1. Refinement of a modified simplified Pulmonary Embolism Severity Index for elderly patients with acute pulmonary embolism.
- Author
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Morillo, Raquel, Jiménez, David, Bikdeli, Behnood, Rodríguez, Carmen, Tenes, Andrés, Yamashita, Yugo, Morimoto, Takeshi, Kimura, Takeshi, Vidal, Gemma, Ruiz-Giménez, Nuria, Espitia, Olivier, and Monreal, Manuel
- Subjects
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OLDER patients , *PULMONARY embolism , *VENOUS thrombosis , *LOGISTIC regression analysis , *MORTALITY - Abstract
To evaluate the utility of a modified (i.e., without the variable "Age >80 years") simplified Pulmonary Embolism Severity Index (sPESI) in elderly patients with acute symptomatic pulmonary embolism (PE), and to derive and validate a refined version of the sPESI for identification of elderly patients at low risk of adverse events. The study included normotensive patients aged >80 years with acute PE enrolled in the RIETE registry. We used multivariable logistic regression analysis to create a new risk score to predict 30-day all-cause mortality. We externally validated the new risk score in elderly patients from the COMMAND VTE registry. Multivariable logistic regression identified four predictors for mortality: high-risk sPESI, immobilization, coexisting deep vein thrombosis (DVT), and plasma creatinine >2 mg/dL. In the RIETE derivation cohort, the new model classified fewer patients as low risk (4.0% [401/10,106]) compared to the modified sPESI (35% [3522/10,106]). Low-risk patients based on the new model had a lower 30-day mortality than those based on the modified sPESI (1.2% [95% CI, 0.4–2.9%] versus 4.7% [95% CI, 4.0–5.4%]). In the COMMAND VTE validation cohort, 1.5% (3/206) of patients were classified as having low risk of death according to the new model, and the overall 30-day mortality of this group was 0% (95% CI, 0–71%), compared to 5.9% (95% CI, 3.1–10.1%) in the high-risk group. For predicting short-term mortality among elderly patients with acute PE, this study suggests that the new model has a substantially higher sensitivity than the modified sPESI. A minority of these patients might benefit from safe outpatient therapy of their disease. • A modified sPESI was not accurate for identifying elderly patients with PE at low-risk for short-term mortality. • We derived a refined version of the modified sPESI to identify low-risk PE within this subgroup of patients. • The new score successfully predicted mortality, but identified a minority of the patients at low-risk. • The new model may not generalize to all settings, and future studies may further address its external validity. [ABSTRACT FROM AUTHOR]
- Published
- 2021
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