30-Day Mortality After Pulmonary Embolism Using PESI and Serum Troponin I

Description

Singanayagam et al studied the use of troponin I and D-dimer concentration in combination with the PESI (Pulmonary Embolism Severity Index) to predict 30-day mortality. This can help to identify a patient who may benefit from more aggressive management. The authors are from Royal Infirmary Edinburgh, Ninewells Hospital Dundee and St. John's Hospital Livingston.

Patient selection: pulmonary embolism

Outcome: 30-day mortality

Parameters:

(1) PESI risk class

(2) serum troponin I on admission (positive if > 0.2 µg/L, method not given)

(3) D-dimer concentration on admission in ng/mL (rapid ELISA, VIDAS)

Total Score	Risk Class	Risk Description
< 65	I	very low
65 to 85	II	low
86 to 105	III	intermediate
106 to 125	IV	high
> 125	V	very high

Parameter	Finding	30-day Mortality
PESI	class I or II	98-99%
	class III	91%
	class IV	89%
	class V	83%
troponin I	negative	98%
	positive	82%
D-dimer	<= 4,000 ng/mL	95-97%
	> 4,000 ng/mL	87%

On multi-variate analysis PESI and troponin I were significant for prediction of 30-day mortality. D-dimer can play a role in supporting the diagnosis and recognizing higher risk.

Performance:

• The area under the ROC curve for combined use of PESI and serum troponin I was 0.85 vs 0.80 for PESI alone.

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30-Day Mortality After Pulmonary Embolism Using PESI and Serum Troponin I

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