Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2023 Aug 5;24(1):195.
doi: 10.1186/s12931-023-02489-0.

Validation of clinical-radiological scores for prognosis of mortality in acute pulmonary embolism

Alexey Surov  1 , Maximilian Thormann  2 , Caroline Bär  3 , Andreas Wienke  4 , Jan Borggrefe  1
Affiliations

Validation of clinical-radiological scores for prognosis of mortality in acute pulmonary embolism

Alexey Surov et al. Respir Res. .

Abstract

Introduction: Acute pulmonary embolism (APE) is a hazardous disorder with a high mortality. Combination of clinical, radiological, and serological parameters can improve risk stratification of APE. Most of the proposed combined scores were not validated in independent cohorts. Our aim was to validate the proposed clinical-radiological scores for prognosis of 7- and 30-day mortality in APE.

Materials and methods: Our sample comprised 531 patients with APE, mean age 64.8 ± 15.6 years, 221 (41.6%) females and 310 (58.4%) males. The following parameters were collected: Age and sex of the patients, mortality within the observation time of 30 days, simplified pulmonary embolism severity index (sPESI), pH troponin level (pg/ml), minimal systolic and diastolic blood pressures (mmHg), heart rate, O2 saturation, episodes of syncope, and need for vasopressors. On CT pulmonary angiography (CTPA), short axis ratio right ventricle/left ventricle (RV/LV), and reflux of contrast medium into the inferior vena cava were obtained. The following clinical-radiological scores were calculated: BOVA score, pulmonary embolism mortality score (PEMS), European Society of Cardiology (ESC) score, Kumamaru score, and Calgary acute pulmonary embolism (CAPE) score.

Results: Overall, 31 patients (5.8%) died within seven and 64 patients (12%) within 30 days. All scores showed high negative prognostic values ranging from 89.0 to 99.0%. PEMS and CAPE score demonstrated the highest specificity for 7-day mortality (93.4% and 85.0%), PEMS and BOVA for 30-day mortality (94.2% and 90.4%). The highest sensitivity was observed for ESC 2019 (96.8% and 95.3%). Kumamaru and CAPE scores had low sensitivity. All scores had low positive and high negative predictive values.

Conclusion: For prognosis of 7- and 30-day mortality in APE, PEMS score has the highest specificity. ESC 2019 shows the highest sensitivity. All scores had low positive and high negative predictive values.

Keywords: Acute pulmonary embolism; Computed tomography; Mortality.

PubMed Disclaimer

Conflict of interest statement

None.

Figures

Fig. 1
Fig. 1
Measure of the RV/LV diameter ratio
Fig. 2
Fig. 2
Estimation of the reflux into the inferior vena cava
Fig. 3
Fig. 3
Receiver operating characteristic curves for the analyzed scores (30 day mortality)
See this image and copyright information in PMC

References

    1. Goldhaber SZ, Visani L, De Rosa M. Acute pulmonary embolism: clinical outcomes in the international cooperative pulmonary embolism registry (ICOPER) Lancet. 1999;353:1386–9. doi: 10.1016/S0140-6736(98)07534-5. - DOI - PubMed
    1. Bajaj A, Saleeb M, Rathor P, Sehgal V, Kabak B, Hosur S. Prognostic value of troponins in acute nonmassive pulmonary embolism: a meta-analysis. Heart Lung. 2015;44(4):327–34. doi: 10.1016/j.hrtlng.2015.03.007. - DOI - PubMed
    1. Vanni S, Nazerian P, Bova C, et al. Comparison of clinical scores for identification of patients with pulmonary embolism at intermediate-high risk of adverse clinical outcome: the prognostic role of plasma lactate. Intern Emerg Med. 2017;12(5):657–65. doi: 10.1007/s11739-016-1487-6. - DOI - PubMed
    1. Bach AG, Taute BM, Baasai N, Wienke A, Meyer HJ, Schramm D, Surov A. 30-Day mortality in Acute Pulmonary Embolism: Prognostic Value of Clinical Scores and Anamnestic features. PLoS ONE. 2016;11(2):e0148728. - PMC - PubMed
    1. Araoz PA, Gotway MB, Harrington JR, Harmsen WS, Mandrekar JN. Pulmonary embolism: prognostic CT findings. Radiology. 2007;242(3):889–97. doi: 10.1148/radiol.2423051441. - DOI - PubMed