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Acute pulmonary embolism: the vulnerable scores

There is a need for a holistic approach to PE patients, with a special focus on short- and long-term follow-up and its improvement. Key requirements in this process include predictive scores capable of forecasting both short- and long-term outcomes following APE, notably death. Both PESI and sPESI have been studied as potential indicators of frailty, therefore can be used to predict long-term death, but they were not designed with this purpose. In light of some non-PE–specific items, sPESI was associated with adverse outcomes even in patients without PE. This did not appear surprising, as the index encompasses age, the presence of cancer or cardiopulmonary disease, and a few vital parameters,…

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 Simplified version of the PESI scale sPESI (Pulmonary Embolism severity index)

In 2005, Aujesky et al1 developed the Pulmonary Embolism Severity Index (PESI) as an epidemiologic tool to categorize patients with APE into 5 classes according to their 30-day death risk. Eleven PESI items encompass some demographic characteristics, hemodynamic criteria of PE severity, vital parameters, and key comorbidities. Six years later, the PESI criteria in combination with a few clinical characteristics were proven safe to identify candidates suitable for early discharge and home treatment after APE.2 As a consequence, PESI became a crucial tool for risk stratification of patients with APE. The sPESI is a simpler version of the PESI that is easy to apply to patients who have been diagnosed with PE. In the derivation study, it had a better negative predictive value than the PESI. It is simpler to use and has comparable inaccuracy.

Articles of Interest

A comparison of the original and simplified Pulmonary Embolism Severity Index

In conclusion, even though the simplified PESI accurately identified patients at low-risk of adverse outcomes, the original PESI classified a higher proportion of patients as low-risk and had a greater discriminatory power than the simplified PESI.

Pulmonary Embolism Severity Index Predicts Adverse Events in Hospitalized COVID-19 Patients: A Retrospective Observational Study

PESI and sPESI scoring systems were both found to be associated with adverse events, and they can be used to predict in-hospital mortality in hospitalized COVID-19 patients without documented venous and/or pulmonary embolism.

Simplification of the Pulmonary Embolism Severity Index for Prognostication in Patients With Acute Symptomatic Pulmonary Embolism

The simplified PESI has similar prognostic accuracy and clinical utility and greater ease of use compared with the original PESI.

The prognostic value of pulmonary embolism severity index in acute pulmonary embolism: a meta-analysis

PESI has discriminative power to predict the short-term death and adverse outcome events in patients with acute pulmonary embolism, the PESI and the sPESI have similar accuracy, while sPESI is easier to use.

Validation of simplified PESI score for identification of low-risk patients with pulmonary embolism: From the COMMAND VTE Registry

In patients with a sPESI score of 0, the 30-day mortality, recurrent venous thromboembolism and major bleeding rates were reasonably low. The sPESI score could be useful to identify candidates for early hospital discharge or home treatment.

Resources

Pulmonary Embolism Severity Index (PESI)

Predicts 30-day outcome of patients with pulmonary embolism.

Simplified PESI (Pulmonary Embolism Severity Index)

Predicts 30-day outcome of patients with PE, with fewer criteria than the original PESI.