Is Advanced Risk Stratification Unnecessary In Patients with Simplified Pulmonary Embolism Severity Index (sPESI) of 0?
Abstract
Aim: The European Society Cardiology guidelines state that advanced risk stratification is unnecessary in patients with simplified pulmonary embolism severity index (sPESI) of 0 because it does not affect treatment decision. Also, these patients can be discharged early or treated as outpatients if feasible. There were three
aims of the present study. The first was to determine the rate of patients with sPESI of 0 but classified into intermediate risk category with advanced risk stratification. is the second was to determine the clinical impact of this risk classification change. And the third was to define risk factors for this condition.
Patients and Methods: This is prospective single-center cohort study. All patients underwent advanced risk stratification at admission independent from the sPESI score. Patients with a sPESI score 0 were included.
Results: There were 33 patients with sPESI score of 0. With advanced risk stratification; 60.6% of patients were low risk, 30.3% were intermediate low risk and 9.1% were intermediate-high risk. In 2 (6.1%) patients, respiratory failure developed. One of these patients became hypotensive and required thrombolytic treatment. D-dimer value (p=0.017) and thrombus in main pulmonary arteries (p=0.000) were statistically significantly high in intermediate risk group.
Conclusions: Advanced risk stratification in sPESI 0 patients has an impact on management decisions. Early discharge or outpatient treatment decisions based on sPESI alone may cause the discharge of unstable patients especially in patients with main pulmonary artery thromboembolism or D-dimer level over 3600 ng/ml.
Keywords
Pulmonary Thromboembolism, Clinical Risk Score, Simplified Pulmonary Embolism Severity Index
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