A comparative study of different types of simplified Pulmonary Embolism Severity Index in predicting the prognosis of patients with acute pulmonary embolism_West China Medical Journal

Authors：

XIA Mengmei ¹ ,  XU Ping ^1,2,3

1. Department of Emergency, the Fourth People’s Hospital of Zigong City, Zigong, Sichuan 643000, P. R. China;
2. Sichuan Vocational College of Health and Rehabilitation, Zigong, Sichuan 643000, P. R. China;
3. Institute of Medical Big Data, Zigong Academy of Artificial Intelligence and Big Data for Medical Science, Zigong, Sichuan 643000, P. R. China;

Corresponding author：

XU Ping, Email: 58124453@qq.com

Keywords：

Simplified Pulmonary Embolism Severity Index; acute pulmonary embolism; arterial oxyhaemoglobin saturation; saturation of pulse oxygen; fraction of inspired oxygen; prognosis

DOI：

10.7507/1002-0179.202210119

Video：

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Objective To compare the prognostic value of different types of simplified Pulmonary Embolism Severity Index (sPESI) in patients with acute pulmonary embolism (APE), so as to select the best scoring system for clinical application. Methods We retrospectively collected the data of consecutive patients with APE in the Fourth People’s Hospital of Zigong City from January 1st, 2014 to January 1st, 2019. The endpoint was 1-month all-cause mortality. We tried to modify sPESI by replacing arterial oxyhaemoglobin saturation with arterial partial pressure of oxygen / fraction of inspired oxygen (new scoring system named psPESI), and modify sPESI by replacing arterial oxyhaemoglobin saturation with saturation of pulse oxygen / fraction of inspired oxygen (new scoring system named ssPESI), and analyzed the area under the receiver-operating characteristic curve (AUC), net reclassification improvement (NRI), integrated discrimination improvement (IDI), calibration and decision curve. Results A total of 280 patients (109 with low-risk APE, 155 with intermediate-risk APE, and 16 with high-risk APE) were enrolled in the study. Of these patients, 165 (58.93%) were male, and the 1-month all-cause mortality rate was 10.71% (30/280). The AUCs of sPESI, psPESI and ssPESI were 0.756, 0.822 and 0.807, respectively, and the AUC of ssPESI was higher than that of sPESI (P=0.038) but not lower than that of psPESI (P=0.388). Comparing ssPESI with sPESI, the NRI was 0.928 (P<0.001) and the IDI was 0.084 (P<0.001); comparing ssPESI with psPESI, the NRI was 0.041 (P=0.227) and the IDI was –0.028 (P=0.060). The psPESI (Hosmer-Lemeshow test χ²=12.591, P=0.182) and ssPESI (Hosmer-Lemeshow test χ²=4.204, P=0.897) were well-calibrated in the internal validation cohort and obtained more net benefits within wide threshold probabilities than sPESI. Conclusion Since the saturation of pulse oxygen is non-invasive and easy to obtain, and the predictive ability of ssPESI is similar to that of psPESI, it is recommended that ssPESI be used as a new scoring system to evaluate the prognosis of APE.

Citation： XIA Mengmei, XU Ping. A comparative study of different types of simplified Pulmonary Embolism Severity Index in predicting the prognosis of patients with acute pulmonary embolism. West China Medical Journal, 2022, 37(11): 1618-1622. doi: 10.7507/1002-0179.202210119 Copy

