Utilidad de las escalas clínicas para la identificación de pacientes normotensos de bajo riesgo con tromboembolia de pulmón aguda sintomática

Abstract

Background. Clinical prognostic models, such as the simplified Pulmonary Embolism Severity Index (sPESI) or the shock index (SI), and cardiac biomarkers (i.e., troponin testing) could help physicians assess risks of patients with acute symptomatic pulmonary embolism (PE) and improve decision-making about early hospital discharge and ambulatory treatment. Methods. This cohort study included a total of 1,291 consecutive patients from a single centre registry with objectively confirmed acute symptomatic PE. On the basis of the sPESI, each patient was classified into low-and high-risk strata. Investigators also calculated the SI for each patient. At the time of hospital admission, patients had troponin I (cTnI) levels measured by a microparticle enzyme immunoassay (Abbot, USA). cTnI concentrations of > 0.1 ng mL-1 were a priori defined as elevated. The endpoint of the study was all-cause mortality within 30 days after diagnosis. Conclusions. Compared to the SI and cTnl testing, sPESI classification more accurately identified patients with PE who are at low risk of all-cause death within 30-days of presentation. Calculation of the PESI and sPESI 48 hours after diagnosis allows identification of an additional group of patients with a very low risk of dying during the first month of follow-up. Experienced clinical gestalt is as useful as standardized prediction rules to assess patient eligibility for the outpatient treatment of PE.