Klok et al developed a prediction score for chronic thromboembolic pulmonary hypertension after acute pulmonary embolism. This can help to identify a patient who may benefit from more aggressive management. The authors are from Leiden University, University Medical Center Mainz, Medical University of Warsaw and Georg-August University of Gottingen.
Patient selection: acute pulmonary embolism
Outcome: chronic thromboembolic pulmonary hypertension
Parameters:
(1) nature of acute PE
(2) hypothryoidism
(3) symptom onset
(4) right ventricular dysfunction on CT or echocardiography
(5) diabetes mellitus
(6) thrombolytic therapy or embolectomy
Parameter
Finding
Points
nature of PE
provoked
0
unprovoked
6
hypothyroidism
absent
0
present
3
symptom onset
> 2 weeks before PE diagnosis
0
<= 2 weeks before PE diagnosis
3
right ventricular dysfunction
absent
0
present
2
diabetes mellitus
absent
0
present
-3
thrombolytic therapy or embolectomy
no
0
yes
-3
total score =
= SUM(points for all 6 parameters)
Interpretation:
• minimum score: -6
• maximum score: 14
• The higher the score the greater the risk for chronic thromboembolic pulmonary hypertension.
• A score <= 6 was associated with low risk. A score >= 7 indicates high risk.
Performance:
• The sensitivity was 91% and specificity was 75%. The area under the ROC was 0.89.
• The negative predictive value was 99.6%.
• The positive predictive value was 10%.
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