Simplification of the Pulmonary Embolism Severity Index for Prognostication in Patients With Acute Symptomatic Pulmonary Embolism
Simplification of the Pulmonary Embolism Severity Index for Prognostication in Patients With Acute Symptomatic Pulmonary Embolism
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DOI：
10.1001/archinternmed.2010.199
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发表时间：
2010-08-09
影响因子：
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通讯作者：
Yusen, Roger D.
中科院分区：
文献类型：
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作者：
Jimenez, David;Aujesky, Drahomir;Yusen, Roger D.
背景：肺栓塞严重性指数(PEST)评估急性肺栓塞(PE)患者30天死亡的风险：我们构建了PESI的简化版本。方法：该研究回顾开发了简化的PESI临床预测规则，用于在西班牙门诊队列中估计30天死亡的风险。在派生队列中比较了简化的和原始的PEST性能。简化的PEST在一个独立的多国门诊队列(Registro Informatizado de la Enfermedad Trombodelica[RIETE])队列中进行了回顾性的外部验证。结果：在派生数据集中，对原始的11个PEST变量进行了单变量Logistic回归，去掉了没有达到统计学意义的变量，随后得到了包含年龄、癌症、慢性心肺疾病、心率、收缩压和氧合血红蛋白饱和度等变量的简化PESI。原始和简化的PESI评分的预后准确性没有差异(曲线下面积，0.75[95%可信区间(CI)，0.69~0.80])。995例患者中，305例(30.7%)按简化PESI分类为低危患者，30天内死亡率为1.0%(95%可信区间为0.0%~2.1%)，而高危组为10.9%(8.5%~13.2%)。在RIETE验证队列中，在7106例(36.2%)被简化PESI归类为低风险的患者中，2569例(36.2%)30天死亡率为1.1%(95%CI，0.7%-1.5%)，而高危组为8.9%(8.1%-9.8%)。结论：简化PESI与原始PESI相比，具有相似的预后准确性和临床实用性，且更易于使用。
Background: The Pulmonary Embolism Severity Index (PEST) estimates the risk of 30-day mortality in patients with acute pulmonary embolism (PE): We constructed a simplified version of the PESI.Methods: The study retrospectively developed a simplified PESI clinical prediction rule for estimating the risk of 30-day mortality in a derivation cohort of Spanish outpatients. Simplified and original PEST performances were compared in the derivation cohort. The simplified PEST underwent retrospective external validation in an independent multinational cohort (Registro Informatizado de la Enfermedad Tromboembolica [RIETE] cohort) of outpatients.Results: In the derivation data set, univariate logistic regression of the original 11 PEST variables led to the removal of variables that did not reach statistical significance and subsequently produced the simplified PESI that contained the variables of age, cancer, chronic cardiopulmonary disease, heart rate, systolic blood pressure, and oxyhemoglobin saturation levels. The prognostic accuracy of the original and simplified PESI scores did not differ (area under the curve, 0.75 [95% confidence interval (CI), 0.69-0.80]). The 305 of 995 patients (30.7%) who were classified as low risk by the simplified PESI had a 30-day mortality of 1.0% (95% CI, 0.0%-2.1%) compared with 10.9% (8.5%-13.2%) in the high-risk group. In the RIETE validation cohort, 2569 of 7106 patients (36.2%) who were classified as low risk by the simplified PESI had a 30-day mortality of 1.1% (95% CI, 0.7%-1.5%) compared with 8.9% (8.1%-9.8%) in the high-risk group.Conclusion: The simplified PESI has similar prognostic accuracy and clinical utility and greater ease of use compared with the original PESI.