Background: The optimal strategy for identification of hemodynamically stable patients with acute pulmonary embolism (PE) at risk for death and clinical deterioration remains undefined. Objectives: We aimed to assess the performances of currently available models/scores for identifying hemodynamically stable patients with acute, symptomatic PE at risk of death and clinical deterioration. Methods: This was a prospective multicenter cohort study including patients with acute PE (NCT03631810). Primary study outcome was in-hospital death within 30 days or clinical deterioration. Other outcomes were in-hospital death, death, and PE-related death, all at 30 days. We calculated positive and negative predictive values, c-statistics of European Society of Cardiology (ESC)-2014, ESC-2019, Pulmonary Embolism Thrombolysis (PEITHO), Bova, Thrombo-embolism lactate outcome study (TELOS), fatty acid binding protein, syncope and tachicardia (FAST), and National Early Warning Scale 2 (NEWS2) for the study outcomes. Results: In 5036 hemodynamically stable patients with acute PE, positive predictive values for the evaluated models/scores were all below 10%, except for TELOS and NEWS2; negative predictive values were above 98% for all the models/scores, except for FAST and NEWS2. ESC-2014 and TELOS had good performances for in-hospital death or clinical deterioration (c-statistic of 0.700 and 0.722, respectively), in-hospital death (c-statistic of 0.713 and 0.723, respectively), and PE-related death (c-statistic of 0.712 and 0.777, respectively); PEITHO, Bova, and NEWS2 also had good performances for PE-related death (c-statistic of 0.738, 0.741, and 0.742, respectively). Conclusion: In hemodynamically stable patients with acute PE, the accuracy for identification of hemodynamically stable patients at risk for death and clinical deterioration varies across the available models/scores; TELOS seems to have the best performance. These data can inform management studies and clinical practice.
Identification of hemodynamically stable patients with acute pulmonary embolism at high risk for death: external validation of different models / Becattini, C.; Vedovati, M. C.; Colombo, S.; Vanni, S.; Abrignani, M. G.; Scardovi, A. B.; Marrazzo, A.; Borselli, M.; Barchetti, M.; Fabbri, A.; Dentali, F.; Maggioni, A. P.; Agnelli, G.; Gulizia, M. M.; Di Lenarda, A.; Enea, I.; Maggioni, A. P.; Pomero, F.; Ruggeri, M. P.; Lucci, D.; Duranti, M.; Guercini, F.; Groff, P.; Verso, M.; Fabbri, G.; Savoia, M.; Baldini, E.; Mecatti, B. B.; Bianchini, F.; Ceseri, M.; Gonzini, L.; Gorini, M.; Lorimer, A.; Orsini, G.; Tricoli, M.; Cimini, L. A.; Becattini, C.; Agnelli, G.; Cesarini, V.; Sanna, M.; Pepe, G.; Marchetti, C.; Roldan, M. O.; Lenzi, L.; Cozzio, S.; Tomio, P.; Diamanti, M.; Beltrame, A.; Glinski, L.; Treleani, M.; Coppa, A.; Vanni, S.; Bartalucci, P.; Taccone, A.; Costacurta, C.; Bortolotti, P.; Bortolussi, M.; De Vecchi, M.; Zanardi, F.; Greco, I.; Cosentini, R.; Gerloni, R.; Artusi, N.; Cominotto, F.; Sisto, U. G.; Picariello, C.; Roncon, L.; Maddalozzo, A.; Nitti, C.; Riccomi, F.; Buzzo, M.; Bassanelli, G.; Savonitto, S.; Bianchi, A.; Bilato, C.; Lobascio, I.; Dalla