A protocol identifying patients with intermediate-high risk pulmonary embolism, a NEWS score > 4, and ≥ 2 risk factors effectively discriminated those needing advanced therapies or dying (AUC 0.85).
Cohort (n=114)
No
Does the presence of ≥ 2 specific risk factors in intermediate-high risk pulmonary embolism patients with a NEWS score > 4 predict the need for advanced therapies or death?
A protocol using a NEWS score > 4 and ≥ 2 specific risk factors effectively discriminates intermediate-high risk pulmonary embolism patients who will require advanced therapies or die (AUC 0.85).
Estimación del efecto: AUC 0.85
Abstract Objective The objective of this study is to verify, in a retrospective cohort of patients with moderate-to-high-risk pulmonary embolism (PTE), the ability of the criteria proposed in our center's protocol to identify patients at risk to require advanced therapies (vasoactive drugs, intubation, ECMO, or fibrinolysis) and/or have died. Methods This is a retrospective observational registry of patients with intermediate-high risk PET between 2019-2025. Applying the criteria proposed in our center's protocol, patients with a NEWS score 4 were selected and evaluated for the presence of risk factors (tachycardia, hypotension, desaturation, lactate ≥ 2 mmol/L, shock index 0.9, syncope, heart failure, renal failure, or neoplasia). Those with ≥ 2 risk factors would be candidates for advanced therapies including catheter-directed therapy. We evaluated whether there were differences between patients with two or more risk factors and those without. Results Between January 2019 and March 2025, 114 patients diagnosed with intermediate-high risk PTE were admitted. Of these patients, a total of 80 had a NEWS score 4. Within this group, they were divided into those with 2 or more risk factors (n=67) and those without (n=13). Patients with the proposed risk factors had a significantly greater need for amines, a higher intubation rate, and received fibrinolysis more frequently. Regarding other complications (ECMO, cardiac arrest, or death), there were no significant differences, probably due to a lack of statistical power. We then performed a regression analysis with these risk factors, using a combination of mortality and need for advanced therapies as the dependent variable. We also performed a ROC curve, which yielded an area under the curve of 0.85, indicating that the model performed well in discriminating between patients at higher risk. Conclusion The criteria proposed in our center's protocol appear to be useful for differentiating patients with poorer clinical outcomes who may be candidates for catheter-directed therapies. However, the limitations of a retrospective study must be taken into account, as well as the fact that some events were rare, which limits the statistical power.
Sarria et al. (Fri,) conducted a cohort in moderate-to-high-risk pulmonary embolism (n=114). Presence of ≥ 2 risk factors vs. Presence of < 2 risk factors was evaluated on Combination of mortality and need for advanced therapies (vasoactive drugs, intubation, ECMO, or fibrinolysis) (AUC 0.85). A protocol identifying patients with intermediate-high risk pulmonary embolism, a NEWS score > 4, and ≥ 2 risk factors effectively discriminated those needing advanced therapies or dying (AUC 0.85).