ABSTRACT
Objective To compare the prognostic value of simplified revised Geneva Prognostic Score (sGPS), Pulmonary Embolism Severity Index (PESI) and simplified Pulmonary Embolism Severity Index (sPESI) in patients with acute pulmonary thromboembolism(PTE). Methods A retrospective cohort study was carried out on 276 consecutive patients with identified acute PTE admitted to our hospital from January 1997 to December 2016. We dichotomized patients as low vs. high risk in all three scoring systems. The 30-day mortality of the patients were used as prognostic factors. The prognostic value of each scoring system was evaluated by the area under the receiver operating characteristic curve(ROC). Results (1) The overall 30-day mortality of 276 patients with acute PTE was 22.5％. The 30-day mortality of patients in low vs. high risk groups according to sGPS, PESI and sPESI were 7.6％vs. 47.1％, 1.0％ vs. 34.3％, 2.4％ vs. 30.9％, respectively. The 30-day mortality of patients in high risk groups according to sGPS, PESI and sPESI were significantly higher than those of patients in low risk groups(P<0.01). The 30-day mortality of patients in low risk groups according to sGPS and PESI were significantly different(P=0.020). The 30-day mortality of patients in high risk groups according to sGPS were significantly different from those of patients in high risk groups according to PESI and sPESI, respectively (P=0.033, P=0.006). (2) The areas under the receiver operating characteristic (ROC) curves for evaluating the prognosis of patients with acute PTE according to sGPS, PESI and sPESI were 0.824, 0.891 and 0.846, respectively. The specificity (84.6％), the accuracy (84.4％) and the positive predictive value (61.2％) of PESI were the highest among the three prediction rules, the sensitivity (83.9％) and the negative predictive value (94.8％) of PESI were also relatively high. The negative predictive value of sPESI (98.6％) was the highest among the three prediction rules. Conclusions PESI can be more accurate for the overall risk stratification of patients with acute PTE, while sPESI is more helpful for identifying those patients with acute PTE who can be discharged early.
ABSTRACT
Objective To evaluate the clinical value of pulmonary embolism severity index (PESI) in non high-risk acute pulmonary thromboembolism (APTE) patients treated with sequential anticoagulation.Methods Non high-risk APTE patients treated with sequential anticoagulation were divided into two groups according to PESI:high-value group and low-value group.Prognosis and treatment response was compared between two groups.Results There were 82 cases in high-value group,and 76 cases in low-value group.The rate of adverse events in high-value group was significantly higher than that in low-value group [23.2％(19/82) vs.7.9％ (6/76)] (x2 =5.0698,P =0.009),and 30 days cumulative hazard was also significantly higher than that in low-value group (P ＜ 0.05).The sensitivity of predicting adverse events by PESI was 76.0％,specificity was 52.6％,positive predicting value was 64.6％,and negative predicting value was 65.9％.The mortality in high-value group was significantly higher than that in low-value group [9.8％(8/82) vs.1.3％ (1/76)] (P =0.022).After 30 days of anticoagulation,the pulmonary artery systolic pressure,internal diameter of right ventricle in high-value group was significantly higher than that in low-value group [(39.4 ± 8.1) mm Hg (1 mm Hg =0.133 kPa) vs.(27.2 ± 5.5) mm Hg,(33.0 ± 7.8) mm vs.(21.7 ± 4.6) mm] (P =0.034,0.021),and arterial oxygen partial pressure was significantly lower than that in low-value group[(75.15 ± 12.41) mm Hg vs.(86.36 ± 9.22) mm Hg](P=0.016).Conclusions PESI can effectively predict short-term prognosis of non high-risk APTE patients treated with sequential anticoagulation.At least some of these patients might need treatment other than sequential anticoagulation.
ABSTRACT
Objective To evaluate the efficacy and safety of self-management anticoagulation treatment for low pulmonary embolism severity index (PESI) outpatient with acute pulmonary embolism (APE).Methods Sixty-eight patients with APE of PESI grade Ⅰ-Ⅱ were divide into inpatient group and outpatient group with 34 cases each by random digits table.All the patients were treated with low molecular heparin followed by oral anticoagulation,and self-management was used in outpatient group.The efficacy was observed within 14 days and 3 months.The efficacy outcome included recurrent venous thromboembolism (VTE),standardization time of international normalized ratio (INR),VTE-related emergency department visit times,bleeding events and total mortality.Results There were 2 cases(5.9％,2/34) in inpatient group and 1 case (2.9％,1/34) in outpatient group with recurrent VTE,and there was no statistical significance between two groups (P ＞ 0.05).Standardization time of INR in inpatient group [(8.5 ± 2.9) d] was shorter than that in outpatient group [(16.1 ± 4.4) d],and there was significant difference (P＜ 0.01).There was no significant difference in the VTE-related emergency department visit times between two groups (P ＞ 0.05).There was 1 case with major bleeding and 1 death respectively in outpatient group.Conclusion It is effective and safe to give early self-management anticoagulation treatment to APE patients with PESI grade Ⅰ-Ⅱ,which could shorten time spending in hospital and release burden both physically and mentally.