Pulmonary embolism (PE) is associated with significant mortality. The PESI correlates with short term mortality. It has not been validated at predicting intermediate term outcomes.
We retrospectively determined 90 day mortality, using the Social Security Death Index, in consecutive patients diagnosed with acute PE. PE was diagnosed based on objective criteria (ie. high probability ventilation-perfusion scintigraphy, CT of the chest with PE protocol, etc). One investigator blinded to outcome calculated PESI based on data available at time of diagnosis. Raw PESI scores were then converted into risk class (I–V), and then further dichotomized into high risk (I–III) and low risk (IV–V) groups. Mortality at 90 days was compared across raw PESI scores, class, and risk groups.
The cohort included 302 patients (mean age: 60 +/− 17; male: 44%). The mean PESI score was 103.4 +/− 39.4 and the overall 90 day mortality rate was 5.0%. Mortality rate increased as PESI score increased. Risk of death also correlated with risk class. There were no deaths in risk classes I-II, while the mortality rate in class III was 1.7% compared to 6.9% in IV and 13.0% in V (p<0.001 for trend). Further separation into low vs high risk groups revealed mortality rates of 0.6% in the low risk group vs 10.4% in the high risk group (p<0.0001); OR for death: 19.2 (95% CI, 2.5–148.0). As a screening test for 90 day mortality, the PESI score had an area under the receiver operating curve (AUROC) of 0.82 (95% CI, 0.75–0.89). The AUROCs for class stratification and risk group stratification were similar 0.80 (95% CI, 0.72–0.88) and 0.76 (95% CI, 0.66–0.85).
PESI is a reliable tool to predict 90 day mortality and identifies patients at high risk for longer term death.
Clinicians can apply the PESI to predict intermediate term mortality. The PESI may facilitate selection of patients potentially in need of closer follow up care beyond the immediate peri-PE period.
Chee Chan, No Financial Disclosure Information; No Product/Research Disclosure Information