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.

Details

Title
Comparison of seven prognostic tools to identify low-risk pulmonary embolism in patients aged <50 years
Author
Jara-Palomares, Luis 1   VIAFID ORCID Logo  ; Alfonso, Maria 2 ; Maestre, Ana 3 ; Jimenez, David 4 ; Garcia-Bragado, Fernando 5 ; Font, Carme 6 ; Raquel Lopez Reyes 7 ; Luis Hernandez Blasco 8 ; Vidal, Gemma 9 ; Otero, Remedios 1 ; Monreal, Manuel 10 ; Adarraga, Mª Dolores 11 ; Aibar, Miguel Ángel 12 ; Aibar, Jesús 13 ; Amado, Cristina 14 ; Arcelus, Juan Ignacio 15 ; Ballaz, Aitor 16 ; Barba, Raquel 17 ; Barrón, Manuel 18 ; Barrón-Andrés, Belén 19 ; Bascuñana, José 20 ; Blanco-Molina, Ángeles 21 ; Camón, Ana María 12 ; Cañas, Inmaculada 22 ; Carrasco, Cristina 23 ; Castro, Joaquín 24 ; de Ancos, Cristina 25 ; Jorge Del Toro 26 ; Demelo, Pablo 26 ; Díaz-Peromingo, José Antonio 27 ; Díaz-Simón, Raquel 28 ; Falgá, Conxita 29 ; Farfán, Ana Isabel 25 ; Fernández-Capitán, Carmen 30 ; María del Carmen Fernández-Criado 23 ; Fernández-Núñez, Sandra 22 ; Fidalgo, Ángeles 31 ; Font, Llorenç 32 ; García, Maria Angelina 17 ; García-Morillo, Marcial 6 ; García-Raso, Aranzázu 33 ; Gavín-Sebastián, Olga 34 ; María del Carmen Gayol 35 ; Gil-Díaz, Aída 36 ; Gómez, Vicente 37 ; Gómez-Cuervo, Covadonga 28 ; González-Martínez, José 38 ; Grau, Enric 39 ; Gutiérrez, Javier 40 ; Gutiérrez-González, Sara 41 ; Iglesias, Marina 35 ; Mª Jesús Jaras 42 ; Jou, Inés 43 ; Joya, María Dolores 17 ; Lalueza, Antonio 28 ; Lima, Jorge 23 ; Llamas, Pilar 33 ; Lobo, Jose Luis 44 ; López-Jiménez, Luciano 21 ; López-Miguel, Patricia 45 ; López-Núñez, Juan José 10 ; Juan Bosco López-Sáez 46 ; Lorente, Manuel Alejandro 47 ; Lorenzo, Alicia 30 ; Loring, Mónica 48 ; Madridano, Olga 49 ; Marchena, Pablo Javier 50 ; Javier Miguel Martín 41 ; Mellado, Meritxell 51 ; Mª del Valle Morales 52 ; Nieto, María Luisa 53 ; Nieto, José Antonio 54 ; Manuel Jesús Núñez 55 ; Olivares, María Carmen 32 ; Pedrajas, José María 56 ; Pellejero, Galadriel 12 ; Pérez-Rus, Gloria 26 ; Peris, Mª Luisa 57 ; Porras, José Antonio 58 ; Rivas, Agustina 44 ; Mª Ángeles Rodríguez-Dávila 30 ; Rodríguez-Hernández, A Adela 6 ; Carmen Mª Rubio 59 ; Ruiz-Artacho, Pedro 56 ; Ruiz-Ruiz, Justo 25 ; Ruiz-Sada, Pablo 60 ; Joan Carles Sahuquillo 61 ; Salazar, Vladimir 62 ; Sampériz, Ángel 60 ; Sánchez Muñoz-Torrero, Juan Francisco 63 ; Sancho, Teresa 30 ; Soler, Silvia 64 ; Suriñach, José María 65 ; Tapia, Elena 41 ; Tolosa, Carles 9 ; Torres, María Isabel 30 ; Trujillo-Santos, Javier 66 ; Uresandi, Fernando 67 ; Valle, Reina 14 ; Villares, Paula 68 ; Gutiérrez, Paula 69 ; Vázquez, Fernando Javier 69 ; Vilaseca, Alicia 70 ; Vanassche, Thomas 71 ; Vandenbriele, Christophe 71 ; Verhamme, Peter 71 ; Hirmerova, Jana 72 ; Malý, Radovan 73 ; Celis, Gregory 74 ; Gustavo del Pozo 74 ; Salgado, Estuardo 74 ; Benzidia, Ilham 75 ; Bertoletti, Laurent 76 ; Bura-Riviere, Alessandra 77 ; Debourdeau, Philippe 78 ; Farge-Bancel, Dominique 75 ; Hij, Adrian 75 ; Mahé, Isabelle 79 ; Farès Moustafa 80 ; Schellong, Sebastian 81 ; Braester, Andrei 82 ; Brenner, Benjamin 83 ; Tzoran, Inna 83 ; Sharif-Kashani, Babak 84 ; Barillari, Giovanni 85 ; Bilora, Franca 86 ; Bortoluzzi, Cristiano 87 ; Brandolin, Barbara 88 ; Bucherini, Eugenio 89 ; Ciammaichella, Maurizio 90 ; Dentali, Francesco 91 ; Pierpaolo Di Micco 92 ; Maida, Rosa 90 ; Mastroiacovo, Daniela 93 ; Mumoli, Nicola 93 ; Pace, Federica 94 ; Parisi, Roberto 87 ; Pesavento, Raffaelle 86 ; Prandoni, Paolo 86 ; Quintavalla, Roberto 95 ; Rocci, Anna 95 ; Romualdi, Roberta 93 ; Sinicalchi, Carmine 95 ; Tufano, Antonella 96 ; Visonà, Adriana 88 ; Ngoc Vo Hong 87 ; Zalunardo, Beniamino 88 ; Gibietis, Valdis 97 ; Kigitovica, Dana 97 ; Skride, Andris 97 ; Bosevski, Marijan 98 ; Bounameaux, Henri 99 ; Mazzolai, Lucia 100 ; Caprini, Joseph A 101 ; Bui, Hanh My 102 ; Pham, Khanh Quoc 103 ; Reis, Abilio 104 

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 
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 Internal Medicine, Hospital Universitario Germans Trias i Pujol de Badalona, Barcelona, Universidad Católica de Murcia, Murcia, Spain 
11  Department of Internal Medicine, Hospital de Montilla, Córdoba, Spain 
12  Department of Internal Medicine, Hospital Clínico Universitario Lozano Blesa, Zaragoza, Spain 
13  Department of Internal Medicine, Hospital Clínic, Barcelona, Spain 
14  Department of Internal Medicine, Hospital Sierrallana, Santander, Spain 
15  Department of General Surgery, Hospital Universitario Virgen de las Nieves, Granada, Spain 
16  Department of Pneumonology, Hospital de Galdakao, Vizcaya, Spain 
17  Department of Internal Medicine, Hospital Rey Juan Carlos, Madrid, Spain 
18  Department of Pneumonology, Complejo Hospitalario San Pedro, La Rioja, Spain 
19  Centro de Investigación Biomédica de la Rioja, Fundación Rioja Salud, La Rioja, Spain 
20  Department of Internal Medicine, Hospital Universitario Infanta Leonor, Madrid, Spain 
21  Department of Internal Medicine, Hospital Universitario Reina Sofía, Córdoba, Spain 
22  Department of Internal Medicine, Hospital General de Granollers, Barcelona, Spain 
23  Department of Pneumonology, Hospital Universitario Virgen de Valme, Sevilla, Spain 
24  Department of Internal Medicine, Hospital Santa Bárbara, Puertollano, Ciudad Real, Spain 
25  Department of Internal Medicine, Hospital Universitario de Fuenlabrada, Madrid, Spain 
26  Department of Internal Medicine, Hospital General Universitario Gregorio Marañón, Madrid, Spain 
27  Department of Internal Medicine, Hospital Clínico Universitario de Santiago, Santiago de Compostela, Spain 
28  Department of Internal Medicine, Hospital Universitario 12 de Octubre, Madrid, Spain 
29  Department of Internal Medicine, Hospital de Mataró, Barcelona, Spain 
30  Department of Internal Medicine, Hospital Universitario La Paz, Madrid, Spain 
31  Department of Internal Medicine, Hospital Universitario de Salamanca, Salamanca, Spain 
32  Department of Haematology, Hospital de Tortosa Verge de la Cinta, Tarragona, Spain 
33  Department of Haematology, Hospital Universitario Fundación Jiménez Díaz, Madrid, Spain 
34  Department of Haematology, Hospital Clínico Universitario Lozano Blesa, Zaragoza, Spain 
35  Department of Internal Medicine, Hospital Comarcal de Barbanza, Ribeira, A Coruña, Spain 
36  Department of Internal Medicine, Hospital Universitario de Gran Canaria Dr. Negrín, Las Palmas, Spain 
37  Department of Pneumonology, Hospital Universitario Ramón y Cajal, Madrid, Spain 
38  Department of Internal Medicine, ALTAHAIA, Xarxa Assistencial de Manresa, Barcelona, Spain 
39  Department of Haematology and Hemotherapy, Hospital Lluis Alcanyis, Valencia, Spain 
