Zatorowość płucna
Rokowania, prognozy i postęp choroby

Zatorowość płucna (ZP) jest trzecią najczęstszą przyczyną zgonów sercowo-naczyniowych, z 30-dniową śmiertelnością sięgającą 30% w przypadku braku leczenia. Kluczowa dla postępowania jest dokładna stratyfikacja ryzyka, oparta na narzędziach takich jak Pulmonary Embolism Severity Index (PESI), uproszczony PESI (sPESI) oraz kryteria Hestia, które umożliwiają identyfikację pacjentów niskiego ryzyka kwalifikujących się do leczenia ambulatoryjnego. PESI, uwzględniający 11 zmiennych klinicznych, klasyfikuje pacjentów do pięciu klas ryzyka, z 30-dniową śmiertelnością od 1,1% (klasy I-II) do 24,5% (klasy III-V). Uproszczony sPESI z wynikiem zero wskazuje na niskie ryzyko z 30-dniową śmiertelnością około 1,1%. Kryteria Hestia potwierdzają bezpieczeństwo leczenia domowego, z 90-dniową śmiertelnością około 1%. Dodatkowo, indeks wstrząsu (HR/SBP), biomarkery takie jak NT-proBNP (>500 ng/L) oraz ocena dysfunkcji prawej komory serca stanowią istotne elementy prognostyczne. Pacjenci z ZP dzielą się na wysokiego ryzyka (4%, 30-dniowa śmiertelność 16-19%), pośredniego ryzyka (ryzyko 5-15%) oraz niskiego ryzyka (około 40%, 30-dniowa śmiertelność ~1%).

  1. Prognostyka zatorowości płucnej
    1. Indeks Ciężkości Zatorowości Płucnej (PESI)
    2. Uproszczony Indeks Ciężkości Zatorowości Płucnej (sPESI)
    3. Kryteria Hestia
    4. Indeks wstrząsu i biomarkery
    5. Dysfunkcja prawej komory
  2. Stratyfikacja ryzyka w zatorowości płucnej
    1. Klasyfikacja pacjentów z ZP na podstawie ryzyka śmiertelności
    2. Czynniki prognostyczne i wskaźniki ryzyka
    3. Skala TELOS i inne modele prognostyczne
  3. Nowe podejścia do oceny prognostycznej zatorowości płucnej
    1. Narodowa Skala Wczesnego Ostrzegania (NEWS2)
    2. Skala Bova
    3. Rokowanie długoterminowe
  4. Implikacje praktyczne i podsumowanie
    1. Kolejne rozdziały

Prognostyka zatorowości płucnej

Zatorowość płucna (ZP) stanowi trzecią najczęstszą przyczynę zgonów z powodów sercowo-naczyniowych na świecie, po chorobie niedokrwiennej serca i udarze mózgu. Charakteryzuje się szerokim spektrum objawów klinicznych i przebiegów choroby. Statystyki wskazują, że krótkoterminowa śmiertelność w przypadku nieleczonej ZP może sięgać nawet 30%.12 Właściwa ocena prognostyczna stanowi podstawę postępowania w ZP, ponieważ determinuje wybór zarówno strategii diagnostycznych, jak i terapeutycznych.3

W ostatnich dekadach poczyniono znaczące wysiłki, aby bezpiecznie wyselekcjonować pacjentów do wczesnego wypisu lub leczenia domowego. Jednak odpowiednia stratyfikacja ryzyka, szczególnie u pacjentów z grupy pośredniego ryzyka, pozostaje wyzwaniem. Obok zalecanych w wytycznych klinicznych narzędzi prognostycznych, takich jak Pulmonary Embolism Severity Index (PESI), uproszczony PESI (sPESI) i/lub kryteria Hestia, kluczowe znaczenie dla stratyfikacji ryzyka i wyboru odpowiedniego postępowania ma podejście wielomodalne oparte również na biomarkerach i obrazowaniu serca.4

Indeks Ciężkości Zatorowości Płucnej (PESI)

