Key result
The PESI-Echo score improved in-hospital mortality prediction in acute pulmonary embolism compared to the PESI score alone (AUC 0.82 vs 0.76; P=0.007).
Why the study?
Combining echocardiographic parameters with the PESI score could potentially improve mortality prediction in patients with acute pulmonary embolism.
Does the addition of echocardiographic parameters (TAPSE and PASP) to the PESI score improve the prediction of in-hospital mortality in patients with acute pulmonary embolism?
Observational (n=684)
Yes
Does the addition of echocardiographic parameters (TAPSE and PASP) to the PESI score improve the prediction of in-hospital mortality in patients with acute pulmonary embolism?
Effect estimate: AUC 0.82 (95% CI 0.77-0.86)
p-value: p=0.007
The addition of echocardiographic parameters (TAPSE and PASP) to the PESI score (PESI-Echo score) significantly improves the prediction of in-hospital mortality in patients with acute pulmonary embolism.
Supports addition of echocardiographic parameters to PESI for refined acute PE risk stratification; leaves open prospective validation before clinical use.
AIMS: Pulmonary embolism severity index (PESI) has been developed to help physicians make decisions about the treatment of patients with pulmonary embolism (PE). The combination of echocardiographic parameters could potentially improve PESI's mortality prediction. To assess the additional prognostic value of tricuspid annular plane systolic excursion (TAPSE) and pulmonary artery systolic pressure (PASP) when combined with the PESI score in patients with PE to predict short-term mortality. METHODS AND RESULTS: A multicentric prospective study database of patients admitted with PE in 75 academic centres in Argentina between 2016 and 2017 was analysed. Patients with an echocardiogram at admission with simultaneous measurement of TAPSE and PASP were included. PESI risk score was calculated blindly and prospectively, and in-hospital all-cause mortality was assessed. Of 684 patients, 91% had an echocardiogram, PASP and TAPSE could be estimated simultaneously in 355 (57%). All-cause in-hospital mortality was 11%. The receiver operating characteristic analysis showed an area under the curve (AUC) [95% confidence interval (CI)] of 0.76 (0.72-0.81), 0.74 (0.69-0.79), and 0.71 (0.62-0.79), for the PESI score, PASP, and TAPSE parameters, respectively. When PESI score was combined with the echocardiogram parameters (PESI + PASP-TAPSE = PESI-Echo), an AUC of 0.82 (0.77-0.86) was achieved (P = 0.007). A PESI-Echo score ≥128 was the optimal cut-off point for predicting hospital mortality: sensitivity 82% (95% CI 67-90%), specificity 69% (95% CI 64-74%). The global net reclassification improvement was 9.9%. CONCLUSIONS: PESI-Echo score is a novel tool for assessing mortality risk in patients with acute PE. The addition of echocardiographic parameters to a validated clinical score improved the prediction of hospital mortality.
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Burgos et al. (2020) conducted an observational in acute pulmonary embolism (n=684). PESI-Echo score vs. PESI score was evaluated on in-hospital all-cause mortality (AUC 0.82, 95% CI 0.77-0.86, p=0.007). The PESI-Echo score improved in-hospital mortality prediction in acute pulmonary embolism compared to the PESI score alone (AUC 0.82 vs 0.76; P=0.007).
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