APACHEⅡ, NEWS, PESI and CCI for predicting mortality in patients with pulmonary embolism: a comparative study_Chinese Journal of Evidence-Based Medicine

Authors：

PENG Manxuan ¹ , LI Cheng ² , DUAN Wenbing ¹ ,  WU Shangjie ¹

1. Department of Respiratory and Critical Care Medicine, The Second Xiangya Hospital of Central South University, Changsha, 410000, P.R.China;
2. Department of Respiratory Medicine, Changsha Central Hospital, Changsha, 410000, P.R.China;

Corresponding author：

WU Shangjie, Email: wushangjie@csu.edu.cn

Keywords：

Pulmonary embolism; Acute physiology and chronic health evaluation Ⅱ; National early warning score; Pulmonary embolism severity index; Charlson comorbidity index

DOI：

10.7507/1672-2531.201901090

Video：

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Objectives To compare the efficacy of acute physiology and chronic health evaluationⅡ (APACHEⅡ), national early warning score (NEWS), pulmonary embolism severity index (PESI) and Charlson comorbidity index (CCI) on pulmonary embolism (PE) prognosis.Methods Clinical data of patients with PE treated in The Second Xiangya Hospital of Central South University from 2010 to 2017 were retrospectively analyzed. They were divided into death group and survival group, and four clinical scores were calculated. The differences of risk factors between the two groups were compared. Logistic regression analysis was used to obtain the independent risk factors related to mortality. The ROC working curve was used to compare the capability of four clinical scores for PE mortality. SPSS 24.0 and Medcalc 18.2.1 software were used for statistical analysis. Results A total of 318 patients with PE were included, and the mortality rate was 13.2%. The APACHEⅡ, NEWS, PESI and CCI of the death group were higher than those of the survival group. There were significant differences between two groups (P<0.05). It was confirmed by logistic regression analysis that cerebrovascular disease, heart rate, leukocyte, troponin T, arterial partial pressure of oxygen, right ventricular dysfunction (RVD) were independent risk factors for 90-day mortality. The areas under the ROC curve of APACHEⅡ, CCI, PESI, NEWS were 0.886, 0.728, 0.715 and 0.731, respectively. The area under the ROC curve of APACHEⅡ was the largest, which was better than NEWS, CCI and PESI (P<0.05), and there was no significant difference among NEWS, CCI and PESI.Conclusions APACHEⅡ may be the best predictor of mortality in PE patients, which is superior to NEWS, CCI and PESI.

Citation： PENG Manxuan, LI Cheng, DUAN Wenbing, WU Shangjie. APACHEⅡ, NEWS, PESI and CCI for predicting mortality in patients with pulmonary embolism: a comparative study. Chinese Journal of Evidence-Based Medicine, 2019, 19(8): 887-893. doi: 10.7507/1672-2531.201901090 Copy

