A New Index for the Prediction of 30-Day Mortality in Patients With Pulmonary Embolism: The Pulmonary Embolism Mortality Score (PEMS)

被引:23
作者
Surov, Alexey [1 ,2 ]
Akritidou, Mideia [3 ]
Bach, Andreas Gunther [4 ]
Bailis, Nikolaos [1 ]
Lerche, Marianne [5 ]
Meyer, Hans Jonas [1 ]
Pech, Maciej [2 ]
Wienke, Andreas [6 ]
机构
[1] Univ Leipzig, Dept Radiol, Leipzig, Germany
[2] Otto von Guericke Univ, Dept Radiol & Nucl Med, Magdeburg, Germany
[3] Otto von Guericke Univ, Dept Internal Med, Magdeburg, Germany
[4] Martin Luther Univ Halle Wittenberg, Dept Radiol, Halle, Germany
[5] Univ Leipzig, Dept Resp Med, Leipzig, Germany
[6] Martin Luther Univ Halle Wittenberg, Inst Med Epidemiol Biostat & Informat, Halle, Germany
关键词
acute pulmonary embolism; 30-day mortality; simplified pulmonary embolism index; computer tomographic pulmonary angiography;
D O I
10.1177/0003319721993346
中图分类号
R6 [外科学];
学科分类号
1002 ; 100210 ;
摘要
Our aim was to analyze possibility of combination of basic clinical and radiological signs to predict 30-day mortality after acute pulmonary embolism (PE). We included 486 patients. Age, gender, simplified pulmonary embolism index (sPESI), pH, troponin, N-terminal natriuretic peptide, minimal systolic and diastolic blood pressure, O-2 saturation, syncope, need for vasopressors, thrombotic obstruction, vessel diameter, short axis ratio right ventricle/left ventricle, and contrast medium reflux into the inferior vena cava (IVC) were analyzed. A backward algorithm in a logistic regression model was used to identify relevant risk factors. Multiple logistic regression analysis identified that sPESI, pH, minimal diastolic blood pressure, IVC reflux, and need for vasopressors influenced 30-day mortality. A score for mortality prediction was constructed (the Pulmonary Embolism Mortality Score): sPESI >2 points (1 point), pH <7.35 (1 point), minimal diastolic blood pressure <45 mm Hg (1 point), IVC reflux (1 point), and need for vasopressors (2 points). Patients with >3 points showed higher 30-day mortality (sensitivity: 84.9%, specificity: 83.0%, positive predictive value: 51.8%, negative predictive value: 96.2%). The net reclassification improvement compared with the sPESI was 0.94 (95% CI = 0.73-1.15). In conclusion, a new score can predict 30-day mortality in patients with PE and is more sensitive than sPESI.
引用
收藏
页码:787 / 793
页数:7
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