Modification of the simplified PESI score to identify low risk patients with acute symptomatic pulmonary embolism

Abstract

Introduction: The simplified Pulmonary Embolism Severity Index (PESI) score has been validated to identify low risk patients with acute symptomatic pulmonary embolism (PE). Aim: To evaluate if the modification in the cut-off value of the heart rate in the sPESI score increases its sensitivity without affecting its clinical utility. Material and Methods: We used the data set of the multicentric study PROTECT, which analysed a variety of prognostic tools in 848 normotensive patients with acute symptomatic PE from 12 different Spanish hospitals. The heart rate cut-off value was modified (positive if ≥100/bpm). The primary efficacy outcome was all-cause mortality during the first 30 days of treatment. The secondary efficacy outcome was a composite of complicated clinical course elements, defined as all-cause mortality, hemodynamic shock or non-fatal thromboembolism recurrence during the first 30 days of treatment. Results: The modified simplified PESI score identified 249 low risk patients (29%, confidence interval [CI] 95%, 26-33%) compared to 37% detected with the original sPESI score. The sensitivity of the modified sPESI for all-cause mortality, PE mortality and complicated clinical course was 100% (CI 95%, 89-100%), 100% (CI 95%, 68-99%) and 97%(CI 95%, 88-99%) respectively, compared to 97%(CI 95%, 85-100%), 91% (CI 95%, 57-100%) and 92% (CI 95%, 82-97%) of the original score. Conclusions: The modification in the cut-off value of the heart rate in the sPESI score diminished its clinical utility but at the same time it increased its sensitivity to identify normotensive patients with PE and low mortality and short-term complications risk.