1.	Konstantinides SV. 2014 ESC Guidelines on the diagnosis and management of acute pulmonary embolism. Eur Heart J, 2014, 35(45): 3145-3146.
2.	Kupis RW, Goldman-Mazur S, Polak M, et al. Faster fibrin clot degradation characterizes patients with central pulmonary embolism at a low risk of recurrent peripheral embolism. Sci Rep, 2019, 9(1): 72.
3.	Giordano NJ, Jansson PS, Young MN, et al. Epidemiology, pathophysiology, stratification, and natural history of pulmonary embolism. Tech Vasc Interv Radiol, 2017, 20(3): 135-140.
4.	Elias A, Mallett S, Daoud-Elias M, et al. Prognostic models in acute pulmonary embolism: a systematic review and meta-analysis. BMJ Open, 2016, 6(4): e010324.
5.	周海霞, 唐永江, 王岚, 等. 肺栓塞远期死亡危险因素及Charlson合并症指数的预测价值. 中华医学杂志, 2016, 96(4): 273-276.
6.	Chen RX, Wang HZ, Dong J, et al. Pulmonary embolism in non-brain tumor patients after surgery-a retrospective study in China. World J Surg Oncol, 2017, 15(1): 22.
7.	中华医学会呼吸病学分会肺栓塞与肺血管病学组, 中国医师协会呼吸医师分会肺栓塞与肺血管病工作委员会, 全国肺栓塞与肺血管病防治协作组. 肺血栓栓塞症诊治与预防指南. 中华医学杂志, 2018, 98(14): 1060-1087.
8.	Jia D, Liu F, Zhang Q, et al. Rapid on-site evaluation of routine biochemical parameters to predict right ventricular dysfunction in and the prognosis of patients with acute pulmonary embolism upon admission to the emergency room. J Clin Lab Anal, 2018, 32(4): e22362.
9.	Barrios D, Yusen RD, Jiménez D. Risk stratification for proven acute pulmonary embolism: what information is needed? Semin Respir Crit Care Med, 2017, 38(1): 11-17.
10.	Morillo R, Moores L, Jiménez D. Prognostic scores for acute pulmonary embolism. Semin Thromb Hemost, 2017, 43(5): 486-492.
11.	Dentali F, Ageno W, Pomero F, et al. Time trends and case fatality rate of in-hospital treated pulmonary embolism during 11 years of observation in Northwestern Italy. Thromb Haemost, 2016, 115(2): 399-405.
12.	暨铭坚, 陈文利, 宫玉翠, 等. 国内肺栓塞危险因素的Meta分析. 中国实用护理杂志, 2014, 30(33): 62-66.
13.	Ne JYA, Chow V, Kritharides L, et al. Predictors for congestive heart failure hospitalization or death following acute pulmonary embolism: A population-linkage study. Int J Cardiol, 2019, 278: 162-166.
14.	Kuo TH, Li HY, Lin SH. Acute kidney injury and risk of deep vein thrombosis and pulmonary embolism in Taiwan: A nationwide retrospective cohort study. Thromb Res, 2017, 151: 29-35.
15.	Polo Friz H, Corno V, Orenti A, et al. Comorbidity assessment as predictor of short and long-term mortality in elderly patients with hemodynamically stable acute pulmonary embolism. J Thromb Thrombolysis, 2017, 44(3): 316-323.
16.	Mizuno A, Yamamoto T, Tanabe Y, et al. Pulmonary embolism severity index and simplified pulmonary embolism severity index risk scores are useful to predict mortality in Japanese patients with pulmonary embolism. Circ J, 2015, 79(4): 889-891.
17.	Kohn CG, Mearns ES, Parker MW, et al. Prognostic accuracy of clinical prediction rules for early post-pulmonary embolism all-cause mortality: a bivariate meta-analysis. Chest, 2015, 147(4): 1043-1062.
18.	Hoikka M, Silfvast T, Ala-Kokko TI. Does the prehospital National Early Warning Score predict the short-term mortality of unselected emergency patients? Scand J Trauma Resusc Emerg Med, 2018, 26(1): 48.
19.	王博, 王秀杰. 英国早期预警评分(NEWS)评估急重症的临床应用研究进展. 中国急救医学, 2014, (10): 945-948.
