Blood Coagulation, Fibrinolysis and Cellular Haemostasis
Schattauer GmbH
A comparison of the original and simplified Pulmonary Embolism Severity Index
Carmen Venetz
1
Division of General Internal Medicine, Bern University Hospital, Bern, Switzerland
,
David Jiménez
2
Respiratory Department, Ramón y Cajal Hospital, Madrid, Spain
,
Marie Méan
1
Division of General Internal Medicine, Bern University Hospital, Bern, Switzerland
,
Drahomir Aujesky
1
Division of General Internal Medicine, Bern University Hospital, Bern, Switzerland
› Author AffiliationsFinancial support: This study was partially supported by grant 1 R21 HL075521–01A1 from the National Heart, Lung, and Blood Institute, and by grant 33CSCO-122659 from the Swiss National Science Foundation.
The Pulmonary Embolism Severity Index (PESI) is a validated clinical prognostic model for patients with pulmonary embolism (PE). Recently, a simplified version of the PESI was developed. We sought to compare the prognostic performance of the original and simplified PESI. Using data from 15,531 patients with PE, we compared the proportions of patients classified as low versus higher risk between the original and simplified PESI and estimated 30-day mortality within each risk group. To assess the models’ accuracy to predict mortality, we calculated sensitivity, specificity, and predictive values and likelihood ratios for low-versus higher-risk patients. We also compared the models’ discriminative power by calculating the area under the receiver-operating characteristic curve. The overall 30-day mortality was 9.3%. The original PESI classified a significantly greater proportion of patients as low-risk than the simplified PESI (40.9% vs. 36.8%; p<0.001). Low-risk patients based on the original and simplified PESI had a mortality of 2.3% and 2.7%, respectively. The original and simplified PESI had similar sensitivities (90% vs. 89%), negative predictive values (98% vs. 97%), and negative likelihood ratios (0.23 vs. 0.28) for predicting mortality. The original PESI had a significantly greater discriminatory power than the simplified PESI (area under the ROC curve 0.78 [95% CI: 0.77–0.79] vs. 0.72 [95% CI: 0.71–0.74]; p<0.001). In conclusion, even though the simplified PESI accurately identified patients at low-risk of adverse outcomes, the original PESI classified a higher proportion of patients as low-risk and had a greater discriminatory power than the simplified PESI.
Institution where the work was carried out: Division of General Internal Medicine, Bern University Hospital, Bern, Switzerland.
Keywords
Pulmonary Embolism Severity Index -
prognosis
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