老年肺栓塞患者临床预后评分的前瞻性比较。
Prospective comparison of clinical prognostic scores in elder patients with a pulmonary embolism.
机构信息
Division of General Internal Medicine, Bern University Hospital, Bern Clinical Trials Unit Bern, Department of Clinical Research, University of Bern, Bern Division of Angiology and Hemostasis, Geneva University Hospital, Geneva Department of Angiology, Basel University Hospital, Basel Cantonal Hospital of Baden, Baden Department of Internal Medicine, Cantonal Hospital of Frauenfeld, Frauenfeld Emergency Department, Cantonal Hospital of St. Gallen, St. Gallen Division of Angiology, Bern University Hospital, Bern Cardiovascular Research, Institute of Physiology, Zurich Center for Integrative Human Physiology, University of Zurich, Zurich Division of Angiology, Cantonal Hospital of Lucerne, Lucerne Service and Central Laboratory of Hematology, Lausanne University Hospital, Lausanne Division of Haematology and Central Haematology Laboratory, Bern University Hospital, Bern Division of Angiology, Lausanne University Hospital, Lausanne Emergency Department, Lausanne University Hospital, Lausanne Division of Angiology, Zurich University Hospital, Zurich Department of Ambulatory Care and Community Medicine, University of Lausanne, Lausanne, Switzerland.
出版信息
J Thromb Haemost. 2012 Nov;10(11):2270-6. doi: 10.1111/j.1538-7836.2012.04929.x.
BACKGROUND
The Geneva Prognostic Score (GPS), the Pulmonary Embolism Severity Index (PESI) and its simplified version (sPESI) are well-known clinical prognostic scores for a pulmonary embolism (PE).
OBJECTIVES
To compare the prognostic performance of these scores in elderly patients with a PE.
PATIENTS AND METHODS
In a multicenter Swiss cohort of elderly patients with venous thromboembolism, we prospectively studied 449 patients aged ≥ 65 years with a symptomatic PE. The outcome was 30-day overall mortality. We dichotomized patients as low vs. higher risk in all three scores using the following thresholds: GPS scores ≤ 2 vs. > 2, PESI risk classes I-II vs. III-V and sPESI scores 0 vs. ≥ 1. We compared 30-day mortality in low- vs. higher-risk patients and the areas under the receiver-operating characteristic curve (ROC).
RESULTS
Overall, 3.8% of patients (17/449) died within 30 days. The GPS classified a greater proportion of patients as low risk (92% [413/449]) than the PESI (36.3% [163/449]) and the sPESI (39.6% [178/449]) (P < 0.001 for each comparison). Low-risk patients based on the sPESI had a mortality of 0% (95% confidence interval [CI] 0-2.1%) compared with 0.6% (95% CI 0-3.4%) for low-risk patients based on the PESI and 3.4% (95% CI 1.9-5.6%) for low-risk patients based on the GPS. The areas under the ROC curves were 0.77 (95% CI 0.72-0.81), 0.76 (95% CI 0.72-0.80) and 0.71 (95% CI 0.66-0.75), respectively (P = 0.47).
CONCLUSIONS
In this cohort of elderly patients with PE, the GPS identified a higher proportion of patients as low risk but the PESI and sPESI were more accurate in predicting mortality.
背景
日内瓦预后评分（GPS）、肺栓塞严重指数（PESI）及其简化版（sPESI）是众所周知的用于评估肺栓塞（PE）的临床预后评分。
目的
比较这些评分在老年 PE 患者中的预后表现。
患者与方法
在一项多中心瑞士静脉血栓栓塞症老年患者队列研究中，我们前瞻性研究了 449 名年龄≥65 岁且有症状性 PE 的患者。结局为 30 天总体死亡率。我们使用以下阈值将所有三种评分中的患者分为低危与高危：GPS 评分≤2 与＞2，PESI 风险类别 I-II 与 III-V 和 sPESI 评分 0 与≥1。我们比较了低危与高危患者的 30 天死亡率和受试者工作特征曲线（ROC）下面积。
结果
总体而言，30 天内有 3.8%的患者（17/449）死亡。GPS 分类为低危的患者比例（92%[413/449]）高于 PESI（36.3%[163/449]）和 sPESI（39.6%[178/449]）（每项比较均 P＜0.001）。基于 sPESI 的低危患者的死亡率为 0%（95%置信区间[CI]0-2.1%），而基于 PESI 的低危患者的死亡率为 0.6%（95%CI0-3.4%），基于 GPS 的低危患者的死亡率为 3.4%（95%CI1.9-5.6%）。ROC 曲线下面积分别为 0.77（95%CI0.72-0.81）、0.76（95%CI0.72-0.80）和 0.71（95%CI0.66-0.75）（P=0.47）。
结论
在本队列研究中，GPS 确定了更高比例的患者为低危，但 PESI 和 sPESI 对死亡率的预测更准确。
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