Pulmonary embolism severity index and troponin testing for the selection of low-risk patients with acute symptomatic pulmonary embolism.

Details

Serval ID
serval:BIB_FA0D655CDB24
Type
Article: article from journal or magazin.
Collection
Publications
Institution
Title
Pulmonary embolism severity index and troponin testing for the selection of low-risk patients with acute symptomatic pulmonary embolism.
Journal
Journal of Thrombosis and Haemostasis
Author(s)
Moores L., Aujesky D., Jiménez D., Díaz G., Gómez V., Martí D., Briongos S., Yusen R.
ISSN
1538-7836[electronic], 1538-7836[linking]
Publication state
Published
Issued date
2009
Volume
8
Number
3
Pages
517-522
Language
english
Abstract
Summary Background: The combination of the Pulmonary Embolism Severity Index (PESI) and troponin testing could help physicians identify appropriate patients with acute pulmonary embolism (PE) for early hospital discharge. Methods: This prospective cohort study included a total of 567 patients from a single center registry with objectively confirmed acute symptomatic PE. On the basis of the PESI, each patient was classified into 1 of 5 classes (I to V). At the time of hospital admission, patients had troponin I (cTnI) levels measured. The endpoint of the study was all-cause mortality within 30 days after diagnosis. We calculated the mortality rates in 4 patient groups: group 1: PESI class I-II plus cTnI <0.1 ng mL(-1); group 2: PESI classes III-V plus cTnI <0.1 ng mL(-1); group 3: PESI classes I-II plus cTnI >/= 0.1 ng mL(-1); and group 4: PESI classes III-V plus cTnI >/= 0.1 ng mL(-1). Results: The study cohort had a 30-day mortality of 10% (95% confidence interval [CI], 7.6 to 12.5%). Mortality rates in the 4 groups were 1.3%, 14.2%, 0% and 15.4%, respectively. Compared to non-elevated cTnl, the low-risk PESI had a higher negative predictive value (NPV) (98.9% vs 90.8%) and negative likelihood ratio (NLR) (0.1 vs 0.9) for predicting mortality. The addition of non-elevated cTnI to low-risk PESI did not improve the NPV or the NLR compared to either test alone. Conclusions: Compared to cTnl testing, PESI classification more accurately identified patients with PE who are at low risk of all-cause death within 30-days of presentation.
Keywords
Mortality, Prognosis, Pulmonary Embolism, Thrombosis, Initial Outpatient Therapy, Prognostic Models, Validation, Thromboembolism, Stratification, Metaanalysis, Angiography, Diagnosis
Pubmed
Web of science
Open Access
Yes
Create date
12/03/2010 10:58
Last modification date
20/08/2019 16:25
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