Özkan Abuzer, Özdemir Serdar
Department of Emergency Medicine, University of Health Sciences Bağcılar Training and Research Hospital, Istanbul, Turkey.
Department of Emergency Medicine, University of Health Sciences Ümraniye Training and Research Hospital, Site Mahallesi, Adıvar sokak, No 44/15 Ümraniye, Istanbul, Turkey.
Egypt Heart J. 2024 Aug 9;76(1):101. doi: 10.1186/s43044-024-00531-0.
Pulmonary embolism (PE) is an important cause of mortality and morbidity in the geriatric population. We aimed to compare the ability of the pulmonary embolism severity index (PESI), rapid emergency medicine score (REMS), and hypotension, oxygen saturation, low temperature, electrocardiogram change, and loss of independence (HOTEL) to predict prognosis and intensive care requirement in geriatric patient with PE.
The median age of 132 patients was 77 (71-82) years. PESI was higher in the non-survivor group [132 (113-172)] (P =0.001). The median REMS was 8 (7-10), and it was higher in the non-survivor group [10 (7.5-12.0)] (p = 0.005). The median HOTEL score was 1 (0-2) in the whole cohort and 2 (1-3) in the non-survivor group, indicating significant difference compared to the survivor group (P = 0.001). The area under the curve (AUC) values of HOTEL, REMS, and PESI were determined as 0.72, 0.65, and 0.71, respectively. For the prediction of intensive care requirement, the AUC values of HOTEL, REMS, and PESI were 0.76, 0.75, and 0.76, respectively, with no significant difference in pairwise comparisons (PESI vs. REMS: p = 0.520, HOTEL vs. PESI: P = 0.526, REMS vs. HOTEL: P = 0.669, overall test: P = 0.96, DeLong's test). The risk ratios of HOTEL and PESI were parallel to each other [5.31 (95% confidence interval (CI): 2.53-11.13) and 5.34 (95% CI: 2.36-12.08), respectively].
HOTEL and REMS were as successful as PESI in predicting short-term mortality and intensive care requirement in geriatric patients with PE. These scores are also more practical since they have fewer parameters than PESI.
肺栓塞（PE）是老年人群死亡和发病的重要原因。我们旨在比较肺栓塞严重程度指数（PESI）、快速急诊医学评分（REMS）以及低血压、血氧饱和度、低温、心电图改变和生活不能自理（HOTEL）评分预测老年PE患者预后和重症监护需求的能力。
132例患者的中位年龄为77（71 - 82）岁。非存活组的PESI更高[132（113 - 172）]（P = 0.001）。REMS的中位数为8（7 - 10），非存活组更高[10（7.5 - 12.0）]（P = 0.005）。整个队列的HOTEL评分中位数为1（0 - 2），非存活组为2（1 - 3），与存活组相比差异有统计学意义（P = 0.001）。HOTEL、REMS和PESI的曲线下面积（AUC）值分别确定为0.72、0.65和0.71。对于重症监护需求的预测，HOTEL、REMS和PESI的AUC值分别为0.76、0.75和0.76，两两比较无显著差异（PESI与REMS比较：P = 0.520，HOTEL与PESI比较：P = 0.526，REMS与HOTEL比较：P = 0.669，总体检验：P = 0.96，德龙检验）。HOTEL和PESI的风险比相互平行[分别为5.31（95%置信区间（CI）：2.53 - 11.13）和5.34（95%CI：2.36 - 12.08）]。
在预测老年PE患者的短期死亡率和重症监护需求方面，HOTEL和REMS与PESI同样成功。这些评分也更实用，因为它们的参数比PESI少。
