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Discriminatory capacity of PESI score depending on age: is it equal for all?
Session:
Posters 3 - Écran 3 - Circulação / Embolia Pulmonar
Speaker:
Inês Grácio Almeida
Congress:
CPC 2019
Topic:
F. Valvular, Myocardial, Pericardial, Pulmonary, Congenital Heart Disease
Theme:
21. Pulmonary Circulation, Pulmonary Embolism, Right Heart Failure
Subtheme:
21.7 Pulmonary Circulation, Pulmonary Embolism, Right Heart Failure - Other
Session Type:
Posters
FP Number:
---
Authors:
Inês Grácio De Almeida; Joana Simões; Daniel Faria; Marco Beringuilho; David Cabrita Roque; João Baltazar; Miguel Santos; Carlos Sequeira De Morais
Abstract
<p><strong>Introduction:</strong> Pulmonary Embolism Severity Index (PESI) score is the most commonly risk stratification tool used for patients (P) with acute pulmonary embolism (PE) and validated in many populations.</p> <p><strong>Objective: </strong>Evaluation of discriminatory capacity of PESI score in P < 65 years <em>versus </em>≥ 65 presented with PE.</p> <p><strong>Material and methods: </strong>Retrospective observational study of 483 P admitted with PE between 2014-16. P were divided into two groups: group 1 (G1) if <65 years and group 2 (G2) if ≥65 years. Collected data regarding clinical and laboratorial parameters in both groups. Evaluated discriminatory capacity of PESI score in predicting in-hospital and 1-year mortality (1yM) in both groups through analysis of <em>receiver-operating characteristics</em> (ROC) curve.</p> <p><strong>Results: </strong>Admitted 483 P with PE, mean age 66.3±17.6 years, 60.2% females. Mean PESI score in global population was 116.9 ± 49.4, smaller in G1 patients (mean value 84.5±39.8 in G1 vs 137.5±43.5, p <0.001). At univariate analysis, PESI score was predictor of in-hospital mortality in G1 ((odds ratio) OR 1.026, p <0.001) and G2 patients (OR 1.025, p <0.001). Its discriminatory capacity was acceptable: for G1 the <em>area under the curve</em> (AUC) was 0.799, p <0.001, confidence interval (CI) 0.693-0.906; and in G2 AUC 0.766, p <0.001, CI 0.704-0.827. Regarding 1yM, PESI score also showed to be predictor of this outcome in both groups (OR 1.026, p <0.001). Its discriminatory capacity was excellent in G1 patients (AUC 0.809, p <0.001, CI 0.732-0.886) and only acceptable in G2 (AUC 0.776, p <0.001, CI 0.718-0.834). The authors determined other predictor factors (not included in PESI score) to accurate risk stratification in this group. At univariate analysis, predictor factors (PF) for 1yM were: protein chain reaction (PCR) (OR 1.066, p <0.001), urea (OR 1.015, p <0.001), creatinine (OR 1.843, p 0.001), lactate (OR 1.240, p 0.002), NTproBNP (OR 0.009, p 0.002), haemoglobin (OR 0.817, p 0.002), cardiopulmonary arrest (CPR) (OR 7.750, p 0.008) and heart rate (OR 1.015, p 0.017). At multivariate analysis, independent PF for 1Ym were: urea (p 0.001), PCR (p 0001), lactate (p 0.015) and CPR (p 0.026).</p> <p><strong>Conclusion: </strong>In our center, PESI score had a similar discrimination between groups in predicting in-hospital mortality. However, as predictor of 1yM, specially in older patients other clinical and laboratorial markers besides PESI should be taken into account to assess risk stratification.</p>
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