1.	Giri J, Sista AK, Weinberg I, et al. Interventional therapies for acute pulmonary embolism: current status and principles for the development of novel evidence: a scientific statement from the american heart association. Circulation, 2019, 140(20): e774-e801.
2.	Chodakowski JD, Courtney DM. Pulmonary embolism critical care update: prognosis, treatment, and research gaps. Curr Opin Crit Care, 2018, 24(6): 540-546.
3.	Erol S, Gürün Kaya A, Arslan Ciftçi F, et al. Is oxygen saturation variable of simplified pulmonary embolism severity index reliable for identification of patients, suitable for outpatient treatment. Clin Respir J, 2018, 12(2): 762-766.
4.	Tang RB, Jing YY, Xu ZY, et al. New-onset atrial fibrillation and adverse in-hospital outcome in patients with acute pulmonary embolism. Semin Thromb Hemost, 2020, 46(8): 887-894.
5.	Zhou XY, Ben SQ, Chen HL, et al. The prognostic value of pulmonary embolism severity index in acute pulmonary embolism: a meta-analysis. Respir Res, 2012, 13(1): 111.
6.	Freitas P, Santos AR, Ferreira AM, et al. Derivation and external validation of the SHIeLD score for predicting outcome in normotensive pulmonary embolism. Int J Cardiol, 2019, 281: 119-124.
7.	Pisani L, Roozeman JP, Simonis FD, et al. Risk stratification using SpO₂/FiO₂ and PEEP at initial ARDS diagnosis and after 24 h in patients with moderate or severe ARDS. Ann Intensive Care, 2017, 7(1): 108.
8.	Konstantinides SV, Meyer G, Becattini C, et al. 2019 ESC Guidelines for the diagnosis and management of acute pulmonary embolism developed in collaboration with the European Respiratory Society (ERS): the Task Force for the diagnosis and management of acute pulmonary embolism of the European Society of Cardiology (ESC). Eur Respir J, 2019, 54(3): 1901647.
9.	Sepehri Shamloo A, Dagres N, Hindricks G. 2020 ESC guidelines on atrial fibrillation: summary of the most relevant recommendations and innovations. Herz, 2021, 46(1): 28-37.
10.	Jiménez D, Aujesky D, Moores L, et al. Simplification of the pulmonary embolism severity index for prognostication in patients with acute symptomatic pulmonary embolism. Arch Intern Med, 2010, 170(15): 1383-1389.
11.	Zhang Z, Gayle AA, Wang J, et al. Comparing baseline characteristics between groups: an introduction to the CBCgrps package. Ann Transl Med, 2017, 5(24): 484.
12.	Konstantinides SV, Meyer G, Becattini C, et al. 2019 ESC Guidelines for the diagnosis and management of acute pulmonary embolism developed in collaboration with the European Respiratory Society (ERS). Eur Heart J, 2020, 41(4): 543-603.
13.	Palm V, Rengier F, Rajiah P, et al. Acute pulmonary embolism: imaging techniques, findings, endovascular treatment and differential diagnoses. Rofo, 2020, 192(1): 38-49.
14.	Jimenz D, Aujesky D, Diaz G, et al. Prognostic significance of deep vein thrombosis in patients presenting with acute symptomatic pulmonary embolism. Am J Respir Crit Care Med, 2010, 181(9): 983-991.
15.	Jiménez D, Yusen RD. Prognostic models for selecting patients with acute pulmonary embolism for initial outpatient therapy. Chest, 2007, 132(1): 24-30.
16.	Batt NM, Radford A, Milinis K, et al. Correlating pulmonary embolism severity with short term mortality to risk stratify for outpatient management. Acute Med, 2020, 19(2): 69-75.
17.	As AK, Erdolu B, Duman B, et al. Can a modified-simplified pulmonary embolism severity index (m-sPESI) be used to predict the need for intensive care in hospitalized COVID-19 patients?. J Thromb Thrombolysis, 2021, 52(3): 759-765.
18.	Aujesky D, Roy PM, Le Manach CP, et al. Validation of a model to predict adverse outcomes in patients with pulmonary embolism. Eur Heart J, 2006, 27(4): 476-481.
19.	Ostovan MA, Ghaffari S, Pourafkari L, et al. Modification of simplified pulmonary embolism severity index and its prognostic value in patients with acute pulmonary embolism. Heart Lung Circ, 2016, 25(2): 184-190.

