discrimination at 30 days (AUC range, 0.550-0.694) with little association among the risk scores. Limitations include failure to capture all presenting PEs and inability to differentiate between all-cause and specific PE-related mortality. 

Bottom line: While helpful in predicting shorter-term mortality, acute PE risk scores are not highly accurate at predicting longer-term mortality and should be integrated with broad clinical information when making management decisions.

Citation: Barnes GD et al. Comparison of 4 acute pulmonary embolism mortality risk scores in patients evaluated by pulmonary embolism response teams. JAMA Netw Open. 2020 Aug 3;3(8):e2010779. doi: 10.1001/jamanetworkopen.2020.10779.

Dr. Korovaichuk is a hospitalist at Northwestern Memorial Hospital and assistant professor of medicine, Feinberg School of Medicine, both in Chicago.

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