Predicting adverse outcome in patients with acute pulmonary embolism: A risk score

Reliable prediction of adverse outcomes in acute pulmonary embolism may hel p choose between in-hospital and ambulatory treatment. We aimed to identify predictors of adverse events in patients with pulmonary embolism and to ge nerate a simple risk score for use in clinical settings. We prospectively f ollowed 296 consecutive patients with pulmonary embolism admitted through t he emergency ward. Logistic regression was used to predict death, recurrent thromboembolic event, or major bleeding at 3 months. Thirty patients (10.1 %) had one or more adverse events during the 3-month follow-up period: 25 p atients (8.4%) died, thromboembolic events recurred in 10 patients (3.4%), and major bleeding occurred in 5 patients (1.7%). Factors associated with a n adverse outcome in multivariate analysis were cancer, heart failure, prev ious deep vein thrombosis. systolic blood pressure <100 mmHg, arterial PaO2 <8 kPa, and presence of deep vein thrombosis on ultrasound. A risk score w as calculated by adding 2 points for cancer and hypotension, and 1 point ea ch for the other predictors. A score of best identified patients at risk of an adverse outcome in a receiver operating characteristic curve analysis. Of 180 low-risk patients (67.2%) (score less than or equal to 2), only 4 ex perienced an adverse outcome (2.2%), compared to 23 (26.1%) of 88 high-risk patients (score greater than or equal to 3). A simple risk score based on easily available variables can accurately identify patients with pulmonary embolism at low risk of an adverse outcome. Such a score may be useful for selecting patients with pulmonary embolism eligible for outpatient care.