40  Department of Internal Medicine, Hospital Monográfico ASEPEYO, Universidad Francisco de Vitoria, Madrid, Spain 
41  Department of Internal Medicine, Hospital Clínico Universitario de Valladolid, Valladolid, Spain 
42  Department of Internal Medicine, Hospital Cantoblanco, Madrid, Spain 
43  Department of Internal Medicine, Hospital de Figueres, Gerona, Spain 
44  Department of Pneumonology, Hospital Universitario Araba, Álava, Spain 
45  Department of Pneumonology, Hospital General Universitario de Albacete, Albacete, Spain 
46  Department of Internal Medicine, Hospital Universitario de Puerto Real, Cádiz, Spain 
47  Department of Internal Medicine, Hospital Vega Baja de Orihuela, Alicante, Spain 
48  Department of Internal Medicine, Hospital Comarcal de Axarquía, Málaga, Spain 
49  Department of Internal Medicine, Hospital Universitario Infanta Sofía, Madrid, Spain 
50  Department of Internal Medicine and Emergency, Parc Sanitari Sant Joan de Déu-Hospital General, Barcelona, Spain 
51  Department of Angiology and Vascular Surgery, Hospital del Mar, Barcelona, Spain 
52  Department of Internal Medicine, Hospital del Tajo, Madrid, Spain 
53  Department of Pneumonology, Hospital Arnau de Vilanova, Valencia, Spain 
54  Department of Internal Medicine, Hospital General Virgen de la Luz, Cuenca, Spain 
55  Department of Internal Medicine, Complejo Hospitalario de Pontevedra, Pontevedra, Spain 
56  Department of Internal Medicine, Hospital Clínico San Carlos, Madrid, Spain 
57  Department of Internal Medicine, Consorcio Hospitalario Provincial de Castellón, Castellón, CEU Cardenal Herrera University, Valencia, Spain 
58  Department of Internal Medicine, Hospital Universitario Joan XXIII de Tarragona, Tarragona, Spain 
59  Department of Internal Medicine, Hospital Alto Guadalquivir Andújar, Jaén, Spain 
60  Department of Internal Medicine, Hospital Reina Sofía, Tudela, Navarra, Spain 
61  Department of Internal Medicine, Hospital Municipal de Badalona, Barcelona, Spain 
62  Department of Internal Medicine, Hospital Universitario Virgen de Arrixaca, Murcia, Spain 
63  Department of Internal Medicine, Hospital San Pedro de Alcántara, Cáceres, Spain 
64  Department of Internal Medicine, Hospital Olot i Comarcal de la Garrotxa, Gerona, Spain 
65  Department of Internal Medicine, Hospital Universitario Vall d’Hebron, Barcelona, Spain 
66  Department of Internal Medicine, Hospital General Universitario Santa Lucía, Murcia, Spain 
67  Department of Pneumonology, Hospital Universitario Cruces, Barakaldo, Vizcaya, Spain 
68  Department of Internal Medicine, Hospital de Madrid Norte Sanchinarro, Madrid, Spain 
69  Department of Internal Medicine, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina 
70  Department of Haematology and Haemostasis, Clínica San Camilo, Buenos Aires, Argentina 
71  Vascular Medicine and Haemostasis, University of Leuven, Leuven, Belgium 
72  Department of Internal Medicine, University Hospital Plzen, Plzen, Czech Republic 
73  Department of Cardiovascular Medicine I, Charles University in Prague, Faculty of Medicine in Hradec Kralove, University Hospital Hradec Kralove, Hradec Kralove, Czech Republic 
74  Intensive Care Unit, Hospital Clínica La Merced, Quito, Ecuador 
75  Department of Internal Medicine and Pathology, Hôpital Saint-Louis, Paris, France 
