Modified Bova score for risk stratification and short-term outcome in acute pulmonary embolism

Introduction: Risk stratification in acute pulmonary embolism (PE) is crucial to identify those patients with a poorer prognosis. We aimed to investigate a modified Bova score for risk stratification in acute PE. Materials and methods: We performed a retrospective analysis of PE patients treated in the internal medicine department. Both haemodynamically stable and unstable PE patients, >= 18 years with measurements of cardiac troponin I (cTnI) and existing echocardiography were included in the analysis. Results: Data from 130 patients were included for this retrospective analysis. Three patients (2.3%) died in hospital; 84 patients had a Bova score of < 4 points and 46 >= 4 points. PE patients with a score = 4 points were older (71.2 +/- 13.8 vs. 66.3 +/- 15.5 years, p = 0.0733), died more frequently during the in-hospital course (6.5% vs. 0.0%, p = 0.0183), had a more prevalent high-risk PE status (10.9% vs. 1.2%, p = 0.0122), more often had right ventricular dysfunction (100.0% vs. 35.7%, p < 0.000001), presented more frequently with syncope/collapse (21.7% vs. 3.6%, p = 0.00101) and had a higher heart rate (104.6 +/- 23.5 vs. 90.0 +/- 20.6/min, p = 0.000143), shock index (0.91 +/- 0.59 vs. 0.62 +/- 0.18, p = 0.000232), cTnI (0.36 +/- 0.42 vs. 0.03 +/- 0.10ng/ml, p < 0.000001) and creatinine (1.32 +/- 0.50 vs. 1.03 +/- 0.27 mg/dl, p = 0.000170). Adjusted multivariate logistic regressions revealed significant associations between the Bova score and in-hospital death (OR 4.172, 95% CI 1.125-15.464, p = 0.0326) as well as pneumonia based on PE-related lung infarction (OR 1.207, 95% CI 1.005-1.449, p = 0.0442). ROC analysis for Bova score predicting in-hospital death and pneumonia based on PE-related lung infarction showed area under the curve values of 0.908 and 0.606 with Bova score cut-off values of 3.5 points and 1.5 points, respectively. Conclusions: The modified Bova score is highly effective to predict poorer outcome in acute PE.