Jiménez David, Aujesky Drahomir, Moores Lisa, Gómez Vicente, Lobo José Luis, Uresandi Fernando, Otero Remedios, Monreal Manuel, Muriel Alfonso, Yusen Roger D
Respiratory Department , Hospital Ramón y Cajal and Alcalá de Henares University, 28034 Madrid, Spain.
Arch Intern Med. 2010 Aug 9;170(15):1383-9. doi: 10.1001/archinternmed.2010.199.
The Pulmonary Embolism Severity Index (PESI) estimates the risk of 30-day mortality in patients with acute pulmonary embolism (PE). We constructed a simplified version of the PESI.
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 PESI performances were compared in the derivation cohort. The simplified PESI underwent retrospective external validation in an independent multinational cohort (Registro Informatizado de la Enfermedad Tromboembólica [RIETE] cohort) of outpatients.
In the derivation data set, univariate logistic regression of the original 11 PESI 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.
The simplified PESI has similar prognostic accuracy and clinical utility and greater ease of use compared with the original PESI.
肺栓塞严重程度指数（PESI）用于评估急性肺栓塞（PE）患者30天死亡率的风险。我们构建了一个简化版的PESI。
本研究回顾性地制定了一个简化的PESI临床预测规则，用于评估西班牙门诊患者推导队列中30天死亡率的风险。在推导队列中比较了简化版和原版PESI的性能。简化版PESI在一个独立的多国门诊患者队列（静脉血栓栓塞疾病信息登记处[RIETE]队列）中进行了回顾性外部验证。
在推导数据集中，对原版11个PESI变量进行单因素逻辑回归，剔除未达到统计学显著性的变量，随后生成了包含年龄、癌症、慢性心肺疾病、心率、收缩压和氧合血红蛋白饱和度水平等变量的简化版PESI。原版和简化版PESI评分的预后准确性无差异（曲线下面积，0.75[95%置信区间（CI），0.69 - 0.80]）。简化版PESI分类为低风险的995例患者中有305例（30.7%）30天死亡率为1.0%（95%CI，0.0% - 2.1%），而高风险组为10.9%（8.5% - 13.2%）。在RIETE验证队列中，简化版PESI分类为低风险的7106例患者中有2569例（36.2%）30天死亡率为1.1%（95%CI，0.7% - 1.5%），高风险组为8.9%（8.1% - 9.8%）。
与原版PESI相比，简化版PESI具有相似的预后准确性和临床实用性，且使用更简便。