Najlepiej zwalidowanymi modelami prognostycznymi w ostrej zatorowości płucnej są Pulmonary Embolism Severity Index (PESI) i jego uproszczona wersja (sPESI).5 PESI jest skalą obejmującą 11 zmiennych klinicznych i stratyfikuje pacjentów do pięciu klas ciężkości.67 Algorytm PESI zawiera 11 rutynowo dostępnych zmiennych klinicznych, które klasyfikują pacjentów do jednej z pięciu klas (I-V), gdzie 30-dniowa śmiertelność waha się od 1,1% do 24,5%. Pacjenci w klasach I i II są uznawani za grupę niskiego ryzyka, a ci w klasach III-V za grupę wysokiego ryzyka.8

Wskaźnik PESI może być użyteczny w przewidywaniu rokowania u pacjentów z zatorowością płucną. Badania wykazały, że klasa PESI jest istotnie skorelowana z 30-dniową śmiertelnością, śmiertelnością szpitalną i śmiertelnością ogólną. Śmiertelność 30-dniowa wynosi około 11,1%, śmiertelność w trakcie hospitalizacji około 15,6%, a całkowita śmiertelność około 30,0%.9

Klasyfikacja grup ryzyka przy użyciu PESI może przewidywać nie tylko 30-dniową śmiertelność, ale także śmiertelność podczas hospitalizacji i całkowitą śmiertelność, co wskazuje, że jest to względnie dokładny wskaźnik prognostyczno-predykcyjny.10 Wyniki te zostały prospektywnie zwalidowane z podobnymi rezultatami. Inni autorzy stwierdzili, że skala PESI może przewidywać śmiertelność i wskaźniki ponownych przyjęć.11

Uproszczony Indeks Ciężkości Zatorowości Płucnej (sPESI)

Uproszczony PESI (sPESI) został opublikowany w 2010 roku w celu uproszczenia wymaganych informacji i wyników. Ryzyko PESI I lub II wskazuje na populację niskiego ryzyka (podobnie jak sPESI równy zero), z 30-dniową śmiertelnością poniżej 3%.12 Autorzy stwierdzili, że 30-dniowa śmiertelność z wszystkich przyczyn w grupie niskiego ryzyka wynosiła 1,1% w porównaniu do 8,9% w grupie wysokiego ryzyka, co nie różni się statystycznie istotnie od wyników uzyskanych przy użyciu skali PESI.13

Kryteria Hestia

Kryteria Hestia zostały zaprojektowane w celu identyfikacji pacjentów z ZP niskiego ryzyka, którzy kwalifikują się do leczenia ambulatoryjnego.14 Stanowią one alternatywne podejście do identyfikacji pacjentów niskiego ryzyka i wyboru tych, którzy mogą być bezpiecznie leczeni w domu.15

Wstępna ocena kryteriów Hestia 3 miesiące po wypisie wykazała, że wśród wszystkich wypisanych pacjentów, wskaźnik nawrotowej żylnej choroby zakrzepowo-zatorowej wynosił 2%, wystąpienie krwawienia wewnątrzczaszkowego 0,7%, a śmiertelność ze wszystkich przyczyn 1%.16 W badaniu prospektywnym, 90-dniowa śmiertelność wyniosła 1% dla pacjentów z ostrą ZP bez kryteriów Hestia do hospitalizacji, którzy byli leczeni ambulatoryjnie.17

Randomizowane badanie porównujące skalę sPESI z kryteriami Hestia w określaniu odpowiedniości do ambulatoryjnego leczenia ZP wykazało podobne wyniki między obiema metodami. Sugeruje to, że jakościowe miary odpowiedniości zawarte w kryteriach Hestia mają istotne znaczenie kliniczne.18

Indeks wstrząsu i biomarkery

Indeks wstrząsu (SI) zawiera informacje o częstości akcji serca (HR) i skurczowym ciśnieniu tętniczym (SBP) pacjenta (indeks wstrząsu = HR/SBP) w celu oceny stanu hemodynamicznego. Wykazano, że indeks wstrząsu jest niezależnym predyktorem 30-dniowej śmiertelności i lepiej różnicuje pacjentów niskiego ryzyka niż samo SBP.19

