Comparison of seven prognostic tools to identify low-risk pulmonary embolism in patients aged <50 years
Por:
Jara-Palomares L, Alfonso M, Maestre A, Jimenez D, Garcia-Bragado F, Font C, Reyes R, Blasco L, Vidal G, Otero R, Monreal M, Adarraga M, Aibar M, Aibar J, Amado C, Arcelus J, Ballaz A, Barba R, Barron M, Barron-Andres B, Bascunana J, Blanco-Molina A, Camon A, Canas I, Carrasco C, Castro J, de Ancos C, Del Toro J, Demelo P, Diaz-Peromingo J, Diaz-Simon R, Falga C, Farfan A, Fernandez-Capitan C, Fernandez-Criado M, Fernandez-Nunez S, Fidalgo A, Font L, Garcia M, Garcia-Morillo M, Garcia-Raso A, Gavin-Sebastian O, Gayol M, Gil-Diaz A, Gomez V, Gomez-Cuervo C, Gonzalez-Martinez J, Grau E, Gutierrez J, Gutierrez-Gonzalez S, Iglesias M, Jaras M, Jou I, Joya M, Lalueza A, Lima J, Llamas P, Lobo J, Lopez-Jimenez L, Lopez-Miguel P, Lopez-Nunez J, Lopez-Saez J, Lorente M, Lorenzo A, Loring M, Madridano O, Marchena P, Martin J, Mellado M, Morales M, Nieto M, Nieto J, Nunez M, Olivares M, Pedrajas J, Pellejero G, Prez-Rus G, Peris M, Porras J, Rivas A, Rodriguez-Davila M, Rodriguez-Hernandez A, Rubio C, Ruiz-Artacho P, Ruiz-Ruiz J, Ruiz-Sada P, Sahuquillo J, Salazar V, Samperiz A, Munoz-Torrero J, Sancho T, Soler S, Surinach J, Tapia E, Tolosa C, Torres M, Trujillo-Santos J, Uresandi F, Valle R, Villares P, Gutierrez P, Vazquez F, Vilaseca A, Vanassche T, Vandenbriele C, Verhamme P, Hirmerova J, Maly R, Celis G, del Pozo G, Salgado E, Benzidia I, Bertoletti L, Bura-Riviere A, Debourdeau P, Farge-Bancel D, Hij A, Mahe I, Moustafa F, Schellong S, Braester A, Brenner B, Tzoran I, Sharif-Kashani B, Barillari G, Bilora F, Bortoluzzi C, Brandolin B, Bucherini E, Ciammaichella M, Dentali F, Di Micco P, Maida R, Mastroiacovo D, Mumoli N, Pace F, Parisi R, Pesavento R, Prandoni P, Quintavalla R, Rocci A, Romualdi R, Sinicalchi C, Tufano A, Visona A, Hong N, Zalunardo B, Gibietis V, Kigitovica D, Skride A, Bosevski M, Bounameaux H, Mazzolai L, Caprini J, Bui H, Pham K, Reis A, RIETE Investigators
Publicada:
27 dic 2019
Resumen:
In young patients with acute pulmonary embolism (PE), the predictive value of currently available prognostic tools has not been evaluated. Our objective was to compare prognostic value of 7 available tools (GPS, PESI, sPESI, Prognostic Algorithm, PREP, shock index and RIETE) in patients aged <50 years. We used the RIETE database, including PE patients from 2001 to 2017. The major outcome was 30-day all-cause mortality. Of 34,651 patients with acute PE, 5,822 (17%) were aged <50 years. Of these, 83 (1.4%) died during the first 30 days. Number of patients deemed low risk with tools was: PREP (95.9%), GPS (89.6%), PESI (87.2%), Shock index (70.9%), sPESI (59.4%), Prognostic algorithm (58%) and RIETE score (48.6%). The tools with a highest sensitivity were: Prognostic Algorithm (91.6%; 95% CI: 85.6-97.5), RIETE score (90.4%; 95%CI: 84.0-96.7) and sPESI (88%; 95% CI: 81-95). The RIETE, Prognostic Algorithm and sPESI scores obtained the highest overall sensitivity estimates for also predicting 7- and 90-day all-cause mortality, 30-day PE-related mortality, 30-day major bleeding and 30-day VTE recurrences. The proportion of low-risk patients who died within the first 30 days was lowest using the Prognostic Algorithm (0.2%), RIETE (0.3%) or sPESI (0.3%) scores. In PE patients less 50 years, 30-day mortality was low. Although sPESI, RIETE and Prognostic Algorithm scores were the most sensitive tools to identify patients at low risk to die, other tools should be evaluated in this population to obtain more efficient results.
