Key result
Peripheral PE is linked to ~2-fold higher 30-day mortality compared to central PE.
Why the study?
Clot burden has not consistently correlated with pulmonary embolism outcomes, but proximal PE is perceived as more severe; the study explored whether the MBPEC score predicts mortality and adverse outcomes.
Does clot burden as assessed by the MBPEC score predict 30-day mortality in patients with acute pulmonary embolism?
Cohort (n=1,743)
No
Does clot burden as assessed by the MBPEC score predict 30-day mortality in patients with acute pulmonary embolism?
Hazard Ratio: 2.02 (95% CI 1.09–3.72)
Absolute Event Rate: 6.4% vs 3.2%
Peripheral pulmonary embolism does not necessarily entail a lower short-term mortality risk than central pulmonary embolism, challenging the clinical assumption that proximal clot burden alone indicates a worse prognosis.
Peripheral PE may not confer lower mortality risk than central; leaves open MBPEC score's prognostic value pending validation.
Background Rapid diagnosis and risk stratification are important to reduce the risk of adverse clinical events and mortality in acute pulmonary embolism (PE). Although clot burden has not been consistently shown to correlate with disease outcomes, proximally located PE is generally perceived as more severe. Purpose To explore the ability of the Mean Bilateral Proximal Extension of the Clot (MBPEC) score to predict mortality and adverse outcome. Methods This was a single center retrospective cohort study. 1743 patients with computed tomography pulmonary arteriography (CTPA) verified PE diagnosed between 2005 and 2020 were included. Patients with active malignancy were excluded. The PE clot burden was assessed with MBPEC score: The most proximal extension of PE was scored in each lung from 1 = sub-segmental to 4 = central. The MBPEC score is the score from each lung divided by two and rounded up to nearest integer. Results We found inconsistent associations between higher and lower MBPEC scores versus mortality. The all-cause 30-day mortality of 3.9% (95% CI: 3.0–4.9). The PE-related mortality was 2.4% (95% CI: 1.7–3.3). Patients with MBPEC score 1 had higher all-cause mortality compared to patients with MBPEC score 4: Crude Hazard Ratio (cHR) was 2.02 (95% CI: 1.09–3.72). PE-related mortality was lower in patients with MBPEC score 3 compared to score 4: cHR 0.22 (95% CI: 0.05–0.93). Patients with MBPEC score 4 did more often receive systemic thrombolysis compared to patients with MBPEC score 1–3: 3.2% vs. 0.6% ( p < .001). Patients with MBPEC score 4 where more often admitted to the intensive care unit: 13% vs. 4.7% ( p < .001). Conclusion We found no consistent association between the MBPEC score and mortality. Our results therefore indicate that peripheral PE does not necessarily entail a lower morality risk than proximal PE.
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Gleditsch et al. (2023) conducted a cohort in Acute pulmonary embolism (PE) (n=1,743). Mean Bilateral Proximal Extension of the Clot (MBPEC) score 1 (peripheral PE) vs. MBPEC score 4 (central PE) was evaluated on All-cause 30-day mortality (cHR 2.02, 95% CI 1.09–3.72). MBPEC score 1 (peripheral PE) was associated with higher all-cause mortality compared to MBPEC score 4 (central PE) (cHR 2.02), indicating that peripheral clot burden does not necessarily entail lower mortality risk.
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