Biomarkery są tradycyjnie wykorzystywane jako część stratyfikacji ryzyka u pacjentów z ZP. Obecne wytyczne zalecają stosowanie NT-proBNP do identyfikacji pacjentów normotensyjnych z przewidywanym łagodnym przebiegiem choroby.20 Podwyższone poziomy peptydów natriuretycznych w osoczu (peptyd natriuretyczny typu B i N-końcowy pro-peptyd natriuretyczny typu B) wiązały się z wyższą śmiertelnością u pacjentów z zatorowością płucną. W jednym badaniu poziomy N-końcowego pro-peptydu natriuretycznego typu B większe niż 500 ng/L były niezależnie związane z centralną zatorowością płucną i były możliwym predyktorem zgonu z powodu zatorowości płucnej.21

Dysfunkcja prawej komory

Dysfunkcja prawej komory (RV) wiąże się ze zwiększonym ryzykiem zgonu.22 Wieloośrodkowe prospektywne badanie kohortowe obejmujące 490 normotensyjnych pacjentów z ZP leczonych zgodnie z aktualnymi wytycznymi ESC zaproponowało optymalną definicję dysfunkcji RV do oceny prognostycznej.23

Istnieje kilka markerów stosowanych do stratyfikacji ryzyka, które są również niezależnymi predyktorami niekorzystnych wyników. Należą do nich hipotensja, wstrząs kardiogenny, omdlenie, dowody dysfunkcji prawego serca i podwyższone enzymy sercowe. Niektóre zmiany w EKG, w tym S1Q3T3, również korelują z gorszym rokowaniem krótkoterminowym.24

Stratyfikacja ryzyka w zatorowości płucnej

Klasyfikacja pacjentów z ZP na podstawie ryzyka śmiertelności

Identyfikacja wysokiego ryzyka śmiertelności u pacjentów powinna być pierwszym krokiem w stratyfikacji ryzyka ZP.25 W zależności od ryzyka pacjentów z ZP można podzielić na trzy główne kategorie:

  • Pacjenci wysokiego ryzyka – stanowią około 4% pacjentów z ZP, z udokumentowaną krótkoterminową śmiertelnością wynoszącą 16% do 19%.26 30-dniowa śmiertelność w ZP wysokiego ryzyka wynosi około 65%.27
  • Pacjenci pośredniego ryzyka – stanowią wysoce heterogeniczną grupę pacjentów, z ryzykiem 30-dniowej śmiertelności wahającym się między 5% a 15%.28 30-dniowa śmiertelność w ZP pośredniego ryzyka wynosi około 5% do 25%.29
  • Pacjenci niskiego ryzyka – stanowią około 40% przypadków ostrej ZP.30 30-dniowa śmiertelność w ZP niskiego ryzyka wynosi około 1%.31

Częstość występowania nawrotowej żylnej choroby zakrzepowo-zatorowej (VTE), poważnego krwawienia lub zgonu u pacjentów zakwalifikowanych do leczenia domowego według strategii Hestia lub sPESI i leczonych w domu była tak niska, jak odpowiednio 1,3% i 1,1%.32

Czynniki prognostyczne i wskaźniki ryzyka

Czynniki rokownicze obejmują wstrząs i dysfunkcję prawej komory, zakrzepicę prawej komory i zakrzepicę żył głębokich.33 Mniej niż 5 do 10% objawowych ZP jest śmiertelnych w ciągu pierwszej godziny od wystąpienia objawów.34

Występowanie objawów i oznak ostrej ZP zależy od ciężkości choroby, płci, wieku i wskaźnika masy ciała (BMI).35 Częstość występowania duszności, omdleń i tachykardii zwiększa się wraz z ryzykiem ZP we wszystkich podgrupach. Obecność objawowej zakrzepicy żył głębokich (DVT) wiązała się z niższą śmiertelnością szpitalną, podczas gdy obecność zapalenia płuc w momencie prezentacji była związana z wyższą śmiertelnością szpitalną, niezależnie od wieku, płci i wyniku ryzyka śmiertelności ESC.36

Skala TELOS i inne modele prognostyczne

Skala TELOS została opracowana na podstawie prospektywnej kohorty 496 pacjentów i obejmuje dysfunkcję RV, troponinę i podwyższenie poziomu mleczanów w osoczu jako predyktory zgonu lub załamania hemodynamicznego w ciągu 7 dni.37