Valle, C.; Pomata, D. P.; Giostra, F.; Tinuper, A. L.; Zalunardo, B.; Visona, A.; Panzavolta, C.; Novelli, A.; Bertini, A.; Granai, C.; Colombo, S.; Periti, E.; Bonacchini, L.; Abrignani, M. G.; Casciolo, M. F.; D'Amato, A.; Scardovi, A. B.; Ricci, R.; Iosi, S.; Fontana, M. C.; Marrazzo, A.; Borselli, M.; Di Fusco, S. A.; Colivicchi, F.; Enea, I.; Triggiani, M.; Papa, I.; Pasini, G. F.; Fioravanti, C.; Panarello, S.; Raggi, F.; Marzolo, M.; Cuppini, S.; Milan, M.; Barchetti, M.; De Laura, D.; Caldarola, P.; Fiorini, R.; Rastelli, G.; Ameri, P.; La Malfa, G.; Cinelli, F.; Sganzerla, P. C.; Ubaldi, S.; Sanchez, F. A.; Forgione, C.; Cuccia, C.; Predieri, S.; Fusco, S.; Mumoli, N.; Porta, C.; Romei, M.; Lucidi, M.; Romaniello, A.; Volpe, M.; Mogni, P.; Pizzolato, E.; Martino, G. P.; Bitti, G.; Righini, G.; Bandiera, G.; Pennacchio, E.; Limauro, S.; Dachille, A.; Ignone, G.; Fuscaldo, G. F.; De Rosa, F. M.; Vazzana, N.; Chesi, G.; Di Filippo, F.; Pierpaoli, L.; Corapi, A.; Vatrano, M.; Angotti, C.; Baccetti, F.; Harari, S. A.; Luisi, F.; Daghini, E.; De Curtis, E.; Luca, F.; Ciancia, F.; Blandizzi, S.; Lettica, G. V.; D'Orazio, S.; Cosmi, F.; Zaccaroni, S.; Silingardi, M.; Valeriano, V.; Pugliese, F. R.; Murgia, A. P.; Parpaglia, P. P.; Martinelli, L.; Caponi, C.; Clemente, M. A.; Ciccarone, A.; Bongarzoni, A.; Garagiola, M.; Leone, M. C.; Veropalumbo, M. R.; Sacco, M.; Morella, P.; Dorigoni, S.; Peterlana, D.; Di Paola, R.; Felis, S.; Correale, M.; Brunetti, N. D.; Petrelli, G.; Feliziani, F. T.; Mastroiacovo, D.; Romualdi, R.; Pasin, F.; Bonardi, S.; Delfino, P.; Scifo, C.; Savioli, G.; Ceresa, I. F.; Galeotalanza, M.; Benazzi, B.; Porzio, M.; Rosini, F.; Ancona, C.; Verrelli, C.; Pasini, A. F.; Dalle Carbonare, L.; Bozza, N.; Nacci, F.; Scarabelli, M. A.; Amico, F.; Marchesi, C.; Mazzone, A.; Di Tommaso, R.; Cocco, F.; Pezzuto, G.; Luciani, A.; Zamboni, P.; Muriago, M.; Del Pesce, L.; Lucarini, A. R.; Guglielmelli, E.; Vannucchi, V.; Moroni, F.; Fichera, D.; Malatino, L.; Sgroi, C.; Morana, I. M.; Cicero, S.; La Rosa, D.; Mete, F.; Gino, M.; De Palma, A.; Alessandri, M.; Maestripieri, V.; Battocchio, M.; De Santis, M. T.; Saladini, F.; Corsi, D. C.; Macarone Palmieri, N.; Pierfranceschi, M. G.; Palmonari, V.; Fontanella, L.; Airoldi, L.; Bonocore, M.; Paliani, U.; Prat, L. I.; Chiecchi, L.; Cuonzo, M.; Paludo, A.; Padula, D.; Antonelli, A.; Bicchi, M.; Tota, G.; Ariello, M.; Sai, R.; Civita, M.; Tucci, M.; Barbati, G.; Conti, M.; Cettina, R.; Magnani, O.; Levato, M.; Gessi, V.; De Rui, M.; Bellizzi, A.; Farneti, L.; Salomone, P.; Mannarini, A.; Grifoni, E.; Del Ghianda, S.; Campodonico, J.; De Cesare, N.; Mutone, D.; Pasoli, P.; Meloni, S.; Frenda, A.; Viola, G.; Torromeo, C.; Campana, C.; Pistone, M. C.; Caravita, S.; La Creta, C. P.; Miscio, F.; Loreno, M.; Fenu, P.; Mazzetti, M.; Rossini, D.; Brunacci, M.; Capuano, A.; Tagliamonte, G.; Pinelli, M.; Ballocca, F.; Parca, G.; Pasini, S. M.; Maragno, M. G.; Vecchi, F.; Mancinelli, L.; Cavalli, A.; Di Mare, F.; Conficoni, E.; Miceli, R.; Pecoraro, R.; Fonti, C.; Pegoraro, S.; Piccinni, G. C.; Caruso, G.; Boriani, G.; Lanzillotta, P.; Piccolo, P.; Calo, L.; Stolfo, D.; Mangiacapra, S.; Marziali, A.; Volponi, M. C.; Querci, G.; Terribile, R.; Menabue, M.; Fiorentini, A.; Musci, R. L.; Uras, S.; Cicini, M. P.; Manetti, S.; Francese, G. M.; Melchio, R.; Scorpiglione, N.; Carrara, D.; Pani, A.; Morisco, C.; Rodolico, M.. - In: JOURNAL OF THROMBOSIS AND HAEMOSTASIS. - ISSN 1538-7933. - 22:9(2024), pp. 2502-2513. [10.1016/j.jtha.2024.04.025]
