The pulmonary embolism severity index (PESI) is a clinical scoring tool to facilitate risk stratification in acute pulmonary embolism. Serum biomarkers, such as Tropinin I (Ti), have also been proposed as a means to identify PE patients at high risk for poor outcome. No data exist comparing the PESI score to Ti for predicting short-term mortality.
We retrospectively compared the PESI and Ti levels in patients with acute PE. PE was diagnosed based on either a high probability VQ scan, a CT angiogram, or a MRA of the chest. Mortality at 30 days served as the primary endpoint. The PESI was calculated by one observer blinded to eventual outcome. We compared mortality rates based on PESI risk class and further stratified patients into low risk (PESI class I-III) and high risk (PESI class IV-V) cohorts. We assessed the ability of the PESI and Ti to predict mortality based on comparing the area under the receiver operating curve (AUROC).
The cohort included 198 subjects (mean age 61 +/− 16, 43% male). The overall mortality rate was 2.0%. Ti was elevated in 24% of subjects. . Persons with elevated Tis had higher PESI scores (135 vs 88, p < 0.001). The proportion of patients with elevated Tis increased with increasing PESI risk class (p < 0.001); 3% of persons in PESI Class I had elevated Tis vs. 44% of those in Class V (p < 0.001). Mortality rates were similar in those with elevated and normal Tis (1.0% vs 1.0%, p = 0.23); mortality rate for low vs high risk PESI groups were 0% vs 2.0%, p = 0.025. The PESI was a more accurate predictor of mortality than the Ti (AUROC 0.93 vs. 0.79).
Elevated Ti correlates closely with the PESI score. However, the PESI is a more accurate predictor of death.
Physicians should preferentially consider employing the PESI over Ti to risk stratify persons with PE.
Chee Chan, No Financial Disclosure Information; No Product/Research Disclosure Information