Derivación y validación de un modelo de riesgo para pacientes normotensos con tromboembolia de pulmón aguda sintomática

Abstract

Not all patients with acute pulmonary embolism (PE) have a high risk of an adverse short-term outcome. This prospective cohort study aimed to develop a multimarker prognostic model and a rule that accurately classifies normotensive patients with acute symptomatic PE into low and high categories of risk of adverse medical outcomes. Methods: The study enrolled 848 outpatients from the Spanish PROTECT study (derivation cohort), and 529 patients from the French PREP study (validation cohort). Investigators assessed study participants for a complicated course 30-days after the diagnosis of PE. Results: A complicated course occurred in 63 (7.4%) of the 848 normotensive patients with acute symptomatic PE in the derivation cohort, and in 24 patients (4.5%) in the validation cohort. The final model included four variables: the simplified Pulmonary Embolism Severity Index (sPESI), cardiac troponin I (cTnI), brain natriuretic peptide (BNP), and lower limb ultrasound testing (CCUS). The model performed similarly in the derivation (c-index of 0.75) and validation (c-index of 0.85) cohorts. The combination of the sPESI and BNP testing showed a negative predictive value for a complicated course of 99.1% (95% CI, 97.8-100%) and 100% in the derivation and validation cohorts, respectively. The combination of all modalities had a positive predictive value for the prediction of a complicated course of 25.8% (95% CI, 10.4-41.2%) in the derivation cohort and 21.2% (7.3-35.2%) in the validation cohort. Conclusions: The PROTECT study validated a multidimensional model that predicts 30-day complicated course in normotensive patients diagnosed with acute symptomatic PE.