Prognostic value of respiratory index in haemodynamically stable patients with acute pulmonary embolism: The Respiratory Index model study

2020 ◽  
Vol 9 (4) ◽  
pp. 286-292
Author(s):  
Maria Cristina Vedovati ◽  
Ludovica Anna Cimini ◽  
Lucia Pierpaoli ◽  
Simone Vanni ◽  
Marilena Cotugno ◽  
...  
Keyword(s):  
Pulmonary Embolism ◽  
Confidence Interval ◽  
Odds Ratio ◽  
Prognostic Value ◽  
Acute Pulmonary Embolism ◽  
Severity Index ◽  
Derivation Cohort ◽  
Index Model ◽  
C Statistic ◽  
Respiratory Index

Background: Current strategies for prognostic stratification in haemodynamically stable patients with acute pulmonary embolism require improvement. The aims of this study in haemodynamically stable patients with acute pulmonary embolism were (a) to evaluate the prognostic value of a novel respiratory index (oxygen saturation in air to respiratory rate ratio) and (b) to derive a risk model which includes the respiratory index and evaluate its value in predicting 30-day mortality. Methods: Prospective cohorts of haemodynamically stable patients with acute pulmonary embolism were merged to a collaborative database that served to create two subsequent derivation and validation cohorts based on a temporal criterion. The study outcome was 30-day all-cause death. Results: Thirty-day all-cause death occurred in 7.5% and in 6.9% of patients in the derivation and validation cohorts (each composed of 319 patients). In the derivation cohort, the respiratory index (odds ratio 0.66, 95% confidence interval 0.48–0.90) and simplified Pulmonary Embolism Severity Index (odds ratio 9.16, 95% confidence interval 1.22–68.89) were predictors of 30-day mortality. The cut-off value of the respiratory index ⩽3.8 was identified to best predict 30-day all-cause death (15.4% vs 5.0%, odds ratio 2.94, 95% confidence interval 1.22–7.11). The respiratory index ⩽3.8 was combined with the simplified Pulmonary Embolism Severity Index to create the Respiratory Index model that showed a good discriminatory power in the derivation (c-statistic 0.703, 95% confidence interval 0.60–0.80) and in the validation cohort (c-statistic 0.838, 95% confidence interval 0.768–0.907). Conclusion: In hemodynamically stable patients with acute pulmonary embolism, the respiratory index was an independent predictor of 30-day all-cause death. The Respiratory Index model which includes the simplified Pulmonary Embolism Severity Index and the respiratory index, provides a good risk stratification of haemodynamically stable patients with acute pulmonary embolism.

P6463Prognostic value of respiratory index (RI) in hemodinamically stable patients with acute pulmonary embolism: the RI-MODEL study

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
M C Vedovati ◽  
L A Cimini ◽  
L Pierpaoli ◽  
S Vanni ◽  
M Cotugno ◽  
...  
Keyword(s):  
Pulmonary Embolism ◽  
Acute Pulmonary Embolism ◽  
Severity Index ◽  
Discriminatory Power ◽  
Clinical Model ◽  
Derivation Cohort ◽  
Model Study ◽  
Lemeshow Test ◽  
Respiratory Index ◽  
Acute Pe

Abstract Background The accuracy of the 2014 ESC model to predict 30-day mortality in hemodynamically stable patients with acute pulmonary embolism (PE) is relatively limited. Purpose The aims of this study in hemodynamically stable patients with acute PE were i) to evaluate the prognostic value of a novel respiratory index (RI) (oxygen saturation in air to respiratory rate ratio) and ii) to assess the accuracy of the RI-model (simplified Pulmonary Embolism Severity Index [sPESI] + RI), both in predicting 30-day mortality. Methods A collaborative database of hemodynamically stable patients with PE was divided into two cohorts (derivation and validation) with equal numbers of patients, based on a temporal criterion. Study outcome was 30-day all-cause-death. Discrimination and calibration were assessed in the derivation and validation cohorts by the c-statistics and by the Hosmer-Lemeshow test, respectively. Results 30-day all-cause-death occurred in 7.5% of the 319 patients in the derivation cohort (mean age 72 years, females 53%). The RI was an independent predictor of 30-day mortality (p=0.004). A RI ≤3.8 was associated with an increased death rate compared to higher RI values (15.4% vs 5.0%, OR 3.4, 95% CI 1.5–8.1). When the RI≤3.8 was integrated in the sPESI, the novel RI-model showed a good discriminatory power (c-statistics 0.703, 95% CI 0.603–0.803). In the 319 patients of the validation cohort (30-day mortality 6.9%, mean age 71 years, females 55%) the discriminatory power of the RI-model was confirmed (c-statistics 0.838, 95% CI 0.768–0.907). The RI-model and the 2014 ESC model had a c-statistics of 0.772 (95% CI 0.709–0.834) and of 0.687 (95% CI 0.620–0.753) in the overall population, respectively. Conclusion In this study, the RI independently predicted 30-day mortality in hemodynamically stable patients with acute PE. A clinical model including RI showed a better discriminatory value than 2014 ESC model and could be used for risk stratification in these patients.

