Yang et al reported the Peking Union Medical College Hospital (PUMCH) rule for evaluating a patient with acute pulmonary embolism. This includes low serum calcium concentration as an adverse prognostic factor. The authors are from multiple institutions around China.
Patient selection: acute pulmonary embolism
Parameters:
(1) age in years
(2) sex
(3) cancer
(4) chronic heart failure
(5) chronic pulmonary disease
(6) heart rate in beats per minute
(7) systolic blood pressure in mm Hg
(8) altered mental status
(9) arterial oxygen saturation in percent
(10) serum calcium in mmol/L
Parameters
Findings
Points
age in years
<= 80 years
0
> 80 years
2
sex
male
1
female
0
cancer
no
0
yes
5
chronic heart failure
no
0
yes
2
chronic pulmonary disease
no
0
yes
3
heart rate
< 110 beats per minute
0
>= 110 beats per minute
3
systolic blood pressure
< 100 mm Hg
3
>= 100 mm Hg
0
altered mental status
no
0
yes
2
oxygen saturation
>= 90%
0
< 90%
1
serum calcium
<= 2.13 mmol/L
1
> 2.13 mmol/L
0
total score =
= SUM(points for all of the parameters)
Interpretation:
• minimum score: 0
• maximum score: 23
• A score >= 4 is associated with high risk.
Performance:
• The area under the ROC curve in the derivation cohort was 0.84 and in the validation cohort was 0.87.
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