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PE-CM Score – an easy tool to assess prognosis of pulmonary embolism
Session:
Posters 3 - Écran 3 - Circulação / Embolia Pulmonar
Speaker:
Daniel Faria
Congress:
CPC 2019
Topic:
F. Valvular, Myocardial, Pericardial, Pulmonary, Congenital Heart Disease
Theme:
21. Pulmonary Circulation, Pulmonary Embolism, Right Heart Failure
Subtheme:
21.2 Pulmonary Circulation, Pulmonary Embolism, Right Heart Failure – Epidemiology, Prognosis, Outcome
Session Type:
Posters
FP Number:
---
Authors:
Daniel Candeias Faria; Joana Simões; d. Roque; Miguel Santos; João Baltazar Ferreira; Hilaryano Ferreira; Marco Beringuilho; João Augusto
Abstract
<p><strong>Background:</strong></p> <p>There are several scoring systems for risk stratification and mortality prediction in patients with pulmonary embolism. The Pulmonary Embolism Severity Index (PESI), its simplified version (sPESI) and the European Society of Cardiology (ESC) 2014 risk models are widely used, however, these are time-consuming and don´t make use of information regarding the patient metabolic status provided by the arterial blood gas (ABG) examination.</p> <p> </p> <p><strong>Purpose:</strong></p> <p>To provide a simple and easy-to-perform score based on physical and ABG parameters at admission and to compare its performance to predict in-hospital all-cause mortality.</p> <p> </p> <p><strong>Material and methods:</strong></p> <p>In a retrospective single-centre observational study, 487 patients with confirmed PE were admitted in a 24-month period. We calculated PESI, sPESI and ESC 2014 stratification risk scores. Data collected included demographics, clinical characteristics, biochemical markers and echocardiographic parameters. Multivariate analysis was performed using logistic regression to identify independent predictors of all-cause mortality. Discriminative power was accessed by Receiver Operating Characteristic (ROC) curve analysis.</p> <p> </p> <p><strong>Results:</strong></p> <p>A total of 483 patients were included in the final analysis. Mean age was 66.3 <u>+</u> 17.4 years (39.4% males). Median in-hospital length of stay was 12 [IQR 7-21] days. In-hospital mortality rate was 18.3% (n=89). Modified Shock Index (MSI) and lactate concentration (Lac) were significantly higher (1.18 vs 0.96 and 4.87 vs 1.87mmol/L, respectively, p<0.0001 for both) while Oxygen saturation/fraction of inspired oxygen (OSF) ratio and blood pH were significantly lower (271.9 vs 364.2 and 7.37 vs 7.43, respectively, p<0.0001 for both) in patients with in-hospital death. There was a significantly higher proportion of patients with Glasgow Coma Scale (GCS) <15 with in-hospital death (68.5% vs 31.4%, p<0.0001). Stratified analysis was based on the cut-off value for the last quartile of MSI (1.0) and Lac (2.5mmol/L) and for the first quartile of OSF ratio (350) and blood pH (7.30). Multivariate analysis using logistic regression is summarized in <strong>Table 1</strong>. Based on the different OR values, we attributed points to each variable: GCS<15 (3 points), pH<7.30 or MSI<u>></u>1.0 (2 points) and OSF ratio<350 or Lac<u>></u>2.50mmol/L (1 point), with a total score (PE-CM Score) range of 0-9. The PE-CM Score yielded a good prognostic performance in predicting in-hospital death using ROC analysis (AUC 0.832, 95% CI 0.77-0.89, p<0.0001) and performed better than other scores in predicting death (PESI: AUC 0.753, p=0.038; sPESI: AUC 0.625, p=0.0001; ESC 2014: AUC 0.723, p=0.002) - <strong>Figure 1</strong>. A PE-CM Score>3 has a sensitivity of 69.0% and a specificity of 88.3% in predicting in-hospital all-cause mortality.</p> <p><br /> <strong>Conclusions:</strong></p> <p>PE-CM Score proves an easier and simple tool with good performance to predict in-hospital all-cause mortality in patients admitted for PE.</p>
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