The shock index and the simplified PESI for identification of low-risk patients with acute pulmonary embolism

A. Sam, D. Sánchez, V. Gómez, C. Wagner, D. Kopecna, C. Zamarro, L. Moores, D. Aujesky, R. Yusen, D. Jiménez Castro

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52 Scopus citations

Abstract

We compared the test characteristics of the shock index (SI) and the simplified pulmonary embolism severity index (sPESI) for predicting 30-day outcomes in a cohort of 1,206 patients with objectively confirmed pulmonary embolism (PE). The primary outcome of the study was all-cause mortality. The secondary outcome was nonfatal symptomatic recurrent venous thromboembolism (VTE) or nonfatal major bleeding. Overall, 119 (9.9%) out of 1,206 patients died (95% CI 8.2-11.5%) during the first month of follow-up. The sPESI classified fewer patients as low-risk (369 (31%) out of 1,206 patients, 95% CI 28-33%) compared to the SI (1,024 (85%) out of 1,206 patients, 95% CI 83-87%) (p<0.001). Low-risk patients based on the sPESI had a lower 30-day mortality than those based on the SI (1.6% (95% CI 0.3-2.9%) versus 8.3% (95% CI 6.6-10.0%)), while the 30-day rate of nonfatal recurrent VTE or major bleeding was similar (2.2% (95%CI 0.7-3.6%) versus 3.3% (95%CI 2.2-4.4%)). The net reclassification improvement with the sPESI was 13.4% (p=0.07). The integrated discrimination improvement was estimated as 1.8% (p<0.001). The sPESI quantified the prognosis of patients with PE better than the SI. Copyright

Original languageEnglish
Pages (from-to)762-766
Number of pages5
JournalEuropean Respiratory Journal
Volume37
Issue number4
DOIs
StatePublished - Apr 1 2011

Keywords

  • Lung
  • Prognosis
  • Pulmonary embolism
  • Thrombosis

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