scholarly journals The prognostic value of pulmonary embolism severity index in acute pulmonary embolism

2018 ◽  
Vol 10 (1) ◽  
pp. 78-79
Author(s):  
M. Hassine ◽  
M. Boussaada ◽  
H. Touil ◽  
M. Mahjoub ◽  
M. Ben Massoued ◽  
...  
Keyword(s):  
Pulmonary Embolism ◽  
Prognostic Value ◽  
Acute Pulmonary Embolism ◽  
Severity Index

Modification of Simplified Pulmonary Embolism Severity Index and its Prognostic Value in Patients with Acute Pulmonary Embolism

2016 ◽  
Vol 25 (2) ◽  
pp. 184-190 ◽  
Author(s):  
Mohammad Ali Ostovan ◽  
Samad Ghaffari ◽  
Leili Pourafkari ◽  
Pooyan Dehghani ◽  
Reza Hajizadeh ◽  
...  
Keyword(s):  
Pulmonary Embolism ◽  
Prognostic Value ◽  
Acute Pulmonary Embolism ◽  
Severity Index

scholarly journals d-Dimer Assessment Improves the Simplified Pulmonary Embolism Severity Index for In-Hospital Risk Stratification in Acute Pulmonary Embolism

2018 ◽  
Vol 24 (8) ◽  
pp. 1340-1346 ◽  
Author(s):  
Marta Kozlowska ◽  
Magdalena Plywaczewska ◽  
Marcin Koc ◽  
Szymon Pacho ◽  
Anna Wyzgal ◽  
...  
Keyword(s):  
Pulmonary Embolism ◽  
Adverse Event ◽  
Risk Stratification ◽  
Prognostic Value ◽  
Acute Pulmonary Embolism ◽  
Clinical Course ◽  
Area Under The Curve ◽  
Severity Index ◽  
Net Reclassification Improvement ◽  
D Dimer

d-dimer (DD) levels are used in the diagnostic workup of suspected acute pulmonary embolism (APE), but data on DD for early risk stratification in APE are limited. In this post hoc analysis of a prospective observational study of 270 consecutive patients, we aimed to optimize the discriminant capacity of the simplified pulmonary embolism severity index (sPESI), an APE risk assessment score currently used, by combining it with DD for in-hospital adverse event prediction. We found that DD levels were higher in patients with complicated versus benign clinical course 7.2 mg/L (25th-75th percentile: 4.5-27.7 mg/L) versus 5.1 mg/L (25th-75th percentile: 2.1-11.2 mg/L), P = .004. The area under the curve of DD for serious adverse event (SAE) was 0.672, P = .003. d-dimer =1.35 mg/L showed 100% negative predictive value for SAE and identified 11 sPESI ≥1 patients with a benign clinical course, detecting the 1 patient with SAE from sPESI = 0. d-dimer >15 mg/L showed heart rate for SAE 3.04 (95% confidence interval [CI]: 1-9). A stratification model which with sPESI + DD >1.35 mg/L demonstrated improved prognostic value when compared to sPESI alone (net reclassification improvement: 0.085, P = .04). d-dimer have prognostic value, values <1.35 mg/L identify patients with a favorable outcome, improving the prognostic potential of sPESI, while DD >15 mg/L is an independent predictor of SAE.

scholarly journals The prognostic value of pulmonary embolism severity index in acute pulmonary embolism

2020 ◽  
Vol 12 (1) ◽  
pp. 99-100
Author(s):  
M. Hassine ◽  
M. Mahjoub ◽  
R. Letaif ◽  
M. Ben Messaoud ◽  
N. Bouchahda ◽  
...  
Keyword(s):  
Pulmonary Embolism ◽  
Prognostic Value ◽  
Acute Pulmonary Embolism ◽  
Severity Index

scholarly journals Developing a scoring tool to estimate the risk of deterioration for normotensive patients with acute pulmonary embolism on admission