20.	Uppanisakorn S, Bhurayanontachai R, Boonyarat J, et al. National Early Warning Score (NEWS) at ICU discharge can predict early clinical deterioration after ICU transfer. J Crit Care, 2018, 43: 225-229.
21.	Donadini MP, Dentali F, Castellaneta M, et al. Pulmonary embolism prognostic factors and length of hospital stay: a cohort study. Thromb Res, 2017, 156: 155-159.
22.	周洪, 綦俊, 张奇, 等. 心肌型脂肪酸结合蛋白联合APACHEⅡ评分对急性肺栓塞病情严重程度及预后的评估价值. 中华胸心血管外科杂志, 2017, 33(4): 204-207.
23.	Bach AG, Taute BM, Baasai N, et al. 30-day mortality in acute pulmonary embolism: prognostic value of clinical scores and anamnestic features. PLoS One, 2016, 11(2): e0148728.
24.	McIntyre KM, Sasahara AA. The hemodynamic response to pulmonary embolism in patients without prior cardiopulmonary disease. Am J Cardiol, 1971, 28(3): 288-294.
25.	Sista AK, Kuo WT, Schiebler M, et al. Stratification, imaging, and management of acute massive and submassive pulmonary embolism. Radiology, 2017, 284(1): 5-24.
26.	Cho JH, Kutti Sridharan G, Kim SH, et al. Right ventricular dysfunction as an echocardiographic prognostic factor in hemodynamically stable patients with acute pulmonary embolism: a meta-analysis. BMC Cardiovasc Disord, 2014, 14: 64.
27.	Keller K, Beule J, Coldewey M, et al. The risk factor age in normotensive patients with pulmonary embolism: Effectiveness of age in predicting submassive pulmonary embolism, cardiac injury, right ventricular dysfunction and elevated systolic pulmonary artery pressure in normotensive pulmonary embolism patients. Exp Gerontol, 2015, 69: 116-121.
28.	Keller K, Beule J, Coldewey M, et al. Heart rate in pulmonary embolism. Intern Emerg Med, 2015, 10(6): 663-669.
29.	Li H, Kang L, Sun Y. Clinical value of cardiac color ultrasound and cardiac troponin T combined with dynamic electrocardiogram in treatment of acute pulmonary embolism. Exp Ther Med, 2018, 15(2): 2044-2048.
30.	Ng AC, Yong AS, Chow V, et al. Cardiac troponin-T and the prediction of acute and long-term mortality after acute pulmonary embolism. Int J Cardiol, 2013, 165(1): 126-133.
31.	Ozsu S, Abul Y, Orem A, et al. Predictive value of troponins and simplified pulmonary embolism severity index in patients with normotensive pulmonary embolism. Multidiscip Respir Med, 2013, 8(1): 34.
32.	Cavuş UY, Yildirim S, Sönmez E, et al. Prognostic value of neutrophil/lymphocyte ratio in patients with pulmonary embolism. Turk J Med Sci, 2014, 44(1): 50-55.
33.	Wang Q, Ma J, Jiang Z, et al. Prognostic value of neutrophil-to-lymphocyte ratio and platelet-to-lymphocyte ratio in acute pulmonary embolism: a systematic review and meta-analysis. Int Angiol, 2018, 37(1): 4-11.
34.	Jun YJ, Young LM, Wook LJ, et al. Leukocytes and systemic inflammatory response syndrome as prognostic factors in pulmonary embolism patients. BMC Pulm Med, 2013, 13: 74.
35.	Pilato F, Calandrelli R, Profice P, et al. Pulmonary embolism in a stroke patient after systemic thrombolysis: clinical decisions and literature review. J Stroke Cerebrovasc Dis, 2013, 22(8): e667-e670.
36.	Kalva SP, Somarouthu B, Hirsch J. Inferior vena cava filters for the cerebrovascular patient. J Neurointerv Surg, 2011, 3(2): 137-140.
37.	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.
38.	Liu X, Chang S, Fu C, et al. Predictors of mid-term prognosis and adverse factors in acute pulmonary embolism. Ther Adv Respir Dis, 2017, 11(8): 293-300.

