Key result
The PE-RPH score predicts 30-day pulmonary embolism deterioration with an AUC of ~0.82.
Why the study?
Prioritization of management in normotensive acute pulmonary embolism depends on identifying early deterioration risk, motivating the development and validation of a novel clinical-imaging prediction score.
Can the PE-RPH score predict deterioration risk in patients with normotensive acute pulmonary embolism?
Cohort (n=3,310)
Yes
Can the PE-RPH score predict deterioration risk in patients with normotensive acute pulmonary embolism?
Effect estimate: AUC 0.82, 0.82, and 0.80
The PE-RPH score, utilizing two CTPA parameters and heart rate, provides a validated tool to predict 30-day deterioration in patients with normotensive acute pulmonary embolism.
May aid risk stratification in normotensive PE; leaves open prospective validation before clinical adoption.
BACKGROUND: Prioritization of management strategies in patients with normotensive acute pulmonary embolism is based on the identification of individuals at risk for early deterioration. This study aims to develop and validate a novel score for deterioration prediction using clinical-imaging features. METHODS: This is multicenter, prospective observational cohort study (AOAPECT [Adverse Outcomes in Acute Pulmonary Embolism patients using Computed Tomography pulmonary angiography] cohort, NCT05098769). Registered-enrolled patients with normotensive acute pulmonary embolism were collected consecutively from 5 centers across China. Derivation set was established from 2 centers, while local and nonlocal external validation sets were derived from the remaining 3 centers. The end point was pulmonary embolism-related deterioration within 30 days after admission. Deterioration-related candidate predictors consisted of clinical, laboratory and computed tomography pulmonary angiography parameters were screened and then split into dichotomous values. The predictive score was conducted by a multivariable logistics regression and validated. Score performances were quantified using the area under the receiver operating characteristic curve. RESULTS: Of 3310 enrolled patients including 1 derivation (n=2061) and 2 validation sets (n=969 and 280), 272 patients (8.2%) experienced deterioration. In the derivation set, an increased risk of deterioration was observed with right to left ventricle diameter ratio ≥1.2, appearance of pulmonary vein sign on computed tomography pulmonary angiography, and heart rate ≥110 beats/min. When at least 2 out of 3 items were positive, patients were assigned to the high-risk deterioration group. This PE-RPH score revealed good discrimination to deterioration in derivation and validation sets (area under the receiver operating characteristic curve, 0.82, 0.82, and 0.80). CONCLUSIONS: This PE-RPH score incorporating 2 computed tomography pulmonary angiography parameters and heart rate may help predict the deterioration risk in patients with normotensive acute pulmonary embolism. REGISTRATION: https://clinicaltrials.gov; identifier: NCT05098769.
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Gao et al. (2025) conducted a cohort in normotensive acute pulmonary embolism (n=3,310). PE-RPH score was evaluated on pulmonary embolism-related deterioration within 30 days after admission (AUC 0.82, 0.82, and 0.80). The PE-RPH score, incorporating two computed tomography pulmonary angiography parameters and heart rate, demonstrated good discrimination for 30-day deterioration (AUC 0.80-0.82).
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