F. Edward Hebert School of Medicine, Uniformed Services University, Bethesda, MD, USA.
Eur Respir J. 2013 Feb;41(2):354-9. doi: 10.1183/09031936.00225011. Epub 2012 Jun 27.
Although the Pulmonary Embolism Severity Index (PESI) accurately identifies 35% of patients with acute pulmonary embolism (PE) as being low risk, some patients deemed high risk by the PESI on admission might be treated safely in the outpatient environment. This retrospective cohort study included a total of 304 consecutive patients with acute PE, classified at the time of hospital admission into PESI class III. The PESI was recalculated 48 h after admission (PESI(48)) and each patient reclassified into the corresponding risk category. The primary outcome of the study was all-cause mortality between day 2 and day 30 after PE diagnosis. 26 (8.5%) patients (95% CI 5.4-11.7%) died between day 2 and day 30 after PE diagnosis. Investigators reclassified 83 (27.3%) patients (95% CI 22.3-32.3%) as low risk (classes I and II) at 48 h. 30-day mortality in these patients was 1.2% (95% CI 0-3.5%) as opposed to 11.3% (95% CI 7.1-15.5%) in those who remained high risk. The net improvement in reclassification was estimated at 54% (p<0.001). In a cohort of intermediate-risk patients with acute PE, calculation of the PESI(48) allows identification of those patients at very low risk of dying during the first month of follow-up.
尽管肺栓塞严重程度指数（PESI）能准确识别出 35%的急性肺栓塞（PE）患者为低危人群，但入院时被 PESI 判定为高危的部分患者可能可以在门诊环境中安全治疗。这项回顾性队列研究共纳入了 304 例连续的急性 PE 患者，在入院时被分为 PESI Ⅲ类。在入院后 48 小时重新计算 PESI（PESI(48)），并根据相应的风险类别对每位患者进行重新分类。研究的主要结局是 PE 诊断后第 2 天至第 30 天的全因死亡率。PE 诊断后第 2 天至第 30 天期间，共有 26 例（8.5%）患者（95%CI：5.4%-11.7%）死亡。研究人员在 48 小时后重新分类了 83 例（27.3%）患者（95%CI：22.3%-32.3%）为低危（I 类和 II 类）。这些患者的 30 天死亡率为 1.2%（95%CI：0%-3.5%），而高危患者的死亡率为 11.3%（95%CI：7.1%-15.5%）。重新分类的净改善估计为 54%（p<0.001）。在急性 PE 中危患者队列中，计算 PESI(48)可以识别出在随访的第一个月内死亡风险极低的患者。