1. Konstantinides SV. 2014 ESC Guidelines on the diagnosis and management of acute pulmonary embolism. Eur Heart J, 2014, 35(45): 3145-3146.
2. Kupis RW, Goldman-Mazur S, Polak M, et al. Faster fibrin clot degradation characterizes patients with central pulmonary embolism at a low risk of recurrent peripheral embolism. Sci Rep, 2019, 9(1): 72.
3. Giordano NJ, Jansson PS, Young MN, et al. Epidemiology, pathophysiology, stratification, and natural history of pulmonary embolism. Tech Vasc Interv Radiol, 2017, 20(3): 135-140.
4. Elias A, Mallett S, Daoud-Elias M, et al. Prognostic models in acute pulmonary embolism: a systematic review and meta-analysis. BMJ Open, 2016, 6(4): e010324.
5. 周海霞, 唐永江, 王岚, 等. 肺栓塞远期死亡危险因素及Charlson合并症指数的预测价值. 中华医学杂志, 2016, 96(4): 273-276.
6. Chen RX, Wang HZ, Dong J, et al. Pulmonary embolism in non-brain tumor patients after surgery-a retrospective study in China. World J Surg Oncol, 2017, 15(1): 22.
7. 中华医学会呼吸病学分会肺栓塞与肺血管病学组, 中国医师协会呼吸医师分会肺栓塞与肺血管病工作委员会, 全国肺栓塞与肺血管病防治协作组. 肺血栓栓塞症诊治与预防指南. 中华医学杂志, 2018, 98(14): 1060-1087.
8. Jia D, Liu F, Zhang Q, et al. Rapid on-site evaluation of routine biochemical parameters to predict right ventricular dysfunction in and the prognosis of patients with acute pulmonary embolism upon admission to the emergency room. J Clin Lab Anal, 2018, 32(4): e22362.
9. Barrios D, Yusen RD, Jiménez D. Risk stratification for proven acute pulmonary embolism: what information is needed? Semin Respir Crit Care Med, 2017, 38(1): 11-17.
10. Morillo R, Moores L, Jiménez D. Prognostic scores for acute pulmonary embolism. Semin Thromb Hemost, 2017, 43(5): 486-492.
11. Dentali F, Ageno W, Pomero F, et al. Time trends and case fatality rate of in-hospital treated pulmonary embolism during 11 years of observation in Northwestern Italy. Thromb Haemost, 2016, 115(2): 399-405.
12. 暨铭坚, 陈文利, 宫玉翠, 等. 国内肺栓塞危险因素的Meta分析. 中国实用护理杂志, 2014, 30(33): 62-66.
13. Ne JYA, Chow V, Kritharides L, et al. Predictors for congestive heart failure hospitalization or death following acute pulmonary embolism: A population-linkage study. Int J Cardiol, 2019, 278: 162-166.
14. Kuo TH, Li HY, Lin SH. Acute kidney injury and risk of deep vein thrombosis and pulmonary embolism in Taiwan: A nationwide retrospective cohort study. Thromb Res, 2017, 151: 29-35.
15. Polo Friz H, Corno V, Orenti A, et al. Comorbidity assessment as predictor of short and long-term mortality in elderly patients with hemodynamically stable acute pulmonary embolism. J Thromb Thrombolysis, 2017, 44(3): 316-323.
16. Mizuno A, Yamamoto T, Tanabe Y, et al. Pulmonary embolism severity index and simplified pulmonary embolism severity index risk scores are useful to predict mortality in Japanese patients with pulmonary embolism. Circ J, 2015, 79(4): 889-891.
17. Kohn CG, Mearns ES, Parker MW, et al. Prognostic accuracy of clinical prediction rules for early post-pulmonary embolism all-cause mortality: a bivariate meta-analysis. Chest, 2015, 147(4): 1043-1062.
18. Hoikka M, Silfvast T, Ala-Kokko TI. Does the prehospital National Early Warning Score predict the short-term mortality of unselected emergency patients? Scand J Trauma Resusc Emerg Med, 2018, 26(1): 48.
19. 王博, 王秀杰. 英国早期预警评分(NEWS)评估急重症的临床应用研究进展. 中国急救医学, 2014, (10): 945-948.
20. Uppanisakorn S, Bhurayanontachai R, Boonyarat J, et al. National Early Warning Score (NEWS) at ICU discharge can predict early clinical deterioration after ICU transfer. J Crit Care, 2018, 43: 225-229.
