Download PDF
CC BY 4.0 · TH Open 2018; 02(03): e265-e271
DOI: 10.1055/s-0038-1669427
Original Article
Georg Thieme Verlag KG Stuttgart · New York

Validation of the Predictive Model of the European Society of Cardiology for Early Mortality in Acute Pulmonary Embolism

Massimo Cugno
1   Division of Internal Medicine, Department of Pathophysiology and Transplantation, Università degli Studi di Milano, Milan, Italy
2   Angelo Bianchi Bonomi Hemophilia and Thrombosis Center, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
,
Federica Depetri
1   Division of Internal Medicine, Department of Pathophysiology and Transplantation, Università degli Studi di Milano, Milan, Italy
,
Laura Gnocchi
1   Division of Internal Medicine, Department of Pathophysiology and Transplantation, Università degli Studi di Milano, Milan, Italy
,
Fernando Porro
3   Emergency Medicine Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
,
Paolo Bucciarelli
2   Angelo Bianchi Bonomi Hemophilia and Thrombosis Center, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
› Author Affiliations Funding This work was supported by “Ricerca corrente,” Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, Milano, Italy. The funder had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.
Further Information

Publication History

10 January 2018

16 July 2018

Publication Date:
06 September 2018 (online)

Also available at
   Permissions and Reprints

Abstract

Background Acute pulmonary embolism (PE) is burdened by high mortality, especially within 30 days from the diagnosis. The development and the validation of predictive models for the risk of early mortality allow to differentiate patients who can undergo home treatment from those who need admission into intensive care units.

Methods To validate the prognostic model for early mortality after PE diagnosis proposed by the European Society of Cardiology (ESC) in 2014, we analyzed data of a cohort of 272 consecutive patients with acute PE, observed in our hospital during a 10-year period. Moreover, we evaluated the additional contribution of D-dimer, measured at PE diagnosis, in improving the prognostic ability of the model. All cases of PE were objectively diagnosed by angiography chest CT scan or perfusion lung scan.

Results The overall mortality rate within 30 days from PE diagnosis was 10% (95% confidence interval [CI]: 6.4–13.5%). According to the ESC prognostic model, the risk of death increased 3.23 times in the intermediate-low-risk category, 5.55 times in the intermediate-high-risk category, and 23.78 times in the high-risk category, as compared with the low-risk category. The receiver operating characteristic analysis showed a good discriminatory power of the model (area under the curve [AUC] = 0.77 [95% CI: 0.67–0.87]), which further increased when D-dimer was added (AUC = 0.85 [95% CI: 0.73–0.96]).

Conclusion This study represents a good validation of the ESC predictive model whose performance can be further improved by adding D-dimer plasma levels measured at PE diagnosis.

Keywords

pulmonary embolism - mortality predictive model - D-dimer

Authors' Contributions

M.C. and P.B. designed the study. F.P., F.D., and L.G. collected the data. M.C. and F.P. organized and evaluated the data. P.B. performed the statistical analysis and all the authors contributed in the interpretation of the results. M.C. drafted the manuscript; P.B., F.D., and L.G. contributed in writing. All the authors critically reviewed the manuscript and approved the final version for submission.


 

