Aujesky D, Perrier A, Roy P-M, Stone R A, Cornuz J, Meyer G, Obrosky D S, Fine M J
Division of General Internal Medicine, University Outpatient Clinic, Clinical Epidemiology Center, University of Lausanne, Lausanne, Switzerland.
J Intern Med. 2007 Jun;261(6):597-604. doi: 10.1111/j.1365-2796.2007.01785.x.
To validate the Pulmonary Embolism Severity Index (PESI), a clinical prognostic model which identifies low-risk patients with pulmonary embolism (PE).
Validation study using prospectively collected data.
A total of 119 European hospitals.
A total of 899 patients diagnosed with PE.
The PESI uses 11 clinical factors to stratify patients with PE into five classes (I-V) of increasing risk of mortality. We calculated the PESI risk class for each patient and the proportion of patients classified as low-risk (classes I and II). The outcomes were overall and PE-specific mortality for low-risk patients at 3 months after presentation. We calculated the sensitivity, specificity and predictive values to predict overall and PE-specific mortality and the discriminatory power using the area under the receiver operating characteristic curve.
Overall and PE-specific mortality was 6.5% (58/899) and 2.3% (21/899) respectively. Forty-seven per cent of patients (426/899) were classified as low-risk. Low-risk patients had an overall mortality of only 1.2% (5/426) and a PE-specific mortality of 0.7% (3/426). The sensitivity was 91 [95% confidence interval (CI): 81-97%] and the negative predictive value was 99% (95% CI: 97-100%) for overall mortality. The sensitivity was 86% (95% CI: 64-97%) and the negative predictive value was 99% (95% CI: 98-100%) for PE-specific mortality. The areas under the receiver operating characteristic curve for overall and PE-specific mortality were 0.80 (95% CI: 0.75-0.86) and 0.77 (95% CI: 0.68-0.86) respectively.
This validation study confirms that the PESI reliably identifies low-risk patients with PE who are potential candidates for less costly outpatient treatment.
验证肺栓塞严重程度指数（PESI），这是一种用于识别低风险肺栓塞（PE）患者的临床预后模型。
使用前瞻性收集的数据进行验证研究。
共119家欧洲医院。
共899例诊断为PE的患者。
PESI使用11个临床因素将PE患者分为死亡风险递增的五个类别（I - V）。我们计算了每位患者的PESI风险类别以及被归类为低风险（I类和II类）患者的比例。结局指标为就诊后3个月时低风险患者的全因死亡率和PE特异性死亡率。我们计算了预测全因死亡率和PE特异性死亡率的敏感性、特异性和预测值，并使用受试者工作特征曲线下面积计算鉴别力。
全因死亡率和PE特异性死亡率分别为6.5%（58/899）和2.3%（21/899）。47%的患者（426/899）被归类为低风险。低风险患者的全因死亡率仅为1.2%（5/426），PE特异性死亡率为0.7%（3/426）。全因死亡率的敏感性为91%[95%置信区间（CI）：81 - 97%]，阴性预测值为99%（95%CI：97 - 100%）。PE特异性死亡率的敏感性为86%（95%CI：64 - 97%），阴性预测值为99%（95%CI：98 - 100%）。全因死亡率和PE特异性死亡率的受试者工作特征曲线下面积分别为0.80（95%CI：0.75 - 0.86）和0.77（95%CI：0.68 - 0.86）。
这项验证研究证实，PESI能够可靠地识别出低风险的PE患者，这些患者有可能成为成本较低的门诊治疗的候选对象。