21. Donadini MP, Dentali F, Castellaneta M, et al. Pulmonary embolism prognostic factors and length of hospital stay: a cohort study. Thromb Res, 2017, 156: 155-159.
22. 周洪, 綦俊, 张奇, 等. 心肌型脂肪酸结合蛋白联合APACHEⅡ评分对急性肺栓塞病情严重程度及预后的评估价值. 中华胸心血管外科杂志, 2017, 33(4): 204-207.
23. Bach AG, Taute BM, Baasai N, et al. 30-day mortality in acute pulmonary embolism: prognostic value of clinical scores and anamnestic features. PLoS One, 2016, 11(2): e0148728.
24. McIntyre KM, Sasahara AA. The hemodynamic response to pulmonary embolism in patients without prior cardiopulmonary disease. Am J Cardiol, 1971, 28(3): 288-294.
25. Sista AK, Kuo WT, Schiebler M, et al. Stratification, imaging, and management of acute massive and submassive pulmonary embolism. Radiology, 2017, 284(1): 5-24.
26. Cho JH, Kutti Sridharan G, Kim SH, et al. Right ventricular dysfunction as an echocardiographic prognostic factor in hemodynamically stable patients with acute pulmonary embolism: a meta-analysis. BMC Cardiovasc Disord, 2014, 14: 64.
27. Keller K, Beule J, Coldewey M, et al. The risk factor age in normotensive patients with pulmonary embolism: Effectiveness of age in predicting submassive pulmonary embolism, cardiac injury, right ventricular dysfunction and elevated systolic pulmonary artery pressure in normotensive pulmonary embolism patients. Exp Gerontol, 2015, 69: 116-121.
28. Keller K, Beule J, Coldewey M, et al. Heart rate in pulmonary embolism. Intern Emerg Med, 2015, 10(6): 663-669.
29. Li H, Kang L, Sun Y. Clinical value of cardiac color ultrasound and cardiac troponin T combined with dynamic electrocardiogram in treatment of acute pulmonary embolism. Exp Ther Med, 2018, 15(2): 2044-2048.
30. Ng AC, Yong AS, Chow V, et al. Cardiac troponin-T and the prediction of acute and long-term mortality after acute pulmonary embolism. Int J Cardiol, 2013, 165(1): 126-133.
31. Ozsu S, Abul Y, Orem A, et al. Predictive value of troponins and simplified pulmonary embolism severity index in patients with normotensive pulmonary embolism. Multidiscip Respir Med, 2013, 8(1): 34.
32. Cavuş UY, Yildirim S, Sönmez E, et al. Prognostic value of neutrophil/lymphocyte ratio in patients with pulmonary embolism. Turk J Med Sci, 2014, 44(1): 50-55.
33. Wang Q, Ma J, Jiang Z, et al. Prognostic value of neutrophil-to-lymphocyte ratio and platelet-to-lymphocyte ratio in acute pulmonary embolism: a systematic review and meta-analysis. Int Angiol, 2018, 37(1): 4-11.
34. Jun YJ, Young LM, Wook LJ, et al. Leukocytes and systemic inflammatory response syndrome as prognostic factors in pulmonary embolism patients. BMC Pulm Med, 2013, 13: 74.
35. Pilato F, Calandrelli R, Profice P, et al. Pulmonary embolism in a stroke patient after systemic thrombolysis: clinical decisions and literature review. J Stroke Cerebrovasc Dis, 2013, 22(8): e667-e670.
36. Kalva SP, Somarouthu B, Hirsch J. Inferior vena cava filters for the cerebrovascular patient. J Neurointerv Surg, 2011, 3(2): 137-140.
37. 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.
38. Liu X, Chang S, Fu C, et al. Predictors of mid-term prognosis and adverse factors in acute pulmonary embolism. Ther Adv Respir Dis, 2017, 11(8): 293-300.

Chinese Journal of Evidence-Based Medicine

APACHEⅡ, NEWS, PESI and CCI for predicting mortality in patients with pulmonary embolism: a comparative study

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