Summary
Reliable prediction of adverse outcomes in acute pulmonary embolism may help choose
between in-hospital and ambulatory treatment. We aimed to identify predictors of adverse
events in patients with pulmonary embolism and to generate a simple risk score for
use in clinical settings. We prospectively followed 296 consecutive patients with
pulmonary embolism admitted through the emergency ward. Logistic regression was used
to predict death, recurrent thromboembolic event, or major bleeding at 3 months. Thirty
patients (10.1%) had one or more adverse events during the 3-month follow-up period:
25 patients (8.4%) died, thromboembolic events recurred in 10 patients (3.4%), and
major bleeding occurred in 5 patients (1.7%). Factors associated with an adverse outcome
in multivariate analysis were cancer, heart failure, previous deep vein thrombosis,
systolic blood pressure <100 mmHg, arterial PaO2 <8 kPa, and presence of deep vein thrombosis on ultrasound. A risk score was calculated
by adding 2 points for cancer and hypotension, and 1 point each for the other predictors.
A score of 2 best identified patients at risk of an adverse outcome in a receiver
operating characteristic curve 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 based on easily available variables can accurately
identify patients with pulmonary embolism at low risk of an adverse outcome. Such
a score may be useful for selecting patients with pulmonary embolism eligible for
outpatient care.
Keywords
Pulmonary embolism - prediction rule - risk
