Predicting Adverse Outcome in Patients with Acute Pulmonary Embolism: A Risk Score
Jacques Wicki (1) , Arnaud Perrier (1) , Thomas V. Perneger (2) , Henri Bounameaux (3) , Alain François Junod (1)
From the (1) Medical Clinic (1), (2) Quality of Care Unit and Institute of Social and Preventive Medicine, (3) Division of Angiology and Hemostasis, Geneva University Hospital, Geneva, Switzerland
Summary Reliable prediction of adverse outcomes in acute pulmonary embolismmay help choose between in-hospital and ambulatory treatment.We aimed to identify predictors of adverse events in patients with pulmonaryembolism and to generate a simple risk score for use in clinicalsettings. We prospectively followed 296 consecutive patients with pulmonaryembolism admitted through the emergency ward. Logistic regressionwas used to predict death, recurrent thromboembolic event, ormajor bleeding at 3 months. Thirty patients (10.1%) had one or moreadverse events during the 3-month follow-up period: 25 patients (8.4%)died, thromboembolic events recurred in 10 patients (3.4%), and majorbleeding occurred in 5 patients (1.7%). Factors associated with an adverseoutcome in multivariate analysis were cancer, heart failure, previousdeep vein thrombosis, systolic blood pressure <100 mmHg, arterialPaO 2 <8 kPa, and presence of deep vein thrombosis on ultrasound. Arisk score was calculated by adding 2 points for cancer and hypotension,and 1 point each for the other predictors. A score of 2 best identifiedpatients at risk of an adverse outcome in a receiver operating characteristiccurve analysis. Of 180 low-risk patients (67.2%) (score ≤2),only 4 experienced an adverse outcome (2.2%), compared to 23(26.1%) of 88 high-risk patients (score ≥3). A simple risk score basedon easily available variables can accurately identify patients with pulmonaryembolism at low risk of an adverse outcome. Such a score maybe useful for selecting patients with pulmonary embolism eligible foroutpatient care.