  • References

  • 1 Righini M, Gal GL, Bounameaux H. Approach to suspected acute pulmonary embolism: should we use scoring systems?. Semin Respir Crit Care Med 2017; 38 (01) 3-10
    Thieme ConnectPubMedSearch in Google Scholar
  • 2 Serhal M, Haddadin IS, Heresi GA, Hornacek DA, Shishehbor MH, Bartholomew JR. Pulmonary embolism response teams. J Thromb Thrombolysis 2017; 44 (01) 19-29
    CrossrefPubMedSearch in Google Scholar
  • 3 Barco S, Konstantinides SV. Risk-adapted management of pulmonary embolism. Thromb Res 2017; 151 (Suppl. 01) S92-S96
    CrossrefPubMedSearch in Google Scholar
  • 4 Vinson DR, Ballard DW, Mark DG. , et al; MAPLE Investigators of the KP CREST Network. Risk stratifying emergency department patients with acute pulmonary embolism: does the simplified Pulmonary Embolism Severity Index perform as well as the original?. Thromb Res 2016; 148: 1-8
    CrossrefPubMedSearch in Google Scholar
  • 5 Agnelli G, Becattini C. Acute pulmonary embolism. N Engl J Med 2010; 363 (03) 266-274
    CrossrefPubMedSearch in Google Scholar
  • 6 Righini M, Le Gal G, Aujesky D. , et al. Diagnosis of pulmonary embolism by multidetector CT alone or combined with venous ultrasonography of the leg: a randomised non-inferiority trial. Lancet 2008; 371 (9621): 1343-1352
    CrossrefPubMedSearch in Google Scholar
  • 7 Konstantinides SV, Torbicki A, Agnelli G. , et al; Task Force for the Diagnosis and Management of Acute Pulmonary Embolism of the European Society of Cardiology (ESC). 2014 ESC guidelines on the diagnosis and management of acute pulmonary embolism. Eur Heart J 2014; 35 (43) 3033-3069 , 3069a–3069k
    CrossrefPubMedSearch in Google Scholar
  • 8 Becattini C, Agnelli G, Lankeit M. , et al. Acute pulmonary embolism: mortality prediction by the 2014 European Society of Cardiology risk stratification model. Eur Respir J 2016; 48 (03) 780-786
    CrossrefPubMedSearch in Google Scholar
  • 9 Masotti L, Panigada G, Landini G. , et al; TUSCAN-PE Investigators. Predictive ability of the new 2014 ESC prognostic model in acute pulmonary embolism. Int J Cardiol 2016; 202: 801-803
    CrossrefPubMedSearch in Google Scholar
  • 10 Tamizifar B, Fereyduni F, Esfahani MA, Kheyri S. Comparing three clinical prediction rules for primarily predicting the 30-day mortality of patients with pulmonary embolism: The “Simplified Revised Geneva Score,” the “Original PESI,” and the “Simplified PESI”. Adv Biomed Res 2016; 5: 137
    CrossrefPubMedSearch in Google Scholar
  • 11 Elias A, Mallett S, Daoud-Elias M, Poggi JN, Clarke M. Prognostic models in acute pulmonary embolism: a systematic review and meta-analysis. BMJ Open 2016; 6 (04) e010324
    CrossrefPubMedSearch in Google Scholar
  • 12 Stein PD, Hull RD, Patel KC. , et al. D-dimer for the exclusion of acute venous thrombosis and pulmonary embolism: a systematic review. Ann Intern Med 2004; 140 (08) 589-602
    PubMedSearch in Google Scholar
  • 13 Palareti G, Cosmi B, Legnani C. , et al; DULCIS (D-dimer and ULtrasonography in Combination Italian Study) Investigators. D-dimer to guide the duration of anticoagulation in patients with venous thromboembolism: a management study. Blood 2014; 124 (02) 196-203
    CrossrefPubMedSearch in Google Scholar
  • 14 Aujesky D, Roy PM, Guy M, Cornuz J, Sanchez O, Perrier A. Prognostic value of D-dimer in patients with pulmonary embolism. Thromb Haemost 2006; 96 (04) 478-482
    Thieme ConnectPubMedSearch in Google Scholar
  • 15 Grau E, Tenías JM, Soto MJ. , et al; RIETE Investigators. D-dimer levels correlate with mortality in patients with acute pulmonary embolism: Findings from the RIETE registry. Crit Care Med 2007; 35 (08) 1937-1941
    CrossrefPubMedSearch in Google Scholar
  • 16 Polo Friz H, Buzzini C, Orenti A. , et al. Prognostic value of D-dimer in elderly patients with Pulmonary Embolism. J Thromb Thrombolysis 2016; 42 (03) 386-392
    CrossrefPubMedSearch in Google Scholar
  • 17 Huang CM, Lin YC, Lin YJ. , et al. Risk stratification and clinical outcomes in patients with acute pulmonary embolism. Clin Biochem 2011; 44 (13) 1110-1115
    CrossrefPubMedSearch in Google Scholar
  • 18 Tagalakis V, Patenaude V, Kahn SR, Suissa S. Incidence of and mortality from venous thromboembolism in a real-world population: the Q-VTE Study Cohort. Am J Med 2013; 126 (09) 832.e13-832.e21
    CrossrefPubMedSearch in Google Scholar
  • 19 Zuin M, Rigatelli G, Picariello C, Carraro M, Zonzin P, Roncon L. Prognostic role of a new risk index for the prediction of 30-day cardiovascular mortality in patients with acute pulmonary embolism: the Age-Mean Arterial Pressure Index (AMAPI). Heart Vessels 2017; 32 (12) 1478-1487
    CrossrefPubMedSearch in Google Scholar
  • 20 Subramanian M, Gopalan S, Ramadurai S. , et al. Derivation and validation of a novel prediction model to identify low-risk patients with acute pulmonary embolism. Am J Cardiol 2017; 120 (04) 676-681
    CrossrefPubMedSearch in Google Scholar
  • 21 Geibel A, Zehender M, Kasper W, Olschewski M, Klima C, Konstantinides SV. Prognostic value of the ECG on admission in patients with acute major pulmonary embolism. Eur Respir J 2005; 25 (05) 843-848
    CrossrefPubMedSearch in Google Scholar
  • 22 Agrawal N, Ramegowda RT, Patra S. , et al. Predictors of inhospital prognosis in acute pulmonary embolism: keeping it simple and effective!. Blood Coagul Fibrinolysis 2014; 25 (05) 492-500
    CrossrefPubMedSearch in Google Scholar
  • 23 Qaddoura A, Digby GC, Kabali C, Kukla P, Zhan ZQ, Baranchuk AM. The value of electrocardiography in prognosticating clinical deterioration and mortality in acute pulmonary embolism: a systematic review and meta-analysis. Clin Cardiol 2017; 40 (10) 814-824
    CrossrefPubMedSearch in Google Scholar
  • 24 Smith SB, Geske JB, Maguire JM, Zane NA, Carter RE, Morgenthaler TI. Early anticoagulation is associated with reduced mortality for acute pulmonary embolism. Chest 2010; 137 (06) 1382-1390
    CrossrefPubMedSearch in Google Scholar
  • 25 Dahhan T, Siddiqui I, Tapson VF. , et al. Clinical and echocardiographic predictors of mortality in acute pulmonary embolism. Cardiovasc Ultrasound 2016; 14 (01) 44
    CrossrefPubMedSearch in Google Scholar