PESI Score for Predicting Clinical Outcomes in Pulmonary Embolism
Patients with Right Ventricular Involvement
Abstract
Background: Pulmonary embolism (PE) patients with right ventricular (RV)
involvement are a heterogenous group who mandate further risk
stratification. Our objective was to evaluate the efficacy of the PE
severity index (PESI) for predicting adverse clinical outcomes among PE
patients with RV involvement. Methods and Results: Consecutive
normotensive PE patients with RV involvement were allocated according to
admission PESI score (PESI <4 vs. PESI ≥4). The primary
outcome included hemodynamic instability and in-hospital mortality.
Secondary outcomes included each component of the primary outcome as
well as mechanical ventilation, thrombolytic therapy, acute kidney
injury, and major bleeding. Multivariable logistic regression model was
performed to assess the independent association between the PESI score
and primary outcome. C-Statistic was used to compare the PESI with the
BOVA score. A total of 253 patients were evaluated: 95 (38%) with a
PESI of ≥4. Of them, 82 (32%) patients were classified as
intermediate-low risk and 171 (68%) as intermediate-high risk. Fifty
(20%) patients had at least 1 adverse event. Multivariate analysis
demonstrated the PESI to be an independent predictor for the primary
outcome (HR 4.81, CI 95%, 1.15-20.09, P=0.031), which was increased
with a concomitant increase of the PESI score (PESI 1:4.2%, PESI 2:
3.4%, PESI 3:12%, PESI 4: 16.3%, PESI 5:23.1%, P for trend
<0.001). C-Statistic analysis for the PESI score yielded an
AUC-0.746 (0.637-0.854), P=0.001, compared to the BOVA score: AUC-0.679
(0.584-0.775), P=0.011. Conclusion: PESI score was found to predict
adverse outcomes among normotensive PE patients with RV involvement.