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Sci Rep. 2019 Dec 27;9(1):20064. doi: 10.1038/s41598-019-55213-8.

Comparison of seven prognostic tools to identify low-risk pulmonary embolism in patients aged <50 years.

Collaborators (146)

Adarraga MD, Aibar MÁ, Aibar J, Amado C, Arcelus JI, Ballaz A, Barba R, Barrón M, Barrón-Andrés B, Bascuñana J, Blanco-Molina Á, Camón AM, Cañas I, Carrasco C, Castro J, de Ancos C, Del Toro J, Demelo P, Díaz-Peromingo JA, Díaz-Simón R, Falgá C, Farfán AI, Fernández-Capitán C, Del Carmen Fernández-Criado M, Fernández-Núñez S, Fidalgo Á, Font L, García MA, García-Morillo M, García-Raso A, Gavín-Sebastián O, Del Carmen Gayol M, Gil-Díaz A, Gómez V, Gómez-Cuervo C, González-Martínez J, Grau E, Gutiérrez J, Gutiérrez-González S, Iglesias M, Jaras MJ, Jou I, Joya MD, Lalueza A, Lima J, Llamas P, Lobo JL, López-Jiménez L, López-Miguel P, López-Núñez JJ, López-Sáez JB, Lorente MA, Lorenzo A, Loring M, Madridano O, Marchena PJ, Martín JM, Mellado M, Morales MDV, Nieto ML, Nieto JA, Núñez MJ, Olivares MC, Pedrajas JM, Pellejero G, Pérez-Rus G, Peris ML, Porras JA, Rivas A, Rodríguez-Dávila MÁ, Adela Rodríguez-Hernández A, Rubio CM, Ruiz-Artacho P, Ruiz-Ruiz J, Ruiz-Sada P, Sahuquillo JC, Salazar V, Sampériz Á, Muñoz-Torrero JFS, Sancho T, Soler S, Suriñach JM, Tapia E, Tolosa C, Torres MI, Trujillo-Santos J, Uresandi F, Valle R, Villares P, Gutiérrez P, Vázquez FJ, Vilaseca A, Vanassche T, Vandenbriele C, Verhamme P, Hirmerova J, Malý R, Celis G, Del Pozo G, Salgado E, Benzidia I, Bertoletti L, Bura-Riviere A, Debourdeau P, Farge-Bancel D, Hij A, Mahé 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, Visonà A, Hong NV, Zalunardo B, Gibietis V, Kigitovica D, Skride A, Bosevski M, Bounameaux H, Mazzolai L, Caprini JA, Bui HM, Pham KQ, Reis A.

Author information

1
Department of Pneumonology, Medical Surgical Unit of Respiratory Diseases, Instituto de Biomedicina de Sevilla (IBiS), Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES), Hospital Universitario Virgen del Rocío, Seville, Spain. luisoneumo@hotmail.com.
2
Department of Pneumonology, Complejo Hospitalario de Navarra, Pamplona, Spain.
3
Department of Internal Medicine, Hospital Universitario de Vinalopó, Alicante, Spain.
4
Respiratory Department, Hospital Universitario Ramón y Cajal, IRYCIS, Madrid, Spain.
5
Department of Internal Medicine, Hospital Universitari de Girona Dr, Josep Trueta, Gerona, Spain.
6
Department of Medical Oncology, Hospital Clínic, Barcelona, Spain.
7
Department of Pneumonology, Hospital Universitari i Politècnic La Fe, Valencia, Spain.
8
Department of Pneumonology, Hospital General Universitario de Alicante, ISABIAL, Alicante, Spain.
9
Department of Internal Medicine, Corporación Sanitaria Parc Taulí, Barcelona, Spain.
10
Department of Pneumonology, Medical Surgical Unit of Respiratory Diseases, Instituto de Biomedicina de Sevilla (IBiS), Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES), Hospital Universitario Virgen del Rocío, Seville, Spain.
11
Department of Internal Medicine, Hospital Universitario Germans Trias i Pujol de Badalona, Barcelona, Universidad Católica de Murcia, Murcia, Spain.

Abstract

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.

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