2021 ◽  
Vol 22 (1) ◽  
Author(s):  
Yizhuo Gao ◽  
Chao Ji ◽  
Hongyu Zhao ◽  
Jun Han ◽  
Haitao Shen ◽  
...  
Keyword(s):  
Pulmonary Embolism ◽  
Acute Pulmonary Embolism ◽  
Clinical Laboratory ◽  
Systolic Pressure ◽  
Adverse Outcomes ◽  
Web Based ◽  
Derivation Cohort ◽  
Risk Scoring ◽  
Scoring Tool ◽  
Acute Pe

Abstract Background It is important to identify deterioration in normotensive patients with acute pulmonary embolism (PE). This study aimed to develop a tool for predicting deterioration among normotensive patients with acute PE on admission. Methods Clinical, laboratory, and computed tomography parameters were retrospectively collected for normotensive patients with acute PE who were treated at a Chinese center from January 2011 to May 2020 on admission into the hospital. The endpoint of the deterioration was any adverse outcome within 30 days. Eligible patients were randomized 2:1 to derivation and validation cohorts, and a nomogram was developed and validated by the aforementioned cohorts, respectively. The areas under the curves (AUCs) with 95% confidence intervals (CIs) were calculated. A risk-scoring tool for predicting deterioration was applied as a web-based calculator. Results The 845 eligible patients (420 men, 425 women) had an average age of 60.05 ± 15.43 years. Adverse outcomes were identified for 81 patients (9.6%). The nomogram for adverse outcomes included heart rate, systolic pressure, N-terminal-pro brain natriuretic peptide, and ventricle/atrial diameter ratios at 4-chamber view, which provided AUC values of 0.925 in the derivation cohort (95% CI 0.900–0.946, p < 0.001) and 0.900 in the validation cohort (95% CI 0.883–0.948, p < 0.001). A risk-scoring tool was published as a web-based calculator (https://gaoyzcmu.shinyapps.io/APE9AD/). Conclusions We developed a web-based scoring tool that may help predict deterioration in normotensive patients with acute PE.

Trends in risk stratification, in-hospital management and mortality of patients with acute pulmonary embolism: an analysis from China pUlmonary thromboembolism REgistry Study (CURES)

2021 ◽  
pp. 2002963
Author(s):  
Zhenguo Zhai ◽  
Dingyi Wang ◽  
Jieping Lei ◽  
Yuanhua Yang ◽  
Xiaomao Xu ◽  
...  
Keyword(s):  
Pulmonary Embolism ◽  
Risk Stratification ◽  
Hospital Mortality ◽  
Acute Pulmonary Embolism ◽  
Severity Index ◽  
Disease Diagnosis ◽  
Initial Therapy ◽  
European Respiratory Society ◽  
Systemic Thrombolysis ◽  
All Cause Mortality

BackgroundSimilar trends of management and in-hospital mortality of acute pulmonary embolism (PE) have been reported in European and American populations. However, these tendencies were not clear in Asian countries.ObjectivesWe retrospectively analyzed the trends of risk stratification, management and in-hospital mortality for patients with acute PE through a multicenter registry in China (CURES).MethodsAdult patients with acute symptomatic PE were included between 2009 and 2015. Trends in disease diagnosis, treatment and death in hospital were fully analyzed. Risk stratification was retrospectively classified by hemodynamical status and the simplified Pulmonary Embolism Severity Index (sPESI) score according to the 2014 European Society of Cardiology/European Respiratory Society guidelines.ResultsAmong overall 7438 patients, the proportions with high (hemodynamically instability), intermediate (sPESI≥1) and low (sPESI=0) risk were 4.2%, 67.1% and 28.7%, respectively. Computed tomographic pulmonary angiography was the widely employed diagnostic approach (87.6%) and anticoagulation was the frequently adopted initial therapy (83.7%). Between 2009 and 2015, a significant decline was observed for all-cause mortality (from 3.1% to 1.3%, adjusted Pfor trend=0.0003), with a concomitant reduction in use of initial systemic thrombolysis (from 14.8% to 5.0%, Pfor trend<0.0001). The common predictors for all-cause mortality shared by hemodynamically stable and unstable patients were co-existing cancer, older age, and impaired renal function.ConclusionsThe considerable reduction of mortality over years was accompanied by changes of initial treatment. These findings highlight the importance of risk stratification-guided management throughout the nation.

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