University of Ottawa and the Ottawa Hospital Research Institute, Ottawa, ON, Canada.
Baylor College of Medicine, Houston, TX, USA.
J Thromb Thrombolysis. 2019 Jul;48(1):149-157. doi: 10.1007/s11239-019-01814-z.
Various risk stratification methods exist for patients with pulmonary embolism (PE). We used the simplified Pulmonary Embolism Severity Index (sPESI) as a risk-stratification method to understand the Veterans Health Administration (VHA) PE population.
Adult patients with ≥ 1 inpatient PE diagnosis (index date = discharge date) from October 2011-June 2015 as well as continuous enrollment for ≥ 12 months pre- and 3 months post-index date were included. We defined a sPESI score of 0 as low-risk (LRPE) and all others as high-risk (HRPE). Hospital-acquired complications (HACs) during the index hospitalization, 90-day follow-up PE-related outcomes, and health care utilization and costs were compared between HRPE and LRPE patients.
Of 6746 PE patients, 95.4% were men, 67.7% were white, and 22.0% were African American; LRPE occurred in 28.4% and HRPE in 71.6%. Relative to HRPE patients, LRPE patients had lower Charlson Comorbidity Index scores (1.0 vs. 3.4, p < 0.0001) and other baseline comorbidities, fewer HACs (11.4% vs. 20.0%, p < 0.0001), less bacterial pneumonia (10.6% vs. 22.3%, p < 0.0001), and shorter average inpatient lengths of stay (8.8 vs. 11.2 days, p < 0.0001) during the index hospitalization. During follow-up, LRPE patients had fewer PE-related outcomes of recurrent venous thromboembolism (4.4% vs. 6.0%, p = 0.0077), major bleeding (1.2% vs. 1.9%, p = 0.0382), and death (3.7% vs. 16.2%, p < 0.0001). LRPE patients had fewer inpatient but higher outpatient visits per patient, and lower total health care costs ($12,021 vs. $16,911, p < 0.0001) than HRPE patients.
Using the sPESI score identifies a PE cohort with a lower clinical and economic burden.
对于肺栓塞（PE）患者，存在多种风险分层方法。我们使用简化的肺栓塞严重程度指数（sPESI）作为风险分层方法，以了解退伍军人健康管理局（VHA）的 PE 人群。
纳入 2011 年 10 月至 2015 年 6 月期间至少有一次住院 PE 诊断（索引日期=出院日期）且在索引日期前 12 个月和后 3 个月持续连续入组的成年患者。我们将 sPESI 评分为 0 定义为低危（LRPE），其余均为高危（HRPE）。比较 HRPE 和 LRPE 患者的索引住院期间发生的医院获得性并发症（HAC）、90 天随访期间的 PE 相关结局、以及卫生保健利用和费用。
在 6746 例 PE 患者中，95.4%为男性，67.7%为白人，22.0%为非裔美国人；LRPE 占 28.4%，HRPE 占 71.6%。与 HRPE 患者相比，LRPE 患者的 Charlson 合并症指数评分较低（1.0 比 3.4，p<0.0001），且合并其他基础疾病较少，HAC 发生率较低（11.4%比 20.0%，p<0.0001），细菌性肺炎较少（10.6%比 22.3%，p<0.0001），且住院期间平均住院时间较短（8.8 天比 11.2 天，p<0.0001）。在随访期间，LRPE 患者的 PE 相关复发静脉血栓栓塞症（4.4%比 6.0%，p=0.0077）、大出血（1.2%比 1.9%，p=0.0382）和死亡（3.7%比 16.2%，p<0.0001）结局较少。LRPE 患者的住院就诊次数较少，但门诊就诊次数较高，每位患者的总医疗费用较低（12021 美元比 16911 美元，p<0.0001）。
使用 sPESI 评分可确定临床和经济负担较低的 PE 患者队列。
