Identification of Low-Risk Patients with Acute Symptomatic Pulmonary Embolism for Outpatient Therapy.
Ann Am Thorac Soc. 2015 Jun 26;
Authors: Maestre A, Trujillo-Santos J, Riera-Mestre A, Jiménez D, Di Micco P, Bascuñana J, Vela JR, Peris L, Malfante PC, Monreal M, RIETE Investigators
Abstract
Background Patients with acute symptomatic pulmonary embolism (PE) deemed low risk for early complications might be candidates for partial or complete outpatient treatment.
OBJECTIVE: To develop and validate a clinical prediction rule that accurately identifies patients with PE and low-risk of short-term complications, and to compare its prognostic ability with two previously validated models (i.e., Pulmonary Embolism Severity Index [PESI], simplified PESI) Design, Setting and Participants: Multivariable logistic regression of a large international cohort of PE patients prospectively enrolled in the RIETE registry. Main Outcomes and Measures: All-cause mortality, recurrent PE and major bleeding up to 10 days after PE diagnosis.
RESULTS: Of 18,707 eligible patients that had acute symptomatic PE, 46 (0.25%) developed recurrent PE, 203 (1.09%) bled and 471 (2.51%) died. Predictors included in the final model were: chronic heart failure, recent immobilization, recent major bleeding, cancer, hypotension, tachycardia, hypoxemia, renal insufficiency, and abnormal platelet count. The area under ROC curve was: 0.77, 95% CI: 0.75-0.78 for the RIETE score; 0.72, 95% CI: 0.70-0.73 for PESI (p <0.05) and 0.71, 95% CI: 0.69-0.73 for sPESI (p <0.05). Our RIETE score outperformed the prognostic value of PESI in terms of net reclassification improvement [NRI], <0.001 and integrated discrimination improvement [IDI], <0.001) and sPESI (NRI, <0.001; IDI, <0.001).
CONCLUSIONS: We built a new score, based on widely available variables that can be used to identify PE patients at low-risk of short-term complications, assisting in triage and potentially shortening duration of hospital stay.
PMID: 26114586 [PubMed - as supplied by publisher]