Key result
For predicting 7- and 30-day mortality in acute pulmonary embolism, the PEMS score demonstrated the highest specificity (93.4% and 94.2%), while the ESC 2019 score showed the highest sensitivity (96.8% and 95.3%).
Why the study?
Most combined clinical-radiological scores for risk stratification in acute pulmonary embolism have not been validated in independent cohorts.
Do combined clinical-radiological scores accurately predict 7- and 30-day mortality in patients with acute pulmonary embolism?
Observational (n=531)
No
Do combined clinical-radiological scores accurately predict 7- and 30-day mortality in patients with acute pulmonary embolism?
Clinical-radiological scores, particularly PEMS and ESC 2019, provide high negative predictive value for short-term mortality in acute pulmonary embolism, aiding in risk stratification.
Answers are grounded in this paper and cite their sources.
Should not yet change acute PE risk stratification; leaves open prospective validation of PEMS versus ESC 2019.
Introduction Acute pulmonary embolism (APE) is a hazardous disorder with a high mortality. Combination of clinical, radiological, and serological parameters can improve risk stratification of APE. Most of the proposed combined scores were not validated in independent cohorts. Our aim was to validate the proposed clinical-radiological scores for prognosis of 7- and 30-day mortality in APE. Materials and methods Our sample comprised 531 patients with APE, mean age 64.8 ± 15.6 years, 221 (41.6%) females and 310 (58.4%) males. The following parameters were collected: Age and sex of the patients, mortality within the observation time of 30 days, simplified pulmonary embolism severity index (sPESI), pH troponin level (pg/ml), minimal systolic and diastolic blood pressures (mmHg), heart rate, O2 saturation, episodes of syncope, and need for vasopressors. On CT pulmonary angiography (CTPA), short axis ratio right ventricle/left ventricle (RV/LV), and reflux of contrast medium into the inferior vena cava were obtained. The following clinical-radiological scores were calculated: BOVA score, pulmonary embolism mortality score (PEMS), European Society of Cardiology (ESC) score, Kumamaru score, and Calgary acute pulmonary embolism (CAPE) score. Results Overall, 31 patients (5.8%) died within seven and 64 patients (12%) within 30 days. All scores showed high negative prognostic values ranging from 89.0 to 99.0%. PEMS and CAPE score demonstrated the highest specificity for 7-day mortality (93.4% and 85.0%), PEMS and BOVA for 30-day mortality (94.2% and 90.4%). The highest sensitivity was observed for ESC 2019 (96.8% and 95.3%). Kumamaru and CAPE scores had low sensitivity. All scores had low positive and high negative predictive values. Conclusion For prognosis of 7- and 30-day mortality in APE, PEMS score has the highest specificity. ESC 2019 shows the highest sensitivity. All scores had low positive and high negative predictive values.
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Surov et al. (2023) conducted an observational in Acute pulmonary embolism (n=531). Clinical-radiological prognostic scores (PEMS, ESC 2019, BOVA, Kumamaru, CAPE, sPESI) was evaluated on 7- and 30-day mortality. For predicting 7- and 30-day mortality in acute pulmonary embolism, the PEMS score demonstrated the highest specificity (93.4% and 94.2%), while the ESC 2019 score showed the highest sensitivity (96.8% and 95.3%).
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