Background: Pulmonary embolism (PE) severity index, its simplified version (PESI,sPESI),and shock index (SI) are used for risk stratification. In this study we aimed to evaluate correlates and prognostic value of our modified (M) SI for patients (pts) with PE.
Methods: Study group comprised 251 pts with PE (female 144, age 61.4+18.1 years). Pre and post-treatment (PreT,PostT) quantification of right to left ventricular and atrial diameter ratio (RV/LV, RA/LA) and pulmonary arterial (PA) thrombotic burden as assessed by Qanadli score (QS) with multidetector computed tomography,PA pressures, tricuspid annular planary systolic excursion and tissue velocity as assessed by echo,biomarkers, and PESI,sPESI,SI and MSI calculations were performed in allpts. A formula [(heart rate/systolic blood pressure) x (1/SatO2%)] was used for calculation of MSI.
Results: The ultrasound-facilitated thrombolysis, rheolytic thrombectomy, tissue-type plasminogen activator and heparin were the treatment of choice in 31,1%, 10.8%, 20.7% and 37,3% ofpts, respectively. In-hospital mortality (IHM), major and minor bleeding, and composite of these end-points (CEP) were noted in 7.2%,5.2%, 4.8% and 14.7% of pts. Only SI (r=0.275, p=0.003) andMSI (r=0.26, p=0.006) showed a correlation to QS. The IHM was associated with PESI (p=0.003), SI (p=0.016), MSI (p=0.016),preT systolic PA pressure (p=0.005), preTandpostTsystolic blood pressure (p=0.003 and p<0.001),SatO2% (p=0.030 and p<0.001), postTheart rate (p<0.001) and RV/LV ratio>1 (p=0.016). Moreover, CEP was associated with PESI (p<0.001), sPESI (p=0.026), SI (p=0.004), MSI (p=0.005), preT and postTsystolic blood pressure (p=0.005 and p=0.016), SatO2% (p=0.006 and p=0.004), RV/LV ratio>1 (p=0.015 and p=0.002), systolic PA pressure (p=0.005 and p=0.016), D-dimer (p=0.04) and post heart rate (p<0.001). For IHM, sensitivity and specificity of (Sens, Spec) of PESI >115,5, SI >0,91, MSI >1,101 and QS >25,5 were 83% and 71%, 100% and 52%, 100% and 53%, and 67% and 59%, respectively. The highest area under curve values was noted with MSI (0,72; 0,57–0,88) and SI (0,71; 0,56–0,87) as compared to those with PESI (0,69; 0,44–0,94), and QS (0,59; 0,34–0,83).
Conclusions: Our MSI provides a simple and comprehensive tool for risk assessment before and after treatment in pts with acute PE.