76  Department of Vascular Medicine and Therapeutics, Hôpital Nord - CHU St-Etienne, Saint-Etienne, France 
77  Department of Vascular Medicine, Hôpital de Rangueil, Toulouse, France 
78  Department of Supportive Care Oncology, Institut Sainte Catherine, Avignon, France 
79  Department of Internal Medicine, Hôpital Louis Mourier, Colombes (APHP), University Paris 7, Paris, France 
80  Department of Emergency, Clermont-Ferrand University Hospital, Clermont-Ferrand, France 
81  Department of Medical Clinic. Municipal Hospital of Dresden Friedrichstadt, Dresden, Germany 
82  Department of Haematology, Azrieli School of Medicine in Galilee, Bar-ilan University, Ramat Gan, Israel 
83  Department of Haematology and Bone Marrow Transplantation, Rambam Health Care Campus, Haifa, Israel 
84  Department of Cardiology and Heart Transplant, Masih-Daneshvari Hospital, Tehran, Iran 
85  Department of Internal Medicine, Ospedale S.Maria della Misericordia, Udine, Italy 
86  Department of Cardiovascular Sciences, Vascular Medicine Unit, University of Padua, Padua, Italy 
87  Department of Internal Medicine, Ospedale SS. Giovanni e Paolo di Venezia, Venice, Italy 
88  Department of Vascular Medicine, Ospedale Castelfranco Veneto, Castelfranco Veneto, Italy 
89  Department of Vascular Medicine, Azienda U.S.L. Di Ravenna – O.C. Di Faenza, Ravenna, Italy 
90  Department of Emergency Internal Medicine, Ospedale St. John, Rome, Italy 
91  Department of Clinical and Experimental Medicine, University of Insubria, Varese, Italy 
92  Department of Internal Medicine and Emergency Room, Ospedale Buon Consiglio Fatebenefratelli, Naples, Italy 
93  Department of Angiology, Ospedale SS. Filippo e Nicola, Avezzano, Italy 
94  Department of Medicina d´Urgenza, Ospedale San Camilo, Rome, Italy 
95  Department of Medicine 3, Azienda Ospedaliera Universitaria, Parma, Italy 
96  Regional Reference Centre for Coagulation Disorders, Department of Clinical Medicine and Surgery, Federico II, University Hospital, Naples, Italy 
97  Department of Cardiology, Ospedale Pauls Stradins Clinical University Hospital, Riga, Latvia 
98  Institute for Cardiovascular Diseases, Faculty of Medicine, Clinical Center, Skopje, Republic of Macedonia 
99  Division of Angiology and Haemostasis, Department of Internal Medicine, University Hospital of Geneva, Geneva, Switzerland 
100  Department of Angiology, Centre Hospitalier Universitaire Vaudois (CHUV), Lausanne, Switzerland 
101  Department of Medicine and Vascular Medicine, Evanston NorthShore University HealthSystem, Evanston, Illinois, USA 
102  Department of Scientific research management, Hanoi Medical University Hospital, Hanoi, Vietnam 
103  Department of Cardiology, Bach Mai Hospital, Hanoi, Vietnam 
104  Head of Pulmonary Vascular Disease Unit, Centro Hospitalar do Porto, Porto, Portugal 
Pages
1-10
Publication year
2019
Publication date
Dec 2019
Publisher
Nature Publishing Group
e-ISSN
20452322
Source type
Scholarly Journal
Language of publication
English
DOI
https://doi.org/10.1038/s41598-019-55213-8
ProQuest document ID
2330970668
Copyright
© 2019. This work is published under http://creativecommons.org/licenses/by/4.0/ (the “License”). Notwithstanding the ProQuest Terms and Conditions, you may use this content in accordance with the terms of the License.