1. Giri J, Sista AK, Weinberg I, et al. Interventional therapies for acute pulmonary embolism: current status and principles for the development of novel evidence: a scientific statement from the american heart association. Circulation, 2019, 140(20): e774-e801.
2. Chodakowski JD, Courtney DM. Pulmonary embolism critical care update: prognosis, treatment, and research gaps. Curr Opin Crit Care, 2018, 24(6): 540-546.
3. Erol S, Gürün Kaya A, Arslan Ciftçi F, et al. Is oxygen saturation variable of simplified pulmonary embolism severity index reliable for identification of patients, suitable for outpatient treatment. Clin Respir J, 2018, 12(2): 762-766.
4. Tang RB, Jing YY, Xu ZY, et al. New-onset atrial fibrillation and adverse in-hospital outcome in patients with acute pulmonary embolism. Semin Thromb Hemost, 2020, 46(8): 887-894.
5. Zhou XY, Ben SQ, Chen HL, et al. The prognostic value of pulmonary embolism severity index in acute pulmonary embolism: a meta-analysis. Respir Res, 2012, 13(1): 111.
6. Freitas P, Santos AR, Ferreira AM, et al. Derivation and external validation of the SHIeLD score for predicting outcome in normotensive pulmonary embolism. Int J Cardiol, 2019, 281: 119-124.
7. Pisani L, Roozeman JP, Simonis FD, et al. Risk stratification using SpO₂/FiO₂ and PEEP at initial ARDS diagnosis and after 24 h in patients with moderate or severe ARDS. Ann Intensive Care, 2017, 7(1): 108.
8. Konstantinides SV, Meyer G, Becattini C, et al. 2019 ESC Guidelines for the diagnosis and management of acute pulmonary embolism developed in collaboration with the European Respiratory Society (ERS): the Task Force for the diagnosis and management of acute pulmonary embolism of the European Society of Cardiology (ESC). Eur Respir J, 2019, 54(3): 1901647.
9. Sepehri Shamloo A, Dagres N, Hindricks G. 2020 ESC guidelines on atrial fibrillation: summary of the most relevant recommendations and innovations. Herz, 2021, 46(1): 28-37.
10. Jiménez D, Aujesky D, Moores L, et al. Simplification of the pulmonary embolism severity index for prognostication in patients with acute symptomatic pulmonary embolism. Arch Intern Med, 2010, 170(15): 1383-1389.
11. Zhang Z, Gayle AA, Wang J, et al. Comparing baseline characteristics between groups: an introduction to the CBCgrps package. Ann Transl Med, 2017, 5(24): 484.
12. Konstantinides SV, Meyer G, Becattini C, et al. 2019 ESC Guidelines for the diagnosis and management of acute pulmonary embolism developed in collaboration with the European Respiratory Society (ERS). Eur Heart J, 2020, 41(4): 543-603.
13. Palm V, Rengier F, Rajiah P, et al. Acute pulmonary embolism: imaging techniques, findings, endovascular treatment and differential diagnoses. Rofo, 2020, 192(1): 38-49.
14. Jimenz D, Aujesky D, Diaz G, et al. Prognostic significance of deep vein thrombosis in patients presenting with acute symptomatic pulmonary embolism. Am J Respir Crit Care Med, 2010, 181(9): 983-991.
15. Jiménez D, Yusen RD. Prognostic models for selecting patients with acute pulmonary embolism for initial outpatient therapy. Chest, 2007, 132(1): 24-30.
16. Batt NM, Radford A, Milinis K, et al. Correlating pulmonary embolism severity with short term mortality to risk stratify for outpatient management. Acute Med, 2020, 19(2): 69-75.
17. As AK, Erdolu B, Duman B, et al. Can a modified-simplified pulmonary embolism severity index (m-sPESI) be used to predict the need for intensive care in hospitalized COVID-19 patients?. J Thromb Thrombolysis, 2021, 52(3): 759-765.
18. Aujesky D, Roy PM, Le Manach CP, et al. Validation of a model to predict adverse outcomes in patients with pulmonary embolism. Eur Heart J, 2006, 27(4): 476-481.
19. Ostovan MA, Ghaffari S, Pourafkari L, et al. Modification of simplified pulmonary embolism severity index and its prognostic value in patients with acute pulmonary embolism. Heart Lung Circ, 2016, 25(2): 184-190.

West China Medical Journal

A comparative study of different types of simplified Pulmonary Embolism Severity Index in predicting the prognosis of patients with acute pulmonary embolism

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