Kucher et al identified risk factors associated with 30 day mortality in a patient with an acute pulmonary embolism. This can help identify patients at increased risk of early death. The authors are from Brigham and Women's Hospital, Harvard Medical School and CINECA in Bologna, Italy.
Patient selection:
(1) acute pulmonary embolism
(2) systolic blood pressure >= 90 mm Hg (a systolic blood pressure < 90 mm Hg is associated with increased mortality)
Parameters:
(1) right ventricular hypokinesis on ultrasonography (or right ventricular enlargement on CT or right ventricular dysfunction)
(2) age of the patient in years
(3) cancer
(4) congestive heart failure
(5) systolic blood pressure in mm Hg
(6) heart rate
(7) right heart thrombus
(8) thrombolytic therapy (perhaps a marker of more severe embolism)
|
Parameter |
Finding |
Points |
|
right ventricular hypokinesis |
absent |
0 |
|
|
present |
1 |
|
age |
<= 70 years of age |
0 |
|
|
> 70 years of age |
1 |
|
cancer |
absent |
0 |
|
|
present |
1 |
|
congestive heart failure |
absent |
0 |
|
|
present |
1 |
|
systolic blood pressure |
> 100 mm Hg |
0 |
|
|
90 - 100 mm Hg |
1 |
|
heart rate |
<= 100 beats per minute |
0 |
|
|
> 100 beats per minute |
1 |
|
right heart thrombus |
absent |
0 |
|
|
present |
1 |
|
thrombolytic therapy |
not given |
0 |
|
|
given |
1 |
number of risk factors for early death =
= SUM(points for all 8 parameters)
Interpretation:
• minimum number of risk factors: 0
• maximum number of risk factors: 8
• The higher the number of risk factors the greater the risk of 30 day mortality.
Performance:
• The odds ratios range from 1.1 (for right heart thrombus) to 2.3 for cancer. Heart rate, thrombolysis and right heart thrombus had odds ratios < 1.5.
Specialty: Pulmonology
ICD-10: ,