Oprócz minimalizacji krótkoterminowej śmiertelności, postępowanie w ZP powinno koncentrować się na długoterminowym rokowaniu i zmniejszeniu ryzyka nawrotu VTE. Charakter ZP (wywołany np. przez przejściowy czynnik ryzyka, taki jak poważna operacja) lub nieprowokowany również wpływa na rokowanie, ponieważ pacjenci z nieprowokowaną ZP są bardziej narażeni na nawrót i stanowią heterogeniczną podgrupę pacjentów, w której potrzebna jest dalsza stratyfikacja ryzyka.38

Obiecującym kierunkiem są modele predykcyjne oparte na uczeniu maszynowym. W niedawnym badaniu wykazano skuteczność modeli uczenia maszynowego w wyprzedzającym identyfikowaniu pacjentów z wysokim ryzykiem wystąpienia ZP przed jej wystąpieniem. Model ten nie tylko poprawia przyszłą predykcję ZP, ale także ułatwia wczesne wykrywanie poprzedzające potwierdzający proces diagnostyczny, w konsekwencji zmniejszając niepotrzebne badania CTPA.39

Nowe podejścia do oceny prognostycznej zatorowości płucnej

Narodowa Skala Wczesnego Ostrzegania (NEWS2)

Narodowa Skala Wczesnego Ostrzegania 2 (NEWS2) została oceniona pod kątem jej zdolności do przewidywania rokowania zatorowości płucnej w oddziale ratunkowym. Badania wykazały, że NEWS2 dokładniej przewiduje 1-tygodniową śmiertelność niż NEWS i skala qSOFA u pacjentów z ZP. NEWS2 wydaje się być bardziej skuteczna niż NEWS i skala qSOFA i może być stosowana do przewidywania ciężkości, 1-tygodniowej śmiertelności, przyjęcia na OIT i długości hospitalizacji pacjentów z ZP.40

Skala Bova

Najbardziej znana z tych skal, znana jako skala Bova, ma na celu identyfikację pacjentów z ZP pośredniego ryzyka (hemodynamicznie stabilnych), którzy mogą odnieść korzyści z bardziej inwazyjnych i ryzykownych interwencji niż sama antykoagulacja.41 Niestety, wskaźnik dekompensacji klinicznej w przypadku ZP pośredniego ryzyka szacuje się na poziomie do 5%; jednak do tej pory nie ma zwalidowanego modelu predykcyjnego pozwalającego zidentyfikować subpopulację pacjentów z ZP pośredniego ryzyka najbardziej narażonych na dekompensację kliniczną lub zgon.42

Rokowanie długoterminowe

Rokowanie pacjentów z ZP zależy od dwóch czynników: podstawowego stanu chorobowego oraz odpowiedniej diagnostyki i leczenia. Po zakończeniu antykoagulacji ryzyko śmiertelnej zatorowości płucnej wynosi 0,5% rocznie.43 Śmiertelność z powodu nieleczonej ZP wynosi około 26%, podczas gdy leczenie przeciwzakrzepowe zmniejsza śmiertelność do mniej niż 5%.44

Ryzyko nawrotu zatorowości płucnej wynika z nawrotu proksymalnej zakrzepicy żylnej; około 17% pacjentów z nawrotową zatorowością płucną ma proksymalną zakrzepicę żył głębokich. U niewielkiej części pacjentów zatorowość płucna nie ustępuje, co prowadzi do przewlekłego zakrzepowo-zatorowego nadciśnienia płucnego.45

W badaniu PIOPED jednoroczna śmiertelność wyniosła 24%. Zgony wystąpiły z powodu chorób serca, nawrotowej zatorowości płucnej, zakażeń i nowotworów.46 Po 5 dniach leczenia przeciwzakrzepowego 36% ubytków w skanach płuc jest rozwiązanych; po 2 tygodniach 52% jest rozwiązanych; a po 3 miesiącach 73% jest rozwiązanych. Większość pacjentów leczonych lekami przeciwzakrzepowymi nie rozwija długoterminowych następstw w czasie obserwacji.47

Implikacje praktyczne i podsumowanie

Zatorowość płucna pozostaje wyzwaniem klinicznym ze względu na wysoką śmiertelność, wysoką niepełnosprawność oraz wysokie wskaźniki przeoczeń i błędnych diagnoz. Dokładna ocena prognostyczna ma kluczowe znaczenie dla podejmowania decyzji medycznych dotyczących leczenia pacjentów z ZP.4849