Identification of hemodynamically stable patients with acute pulmonary embolism at high risk for death: external validation of different models
Colombo S.;Marrazzo A.;Agnelli G.;Bianchini F.;Agnelli G.;Pepe G.;Lenzi L.;Tomio P.;Diamanti M.;Zanardi F.;Colombo S.;Marrazzo A.;La Malfa G.;Fusco S.;Bandiera G.;Harari S. A.;Luisi F.;Cosmi F.;Petrelli G.;Rosini F.;Scarabelli M. A.;Di Tommaso R.;Cocco F.;Pezzuto G.;Moroni F.;Sai R.;Meloni S.;Viola G.;Mazzetti M.;Rossini D.;Cavalli A.;Miceli R.;Boriani G.;Fiorentini A.;Uras S.;Manetti S.;
2024
Abstract
Background: The optimal strategy for identification of hemodynamically stable patients with acute pulmonary embolism (PE) at risk for death and clinical deterioration remains undefined. Objectives: We aimed to assess the performances of currently available models/scores for identifying hemodynamically stable patients with acute, symptomatic PE at risk of death and clinical deterioration. Methods: This was a prospective multicenter cohort study including patients with acute PE (NCT03631810). Primary study outcome was in-hospital death within 30 days or clinical deterioration. Other outcomes were in-hospital death, death, and PE-related death, all at 30 days. We calculated positive and negative predictive values, c-statistics of European Society of Cardiology (ESC)-2014, ESC-2019, Pulmonary Embolism Thrombolysis (PEITHO), Bova, Thrombo-embolism lactate outcome study (TELOS), fatty acid binding protein, syncope and tachicardia (FAST), and National Early Warning Scale 2 (NEWS2) for the study outcomes. Results: In 5036 hemodynamically stable patients with acute PE, positive predictive values for the evaluated models/scores were all below 10%, except for TELOS and NEWS2; negative predictive values were above 98% for all the models/scores, except for FAST and NEWS2. ESC-2014 and TELOS had good performances for in-hospital death or clinical deterioration (c-statistic of 0.700 and 0.722, respectively), in-hospital death (c-statistic of 0.713 and 0.723, respectively), and PE-related death (c-statistic of 0.712 and 0.777, respectively); PEITHO, Bova, and NEWS2 also had good performances for PE-related death (c-statistic of 0.738, 0.741, and 0.742, respectively). Conclusion: In hemodynamically stable patients with acute PE, the accuracy for identification of hemodynamically stable patients at risk for death and clinical deterioration varies across the available models/scores; TELOS seems to have the best performance. These data can inform management studies and clinical practice.
| File | Dimensione | Formato | |
|---|---|---|---|
|
1-s2.0-S1538783624003027-main.pdf
Open access
Tipologia:
Versione pubblicata dall'editore
Dimensione
1.02 MB
Formato
Adobe PDF
|
1.02 MB | Adobe PDF | Visualizza/Apri |
Pubblicazioni consigliate
I metadati presenti in IRIS UNIMORE sono rilasciati con licenza Creative Commons CC0 1.0 Universal, mentre i file delle pubblicazioni sono rilasciati con licenza Attribuzione 4.0 Internazionale (CC BY 4.0), salvo diversa indicazione.
In caso di violazione di copyright, contattare Supporto Iris
