Department of Cardiology, Loyola University Medical Center, Maywood, IL, USA.
Department of Medicine, Loyola University Medical Center, Maywood, IL, USA.
Clin Appl Thromb Hemost. 2024 Jan-Dec;30:10760296241278353. doi: 10.1177/10760296241278353.
To construct a new scoring system utilizing biomarkers, vitals, and imaging data to predict 30-day mortality in acute pulmonary embolism (PE).
Acute PE, a well-known manifestation of venous thromboembolic disease, is responsible for over 100,000 deaths worldwide yearly. Contemporary management algorithms rely on a multidisciplinary approach to care via PE response teams (PERT) in the identification of low, intermediate, and high-risk patients. The PESI and sPESI scores have been used as cornerstones of the triage process in assigning risk of 30-day mortality for patients presenting with acute PE; however, the specificity of these scoring systems has often come into question.
This study retrospectively analyzed 488 patients with acute PE who were managed at a tertiary care institution with either conservative therapy consisting of low molecular weight or unfractionated heparin, advanced therapies consisting of catheter directed therapies, aspiration thrombectomy, or a combination of these therapies, or surgical embolectomy. The CLOT-5 score was designed to include vital signs, biomarkers, and imaging data to predict 30-day mortality in patients presenting with acute PE.
The CLOT-5 score had an area under the curve (AUC) of 0.901 with a standard error of 0.29, while the PESI and sPESI scores had an AUC and standard errors of 0.793 ±- 0.43 and 0.728 ± 0.55, respectively.
When incorporated into the management algorithms of national PERT programs, the CLOT-5 score may allow for rapid and comprehensive assessment of patients with acute PE at high risk for clinical decompensation, leading to early escalation of care where appropriate.
利用生物标志物、生命体征和影像学数据构建新的评分系统，以预测急性肺栓塞（PE）患者 30 天死亡率。
急性 PE 是静脉血栓栓塞性疾病的一种常见表现，每年在全球导致超过 10 万人死亡。当代管理算法依赖于通过 PE 反应团队（PERT）对低、中、高危患者进行多学科护理的方法。PESI 和 sPESI 评分已被用作急性 PE 患者分诊过程中评估 30 天死亡率风险的基石；然而，这些评分系统的特异性经常受到质疑。
本研究回顾性分析了在一家三级医疗机构接受治疗的 488 例急性 PE 患者，治疗方法包括低分子肝素或未分级肝素的保守治疗、导管定向治疗、抽吸血栓切除术或这些治疗方法的联合治疗，或手术取栓术。CLOT-5 评分旨在纳入生命体征、生物标志物和影像学数据，以预测急性 PE 患者 30 天死亡率。
CLOT-5 评分的曲线下面积（AUC）为 0.901，标准误差为 0.29，而 PESI 和 sPESI 评分的 AUC 和标准误差分别为 0.793±0.43 和 0.728±0.55。
当纳入国家 PERT 计划的管理算法中时，CLOT-5 评分可用于快速全面评估有临床失代偿风险的急性 PE 患者，从而在适当情况下尽早升级护理。