Filiaciones:
Jara-Palomares L:
Hosp Univ Virgen del Rocio, Ctr Invest Biomed Red Enfermedades Resp CIBERES, Inst Biomed Sevilla IBiS, Dept Pneumonol,Med Surg Unit Resp Dis, Seville, Spain
Alfonso M:
Complejo Hosp Navarra, Dept Pneumonol, Pamplona, Spain
Maestre A:
Hosp Univ Vinalopo, Dept Internal Med, Alicante, Spain
Jimenez D:
Hosp Univ Ramon y Cajal, Resp Dept, IRYCIS, Madrid, Spain
Garcia-Bragado F:
Hosp Univ Girona Dr Josep Trueta, Dept Internal Med, Girona, Spain
Font C:
Hosp Clin Barcelona, Dept Med Oncol, Barcelona, Spain
Reyes R:
Hosp Univ & Politecn La Fe, Dept Pneumonol, Valencia, Spain
Blasco L:
Hosp Gen Univ Alicante, Dept Pneumonol, ISABIAL, Alicante, Spain
Vidal G:
Corp Sanitaria Parc Tauli, Dept Internal Med, Barcelona, Spain
Otero R:
Hosp Univ Virgen del Rocio, Ctr Invest Biomed Red Enfermedades Resp CIBERES, Inst Biomed Sevilla IBiS, Dept Pneumonol,Med Surg Unit Resp Dis, Seville, Spain
Monreal M:
Univ Catolica Murcia, Hosp Univ Germans Trias & Pujol Badalona, Dept Internal Med, Murcia, Spain
Adarraga M:
Hosp Montilla, Dept Internal Med, Cordoba, Spain
Aibar M:
Hosp Clin Univ Lozano Blesa, Dept Internal Med, Zaragoza, Spain
Aibar J:
Hosp Clin Barcelona, Dept Internal Med, Barcelona, Spain
Amado C:
Hosp Sierrallana, Dept Internal Med, Santander, Spain
Arcelus J:
Hosp Univ Virgen de las Nieves, Dept Gen Surg, Granada, Spain
Ballaz A:
Hosp Galdakao, Dept Pneumonol, Vizcaya, Spain
Barba R:
Hosp Rey Juan Carlos, Dept Internal Med, Madrid, Spain
Barron M:
Complejo Hosp San Pedro, Dept Pneumonol, La Rioja, Spain
Barron-Andres B:
Fdn Rioja Salud, Ctr Invest Biomed la Rioja, La Rioja, Spain
Bascunana J:
Hosp Univ Infanta Leonor, Dept Internal Med, Madrid, Spain
Blanco-Molina A:
Hosp Univ Reina Sofia, Dept Internal Med, Cordoba, Spain
Camon A:
Hosp Clin Univ Lozano Blesa, Dept Internal Med, Zaragoza, Spain
Canas I:
Hosp Gen Granollers, Dept Internal Med, Barcelona, Spain
Carrasco C:
Hosp Univ Virgen de Valme, Dept Pneumonol, Seville, Spain
Castro J:
Hosp Santa Barbara, Dept Internal Med, Ciudad Real, Spain
de Ancos C:
Hosp Univ Fuenlabrada, Dept Internal Med, Madrid, Spain
Del Toro J:
Hosp Gen Univ Gregorio Maranon, Dept Internal Med, Madrid, Spain
Demelo P:
Hosp Gen Univ Gregorio Maranon, Dept Internal Med, Madrid, Spain
Diaz-Peromingo J:
Hosp Clin Univ Santiago, Dept Internal Med, Santiago De Compostela, Spain
Diaz-Simon R:
Hosp Univ 12 Octubre, Dept Internal Med, Madrid, Spain
Falga C:
Hosp Mataro, Dept Internal Med, Barcelona, Spain
Farfan A:
Hosp Univ Fuenlabrada, Dept Internal Med, Madrid, Spain
Fernandez-Capitan C:
Hosp Univ La Paz, Dept Internal Med, Madrid, Spain
Fernandez-Criado M:
Hosp Univ Virgen de Valme, Dept Pneumonol, Seville, Spain
Fernandez-Nunez S:
Hosp Gen Granollers, Dept Internal Med, Barcelona, Spain
Fidalgo A:
Hosp Univ Salamanca, Dept Internal Med, Salamanca, Spain
Font L:
Hosp Tortosa Verge de la Cinta, Dept Haematol, Tarragona, Spain
Garcia M:
Hosp Rey Juan Carlos, Dept Internal Med, Madrid, Spain
Garcia-Morillo M:
Hosp Clin Barcelona, Dept Med Oncol, Barcelona, Spain
Garcia-Raso A:
Hosp Univ Fdn Jimenez Diaz, Dept Haematol, Madrid, Spain
Gavin-Sebastian O:
Hosp Clin Univ Lozano Blesa, Dept Haematol, Zaragoza, Spain
Gayol M:
Hosp Comarcal de Barbanza, Dept Internal Med, La Coruna, Spain
Gil-Diaz A:
Hosp Univ Gran Canaria Dr Negrin, Dept Internal Med, Las Palmas Gran Canaria, Spain
Gomez V:
Hosp Univ Ramon y Cajal, Dept Pneumonol, Madrid, Spain
Gomez-Cuervo C:
Hosp Univ 12 Octubre, Dept Internal Med, Madrid, Spain
Gonzalez-Martinez J:
Xarxa Assistencial Manresa, Dept Internal Med, ALTAHAIA, Barcelona, Spain
Grau E:
Hosp Lluis Alcanyis, Dept Haematol & Hemotherapy, Valencia, Spain
Gutierrez J:
Univ Francisco de Vitoria, Hosp Monog ASEPEYO, Dept Internal Med, Madrid, Spain
Gutierrez-Gonzalez S:
Hosp Clin Univ Valladolid, Dept Internal Med, Valladolid, Spain
Iglesias M:
Hosp Comarcal de Barbanza, Dept Internal Med, La Coruna, Spain
Jaras M:
Hosp Cantoblanco, Dept Internal Med, Madrid, Spain
Jou I:
Hosp Figueres, Dept Internal Med, Girona, Spain
Joya M:
Hosp Rey Juan Carlos, Dept Internal Med, Madrid, Spain
Lalueza A:
Hosp Univ 12 Octubre, Dept Internal Med, Madrid, Spain
Lima J:
Hosp Univ Virgen de Valme, Dept Pneumonol, Seville, Spain
Llamas P:
Hosp Univ Fdn Jimenez Diaz, Dept Haematol, Madrid, Spain
Lobo J:
Hosp Univ Araba, Dept Pneumonol, Alava, Spain
Lopez-Jimenez L:
Hosp Univ Reina Sofia, Dept Internal Med, Cordoba, Spain
Lopez-Miguel P:
Hosp Gen Univ Albacete, Dept Pneumonol, Albacete, Spain
Lopez-Nunez J:
Univ Catolica Murcia, Hosp Univ Germans Trias & Pujol Badalona, Dept Internal Med, Murcia, Spain
Lopez-Saez J:
Hosp Univ Puerto Real, Dept Internal Med, Cadiz, Spain
Lorente M:
Hosp Vega Baja de Orihuela, Dept Internal Med, Alicante, Spain
Lorenzo A:
Hosp Univ La Paz, Dept Internal Med, Madrid, Spain
Loring M:
Hosp Comarcal de Axarquia, Dept Internal Med, Malaga, Spain
Madridano O:
Hosp Univ Infanta Sofia, Dept Internal Med, Madrid, Spain
Marchena P:
Parc Sanitari St Joan de Deu Hosp Gen, Dept Internal Med & Emergency, Barcelona, Spain
Martin J:
Hosp Clin Univ Valladolid, Dept Internal Med, Valladolid, Spain
Mellado M:
Hosp del Mar, Dept Angiol & Vasc Surg, Barcelona, Spain
Morales M:
Hosp Tajo, Dept Internal Med, Madrid, Spain
Nieto M:
Hosp Arnau Vilanova, Dept Pneumonol, Valencia, Spain
Nieto J:
Hosp Gen Virgen de la Luz, Dept Internal Med, Cuenca, Spain
Nunez M:
Complejo Hosp Pontevedra, Dept Internal Med, Pontevedra, Spain
Olivares M:
Hosp Tortosa Verge de la Cinta, Dept Haematol, Tarragona, Spain
Pedrajas J:
Hosp Clin San Carlos, Dept Internal Med, Madrid, Spain
Pellejero G:
Hosp Clin Univ Lozano Blesa, Dept Internal Med, Zaragoza, Spain
Prez-Rus G:
Hosp Gen Univ Gregorio Maranon, Dept Internal Med, Madrid, Spain
Peris M:
CEU Cardenal Herrera Univ, Consorcio Hosp Prov Castellon, Dept Internal Med, Valencia, Spain
Porras J:
Hosp Univ Joan XXIII Tarragona, Dept Internal Med, Tarragona, Spain
Rivas A:
Hosp Univ Araba, Dept Pneumonol, Alava, Spain
Rodriguez-Davila M:
Hosp Univ La Paz, Dept Internal Med, Madrid, Spain
Rodriguez-Hernandez A:
Hosp Clin Barcelona, Dept Med Oncol, Barcelona, Spain
Rubio C:
Hosp Alto Guadalquivir Andujar, Dept Internal Med, Jaen, Spain
Ruiz-Artacho P:
Hosp Clin San Carlos, Dept Internal Med, Madrid, Spain
Ruiz-Ruiz J:
Hosp Univ Fuenlabrada, Dept Internal Med, Madrid, Spain
Ruiz-Sada P:
Hosp Reina Sofia, Dept Internal Med, Tudela, Navarra, Spain
Sahuquillo J:
Hosp Municipal Badalona, Dept Internal Med, Barcelona, Spain
Salazar V:
Hosp Univ Virgen de Arrixaca, Dept Internal Med, Murcia, Spain
Samperiz A:
Hosp Reina Sofia, Dept Internal Med, Tudela, Navarra, Spain
Munoz-Torrero J:
Hosp San Pedro de Alcantara, Dept Internal Med, Caceres, Spain
Sancho T:
Hosp Univ La Paz, Dept Internal Med, Madrid, Spain
Soler S:
Hosp Olot & Comarcal de la Garrotxa, Dept Internal Med, Girona, Spain
Surinach J:
Hosp Univ Vall dHebron, Dept Internal Med, Barcelona, Spain
Tapia E:
Hosp Clin Univ Valladolid, Dept Internal Med, Valladolid, Spain
Tolosa C:
Corp Sanitaria Parc Tauli, Dept Internal Med, Barcelona, Spain
Torres M:
Hosp Univ La Paz, Dept Internal Med, Madrid, Spain
Trujillo-Santos J:
Hosp Gen Univ Santa Lucia, Dept Internal Med, Murcia, Spain
Uresandi F:
Hosp Univ Cruces, Dept Pneumonol, Baracaldo, Vizcaya, Spain
Valle R:
Hosp Sierrallana, Dept Internal Med, Santander, Spain
Villares P:
Hosp Madrid Norte Sanchinarro, Dept Internal Med, Madrid, Spain
Gutierrez P:
Hosp Italiano Buenos Aires, Dept Internal Med, Buenos Aires, DF, Argentina
Vazquez F:
Hosp Italiano Buenos Aires, Dept Internal Med, Buenos Aires, DF, Argentina
Vilaseca A:
Clin San Camilo, Dept Haematol & Haemostasis, Buenos Aires, DF, Argentina
Vanassche T:
Univ Leuven, Vasc Med & Haemostasis, Leuven, Belgium
Vandenbriele C:
Univ Leuven, Vasc Med & Haemostasis, Leuven, Belgium
Verhamme P:
Univ Leuven, Vasc Med & Haemostasis, Leuven, Belgium
Hirmerova J:
Univ Hosp Plzen, Dept Internal Med, Plzen, Czech Republic
Maly R:
Charles Univ Prague, Univ Hosp Hradec Kralove, Fac Med Hradec Kralove, Dept Cardiovasc Med 1, Hradec Kralove, Czech Republic
Celis G:
Hosp Clin La Merced, Intens Care Unit, Quito, Ecuador
del Pozo G:
Hosp Clin La Merced, Intens Care Unit, Quito, Ecuador
Salgado E:
Hosp Clin La Merced, Intens Care Unit, Quito, Ecuador
Benzidia I:
Hop St Louis, Dept Internal Med & Pathol, Paris, France
Bertoletti L:
CHU St Etienne, Dept Vasc Med & Therapeut, Hop Nord, St Etienne, France
Bura-Riviere A:
Hop Rangueil, Dept Vasc Med, Toulouse, France
Debourdeau P:
Inst St Catherine, Dept Support Care Oncol, Avignon, France
Farge-Bancel D:
Hop St Louis, Dept Internal Med & Pathol, Paris, France
Hij A:
Hop St Louis, Dept Internal Med & Pathol, Paris, France
Mahe I:
Univ Paris 07, Hop Louis Mourier, Colombes APHP, Dept Internal Med, Paris, France
