den Exter et al developed a score for determining the risk of 30-day mortality in a patient with acute pulmonary embolism and active cancer. This can help to identify a patient who may benefit from more aggressive management. The authors are from multiple institutions in Spain participating in the Reigistro Informatizado de la Enfermedad TromboEmbolica (RIETE) Study.
Patient selection: acute pulmonary embolism and active cancer
Outcome: 30-day mortality
Parameters:
(1) metastases
(2) immobilization
(3) age in years
(4) heart rate in beats per minute
(5) systolic blood pressure in mm Hg
(6) body weight in kilograms
|
Parameters
|
Findings
|
Points
|
|
metastases
|
no
|
-
|
|
|
yes
|
4
|
|
immobilization
|
no
|
0
|
|
|
yes
|
2
|
|
age
|
<= 80 years
|
0
|
|
|
> 80 years
|
1
|
|
heart rate
|
< 110 beats per minute
|
0
|
|
|
>= 110 beats per minute
|
1
|
|
systolic blood pressure
|
>= 100 mm Hg
|
0
|
|
|
< 100 mm Hg
|
1
|
|
body weight
|
>= 60 kg
|
0
|
|
|
< 60 kg
|
1
|
total score =
= SUM(points for all 6 parameters)
Interpretation:
• minimum score: 0
• maximum score: 10
• The higher the score the greater the risk of short-term mortality.
|
Total Score
|
Risk Group
|
30-Day Mortality
|
|
0 or 1
|
low risk
|
2%
|
|
2 to 4
|
intermediate risk
|
15%
|
|
5 to 7
|
high risk
|
36%
|
|
8 to 10
|
very high risk
|
56%
|
Additional laboratory findings associated with a poor prognosis:
(1) creatinine clearance < 30 mL per minute
(2) white blood cell count > 11,000 per µL
Performance:
• The area under the ROC curve is 0.76.
