Department of Radiology, Neuroradiology and Nuclear Medicine, Johannes Wesling University Hospital, Ruhr University Bochum, Minden, Germany.
Department of Radiology and Nuclear Medicine, Otto-von-Guericke University Magdeburg, Leipziger Str. 44, 39120, Magdeburg, Germany.
Respir Res. 2023 Aug 5;24(1):195. doi: 10.1186/s12931-023-02489-0.
Acute pulmonary embolism (APE) is a hazardous disorder with a high mortality. Combination of clinical, radiological, and serological parameters can improve risk stratification of APE. Most of the proposed combined scores were not validated in independent cohorts. Our aim was to validate the proposed clinical-radiological scores for prognosis of 7- and 30-day mortality in APE.
Our sample comprised 531 patients with APE, mean age 64.8 ± 15.6 years, 221 (41.6%) females and 310 (58.4%) males. The following parameters were collected: Age and sex of the patients, mortality within the observation time of 30 days, simplified pulmonary embolism severity index (sPESI), pH troponin level (pg/ml), minimal systolic and diastolic blood pressures (mmHg), heart rate, O saturation, episodes of syncope, and need for vasopressors. On CT pulmonary angiography (CTPA), short axis ratio right ventricle/left ventricle (RV/LV), and reflux of contrast medium into the inferior vena cava were obtained. The following clinical-radiological scores were calculated: BOVA score, pulmonary embolism mortality score (PEMS), European Society of Cardiology (ESC) score, Kumamaru score, and Calgary acute pulmonary embolism (CAPE) score.
Overall, 31 patients (5.8%) died within seven and 64 patients (12%) within 30 days. All scores showed high negative prognostic values ranging from 89.0 to 99.0%. PEMS and CAPE score demonstrated the highest specificity for 7-day mortality (93.4% and 85.0%), PEMS and BOVA for 30-day mortality (94.2% and 90.4%). The highest sensitivity was observed for ESC 2019 (96.8% and 95.3%). Kumamaru and CAPE scores had low sensitivity. All scores had low positive and high negative predictive values.
For prognosis of 7- and 30-day mortality in APE, PEMS score has the highest specificity. ESC 2019 shows the highest sensitivity. All scores had low positive and high negative predictive values.
急性肺栓塞（APE）是一种死亡率较高的危险疾病。将临床、影像学和血清学参数相结合可以提高 APE 的风险分层。大多数提出的联合评分都没有在独立队列中得到验证。我们的目的是验证用于预测 APE 7 天和 30 天死亡率的临床-影像学评分。
我们的样本包括 531 名 APE 患者，平均年龄为 64.8±15.6 岁，221 名（41.6%）女性和 310 名（58.4%）男性。收集了以下参数：患者的年龄和性别、观察期内 30 天内的死亡率、简化的肺栓塞严重程度指数（sPESI）、肌钙蛋白 pH 值（pg/ml）、最小收缩压和舒张压（mmHg）、心率、O 饱和度、晕厥发作次数和血管加压素需求。在 CT 肺动脉造影（CTPA）上，获得右心室/左心室（RV/LV）的短轴比和对比剂回流至下腔静脉。计算了以下临床-影像学评分：BOVA 评分、肺栓塞死亡率评分（PEMS）、欧洲心脏病学会（ESC）评分、Kumamaru 评分和卡尔加里急性肺栓塞（CAPE）评分。
总共有 31 名（5.8%）患者在 7 天内死亡，64 名（12%）患者在 30 天内死亡。所有评分的预后价值均较高，范围从 89.0 到 99.0%。PEMS 和 CAPE 评分对 7 天死亡率具有最高的特异性（93.4%和 85.0%），PEMS 和 BOVA 评分对 30 天死亡率具有最高的特异性（94.2%和 90.4%）。ESC 2019 评分的灵敏度最高（96.8%和 95.3%）。Kumamaru 和 CAPE 评分的灵敏度较低。所有评分的阳性预测值较低，阴性预测值较高。
对于 APE 7 天和 30 天死亡率的预后，PEMS 评分的特异性最高。ESC 2019 评分的灵敏度最高。所有评分的阳性预测值较低，阴性预测值较高。
