Simplification of the pulmonary embolism severity index for prognostication in patients with acute symptomatic pulmonary embolism.
Details
Serval ID
serval:BIB_4F65B26A9994
Type
Article: article from journal or magazin.
Collection
Publications
Institution
Title
Simplification of the pulmonary embolism severity index for prognostication in patients with acute symptomatic pulmonary embolism.
Journal
Archives of Internal Medicine
Working group(s)
RIETE Investigators
Contributor(s)
Monreal M., Decousus H., Prandoni P., Brenner B., Barba R., Di Micco P., Rivron-Guillot K., Arcelus JI., Barrón M., Blanco A., Bonilla M., Bueso T., Cañas I., Casado I., Conget F., Falgá C., Fernández-Capitán C., Gallego P., García-Bragado F., Guijarro R., Grau E., Guil£££María£££ M. , Gutiérrez J., Hernández£££Luís£££ L. , Jiménez D., Lecumberri R., León JM., Llado£££María£££ M. , Lobo JL., López L., Lorenzo A., Luque JM., Madridano O., Maestre A., Marchena PJ., Martín A., Martín-Villasclaras JJ., Monte R., Muñóz FJ., Naufall MD., Nieto JA., Oribe M., Orue£££María Teresa£££ MT. , Otero R., Portillo J., Rabuñal£££Ramón£££ R. , Renzi C., Riera-Mestre A., Rosa V., Rubio S., Ruiz-Gamietea A., Sahuquillo JC., Samperiz AL., Sánchez R., Sánchez Muñoz-Torrero JF. , Sandoval£££Raúl£££ R. , Soler S., Tiberio G., Tirado R., Todolí JA., Tolosa C., Torres I., Trujillo-Santos J., Uresandi F., Valdés M., Valdés£££Valentín£££ V. , Valle R., Vasco B., Vela£££Jerónimo£££ J. , Boccalon H., Falvo N., Le Corvoisier P., Rivron-Guillot K., Barillari G., Ciammaichella M., Dalla Valle F., Duce R., Ferrari A., Pasca S., Piovaccari G., Poggio R., Prandoni P., Quintavalla R., Rocci A., Rota L., Schenone A., Tiraferri E., Visonà A.
ISSN
1538-3679 (Electronic)
ISSN-L
0003-9926
Publication state
Published
Issued date
2010
Volume
170
Number
15
Pages
1383-1389
Language
english
Notes
Publication types: Comparative Study ; Journal Article ; Research Support, Non-U.S. Gov't
Publication Status: ppublish
Publication Status: ppublish
Abstract
BACKGROUND: The Pulmonary Embolism Severity Index (PESI) estimates the risk of 30-day mortality in patients with acute pulmonary embolism (PE). We constructed a simplified version of the PESI.
METHODS: The study retrospectively developed a simplified PESI clinical prediction rule for estimating the risk of 30-day mortality in a derivation cohort of Spanish outpatients. Simplified and original PESI performances were compared in the derivation cohort. The simplified PESI underwent retrospective external validation in an independent multinational cohort (Registro Informatizado de la Enfermedad Tromboembólica [RIETE] cohort) of outpatients.
RESULTS: In the derivation data set, univariate logistic regression of the original 11 PESI variables led to the removal of variables that did not reach statistical significance and subsequently produced the simplified PESI that contained the variables of age, cancer, chronic cardiopulmonary disease, heart rate, systolic blood pressure, and oxyhemoglobin saturation levels. The prognostic accuracy of the original and simplified PESI scores did not differ (area under the curve, 0.75 [95% confidence interval (CI), 0.69-0.80]). The 305 of 995 patients (30.7%) who were classified as low risk by the simplified PESI had a 30-day mortality of 1.0% (95% CI, 0.0%-2.1%) compared with 10.9% (8.5%-13.2%) in the high-risk group. In the RIETE validation cohort, 2569 of 7106 patients (36.2%) who were classified as low risk by the simplified PESI had a 30-day mortality of 1.1% (95% CI, 0.7%-1.5%) compared with 8.9% (8.1%-9.8%) in the high-risk group.
CONCLUSION: The simplified PESI has similar prognostic accuracy and clinical utility and greater ease of use compared with the original PESI.
METHODS: The study retrospectively developed a simplified PESI clinical prediction rule for estimating the risk of 30-day mortality in a derivation cohort of Spanish outpatients. Simplified and original PESI performances were compared in the derivation cohort. The simplified PESI underwent retrospective external validation in an independent multinational cohort (Registro Informatizado de la Enfermedad Tromboembólica [RIETE] cohort) of outpatients.
RESULTS: In the derivation data set, univariate logistic regression of the original 11 PESI variables led to the removal of variables that did not reach statistical significance and subsequently produced the simplified PESI that contained the variables of age, cancer, chronic cardiopulmonary disease, heart rate, systolic blood pressure, and oxyhemoglobin saturation levels. The prognostic accuracy of the original and simplified PESI scores did not differ (area under the curve, 0.75 [95% confidence interval (CI), 0.69-0.80]). The 305 of 995 patients (30.7%) who were classified as low risk by the simplified PESI had a 30-day mortality of 1.0% (95% CI, 0.0%-2.1%) compared with 10.9% (8.5%-13.2%) in the high-risk group. In the RIETE validation cohort, 2569 of 7106 patients (36.2%) who were classified as low risk by the simplified PESI had a 30-day mortality of 1.1% (95% CI, 0.7%-1.5%) compared with 8.9% (8.1%-9.8%) in the high-risk group.
CONCLUSION: The simplified PESI has similar prognostic accuracy and clinical utility and greater ease of use compared with the original PESI.
Keywords
Acute Disease, Adult, Aged, Aged, 80 and over, Female, Humans, Logistic Models, Male, Middle Aged, Outpatients/statistics & numerical data, Predictive Value of Tests, Prognosis, Prospective Studies, Pulmonary Embolism/diagnosis, Pulmonary Embolism/mortality, ROC Curve, Registries, Reproducibility of Results, Retrospective Studies, Risk Assessment, Risk Factors, Severity of Illness Index, Spain/epidemiology
Pubmed
Web of science
Open Access
Yes
Create date
25/08/2010 11:42
Last modification date
20/08/2019 15:05
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