Key result
CPES score outperforms other risk scores in predicting adverse events in intermediate-risk PE.
Why the study?
Guidelines recommend further risk stratification in intermediate-risk PE, but head-to-head comparisons of different risk stratification tools are lacking.
Does the CPES score improve prediction of adverse clinical events compared to other risk scores in patients with intermediate-risk pulmonary embolism?
Cohort (n=192)
Does the CPES score improve prediction of adverse clinical events compared to other risk scores in patients with intermediate-risk pulmonary embolism?
The CPES score outperforms other commonly used risk stratification tools (Bova, sPESI, NEWS, ESC) in predicting in-hospital morbidity and mortality for intermediate-risk PE patients.
Answers are grounded in this paper and cite their sources.
May aid risk stratification in intermediate-risk PE; leaves open prospective validation before adoption.
BACKGROUND: In patients with intermediate-risk pulmonary embolism (PE), guidelines recommend further risk stratification (Class 1 indication). However, head-to-head comparison of different risk stratification tools are lacking. Our objective was to compare the performance of 4 scores in predicting adverse clinical events in intermediate-risk PE. METHODS: This was a retrospective study of 192 intermediate-risk PE patients spanning October 2016 to July 2019. Receiver operator characteristic curves were used to compare the predictive performance of the composite PE shock (CPES) score, Bova, simplified PE shock index (sPESI), National Early Warning Score (NEWS) and ESC intermediate-risk subcategory types for the primary outcome, which was a composite of PE-related in-hospital mortality, resuscitated cardiac arrest, or hemodynamic decompensation and its individual components. RESULTS: A total of 28 patients (14.6%) experienced the primary composite outcome. CPES demonstrated the highest discriminatory power for predicting the primary composite outcome (AUC: 0.74; 95% CI: 0.66-0.83) as well as its individual components compared to the other risk scores (p = 0.008). The AUCs for the other scores were as follows: Bova, 0.66 (95% CI: 0.56-0.76); sPESI, 0.67 (95% CI: 0.57-0.77); NEWS, 0.71 (95% CI: 0.63-0.82) and ESC intermediate-risk subcategory, AUC of 0.59 (95% CI: 0.51-0.68). The ESC intermediate-risk subcategory exhibited the lowest performance for the primary composite outcome and across all individual components. CONCLUSION: CPES score outperformed other commonly used risk stratification tools for PE-related morbidity and mortality in intermediate-risk PE patients. The findings support the integration of CPES into clinical practice to enhance patient selection for escalated care and timely interventions.
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Zhang et al. (2025) conducted a cohort in Intermediate-risk pulmonary embolism (n=192). Composite PE shock (CPES) score vs. Bova, simplified PE shock index (sPESI), National Early Warning Score (NEWS), and ESC intermediate-risk subcategory was evaluated on Composite of PE-related in-hospital mortality, resuscitated cardiac arrest, or hemodynamic decompensation (AUC 0.74, 95% CI 0.66-0.83, p=0.008). The composite PE shock (CPES) score outperformed other risk scores in predicting adverse clinical events in intermediate-risk pulmonary embolism (AUC 0.74; 95% CI 0.66-0.83; p=0.008).
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