PrOgnosis in Pulmonary Embolism (PoPE): 30-Day mortality risk score based on five admission parameters

Abstract

Introduction and objective: Several scoring systems have been developed for risk stratification in patients with acute pulmonary embolism (PE). The Pulmonary Embolism Severity Index (PESI) and its simplified version (sPESI) are among the most used, however the high number of variables hinder its application. Our aim was to derive an easy-to-perform score based on simple parameters obtained at admission to predict 30-day mortality in acute PE patients. Methods: Retrospective study in 1115 patients with acute PE from two institutions (derivation cohort n=835, validation cohort n=280). The primary endpoint was all-cause mortality at 30 days. Statistically and clinically relevant variables were selected for multivariable Cox regression analysis. We derived and validated a multivariable risk score model and compared to other established scores. Results: The primary endpoint occurred in 207 patients (18.6%). Our model included five variables weighted as follows: modified shock index ≥1.1 (hazard ratio [HR] 2.57, 1.68–3.92, p1,1 (HR 2,57, 1,68-3,92, p<0,001), neoplasia ativa (HR 2,27, 1,45-3,56, p<0,001), alteração do estado de consciência (HR 3,82, 2,50-5,83, p<0,001), concentração de lactato sérica ≥2,50 mmol/L (HR 5,01, 3,25-7,72, p<0,001) e idade ≥80 anos (HR 1,95, 1,26-3,03, p=0,003). O desempenho prognóstico foi superior a outros scores (AUC 0,83 [0,79-0,87] versus 0,72 [0,67-0,79] no PESI e (0,70 [0,62-0,75]) no sPESI, p<0,001) e a sua performance na cohort de validação foi boa (73 eventos em 280 doentes, 26,1%, AUC 0,76, 0,71-0,82, p<0,0001) e superior aos outros scores (p<0,05). Conclusões: O score PoPE (https://tinyurl.com/ybsnka8s) é um instrumento fácil com performance superior para prever mortalidade precoce em doentes admitidos com EP de baixo risco.

Keywords

• Embolia pulmonar
• Mortalidade
• Prognóstico
• Score de risco