Prognostic value of a previous medical or surgical admission in outpatients with symptomatic pulmonary embolism.

Objective: To determine whether an earlier medical (MA) or surgical (SA) admission in the previous three months is a factor associated with mortality at 30 days in outpatients with acute symptomatic pulmonary embolism.
Method: Observational, retrospective cohort study on adult patients diagnosed with acute symptomatic pulmonary embolism in a tertiary hospital over a period of 6 years.
Results: The study included 870 patients with a mean age of 72.7 years: 10.6% (92) had a prior MA, 4.9% (43) had a SA and 12.9% (112) died within the first 30 days. The MA group showed a higher frequency of simplified Pulmonary Embolism Severity Index (PESI) of high risk (≥1) (MA 90.2% vs SA 65.1% vs no prior admission 67.0%; p<0.001) and mortality at 30 days (MA 20.7% vs SA 7.0% vs no prior admission 12.9%; p=0.038). The logistic regression analysis demonstrated that a simplified PESI≥1 was the only independent risk factor for mortality at 30 days.
Conclusions: The severity of the acute episode, as assessed by the simplified PESI scale, is independently associated with mortality at 30 days in outpatients with acute symptomatic pulmonary embolism. An earlier MA in the previous 3 months usually involves greater severity in the acute episode.
(Copyright © 2015 Elsevier España, S.L.U. y Sociedad Española de Medicina Interna (SEMI). All rights reserved.)