Moustafa F:
Clermont Ferrand Univ Hosp, Dept Emergency, Clermont Ferrand, France
Schellong S:
Municipal Hosp Dresden Friedrichstadt, Dept Med Clin, Dresden, Germany
Braester A:
Bar Ilan Univ, Azrieli Sch Med Galilee, Dept Haematol, Ramat Gan, Israel
Brenner B:
Rambam Hlth Care Campus, Dept Haematol & Bone Marrow Transplantat, Haifa, Israel
Tzoran I:
Rambam Hlth Care Campus, Dept Haematol & Bone Marrow Transplantat, Haifa, Israel
Sharif-Kashani B:
Masih Daneshvari Hosp, Dept Cardiol & Heart Transplant, Tehran, Iran
Barillari G:
Osped S Maria Misericordia, Dept Internal Med, Udine, Italy
Bilora F:
Univ Padua, Dept Cardiovasc Sci, Vasc Med Unit, Padua, Italy
Bortoluzzi C:
Osped SS Giovanni & Paolo Venezia, Dept Internal Med, Venice, Italy
Brandolin B:
Osped Castelfranco Veneto, Dept Vasc Med, Castelfranco Veneto, Italy
Bucherini E:
Azienda USL Ravenna OC Faenza, Dept Vasc Med, Ravenna, Italy
Ciammaichella M:
Osped St John, Dept Emergency Internal Med, Rome, Italy
Dentali F:
Univ Insubria, Dept Clin & Expt Med, Varese, Italy
Di Micco P:
Osped Buon Consiglio Fatebenefratelli, Dept Internal Med & Emergency Room, Naples, Italy
Maida R:
Osped St John, Dept Emergency Internal Med, Rome, Italy
Mastroiacovo D:
Osped SS Filippo & Nicola, Dept Angiol, Avezzano, Italy
Mumoli N:
Osped SS Filippo & Nicola, Dept Angiol, Avezzano, Italy
Pace F:
Osped San Camilo, Dept Med Urgenza, Rome, Italy
Parisi R:
Osped SS Giovanni & Paolo Venezia, Dept Internal Med, Venice, Italy
Pesavento R:
Univ Padua, Dept Cardiovasc Sci, Vasc Med Unit, Padua, Italy
Prandoni P:
Univ Padua, Dept Cardiovasc Sci, Vasc Med Unit, Padua, Italy
Quintavalla R:
Azienda Osped Univ, Dept Med 3, Parma, Italy
Rocci A:
Azienda Osped Univ, Dept Med 3, Parma, Italy
Romualdi R:
Osped SS Filippo & Nicola, Dept Angiol, Avezzano, Italy
Sinicalchi C:
Azienda Osped Univ, Dept Med 3, Parma, Italy
Tufano A:
Federico II Univ Hosp, Reg Reference Ctr Coagulat Disorders, Dept Clin Med & Surg, Naples, Italy
Visona A:
Osped Castelfranco Veneto, Dept Vasc Med, Castelfranco Veneto, Italy
Hong N:
Osped SS Giovanni & Paolo Venezia, Dept Internal Med, Venice, Italy
Zalunardo B:
Osped Castelfranco Veneto, Dept Vasc Med, Castelfranco Veneto, Italy
Gibietis V:
Osped Pauls Stradins Clin Univ Hosp, Dept Cardiol, Riga, Latvia
Kigitovica D:
Osped Pauls Stradins Clin Univ Hosp, Dept Cardiol, Riga, Latvia
Skride A:
Osped Pauls Stradins Clin Univ Hosp, Dept Cardiol, Riga, Latvia
Bosevski M:
Clin Ctr, Fac Med, Inst Cardiovasc Dis, Skopje, North Macedonia
Bounameaux H:
Univ Hosp Geneva, Dept Internal Med, Div Angiol & Haemostasis, Geneva, Switzerland
Mazzolai L:
CHU Vaudois, Dept Angiol, Lausanne, Switzerland
Caprini J:
Evanston NorthShore Univ Hlth Syst, Dept Med & Vasc Med, Evanston, IL USA
Bui H:
Hanoi Med Univ Hosp, Dept Sci Res Management, Hanoi, Vietnam
Pham K:
Bach Mai Hosp, Dept Cardiol, Hanoi, Vietnam
Reis A:
Ctr Hosp Porto, Pulm Vasc Dis Unit, Porto, Portugal
|