Obecne modele prognostyczne, takie jak PESI, sPESI i kryteria Hestia, zapewniają solidne narzędzia do stratyfikacji ryzyka i identyfikacji pacjentów niskiego ryzyka, którzy mogą być bezpiecznie leczeni ambulatoryjnie. Jednakże nadal istnieje potrzeba lepszych narzędzi do oceny ryzyka dekompensacji klinicznej u pacjentów z grupy pośredniego ryzyka.5051

Świadomość, że objawy i oznaki ostrej ZP zależą od ciężkości choroby, płci, wieku i BMI, może przyczynić się do jej szybkiej diagnozy i leczenia.52 Nowsze modele, takie jak skala TELOS i NEWS2, wydają się atrakcyjne dla normotensyjnych pacjentów z ZP wysokiego ryzyka, ale wymagają zewnętrznej walidacji, a następnie oceny w badaniach wpływu.53

Podstawą leczenia ZP pozostaje wsparcie hemodynamiczne w razie potrzeby, ogólnoustrojowa antykoagulacja oraz ogólnoustrojowa tromboliza, jeśli jest wskazana na podstawie ciężkości.54 Właściwe zastosowanie narzędzi prognostycznych może pomóc w optymalizacji wczesnej diagnozy i strategii leczenia, aby poprawić wyniki u pacjentów z ZP.55

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  1. 09.04.2026
  2. www.leksykon.com.pl

Materiały źródłowe

  • #1 Prediction of pulmonary embolism by an explainable machine learning approach in the real world | Scientific Reports
    https://www.nature.com/articles/s41598-024-75435-9
    In recent years, large amounts of researches showed that pulmonary embolism (PE) has become a common disease, and PE remains a clinical challenge because of its high mortality, high disability, high missed and high misdiagnosed rates. […] Regarding the efficacy of the single model that most accurately predicted the outcome, RF demonstrated the highest efficacy in predicting outcomes, with an AUC of 0.776 (95% CI 0.7740.778). […] In this study, PE prediction model was successfully established and designed as a web page, facilitating the optimization of early diagnosis and timely treatment strategies to enhance PE patient outcomes. […] Acute pulmonary embolism (PE) stands as the third leading cause of cardiovascular death globally, following coronary heart disease and stroke. Statistics indicate that the short-term mortality rate for untreated PE reaches as high as 30%.
  • #2 Pulmonary Embolism (PE): Practice Essentials, Background, Anatomy
    https://emedicine.medscape.com/article/300901-overview
    The prognosis of patients with PE depends on two factors: the underlying disease state and appropriate diagnosis and treatment. According to the CDC, sudden death will occur in 25% of individuals with a PE. Mortality for acute pulmonary embolism can be broken down into three categories: high-risk pulmonary embolism and low- or moderate-risk pulmonary embolism. […] Anticoagulant treatment decreases mortality to less than 5%. At 5 days of anticoagulant therapy, 36% of lung scan defects are resolved; at 2 weeks, 52% are resolved; and at 3 months, 73% are resolved. Most patients treated with anticoagulants do not develop long-term sequelae upon follow-up evaluation. The mortality in patients with undiagnosed pulmonary embolism is 30%. […] In the PIOPED study, the 1-year mortality rate was 24%. The deaths occurred due to cardiac disease, recurrent pulmonary embolism, infection, and cancer.
  • #3 How to predict prognosis in patients with acute pulmonary embolism? Recent advances | Silva | Polish Heart Journal (Kardiologia Polska)
    https://journals.viamedica.pl/polish_heart_journal/article/view/KP.a2023.0143
    How to predict prognosis in patients with acute pulmonary embolism? Recent advances […] Pulmonary embolism (PE) is the third most frequent cardiovascular disease, characterized by a wide range of presentations and clinical courses. Prognostic assessment is a cornerstone of PE management as it determines the choice of both diagnostic and therapeutic strategies. During the previous decades significant efforts have been made to safely select patients for early discharge or home treatment, but appropriate risk stratification, particularly of intermediate-risk patients, remains challenging. In addition to the guideline-recommended clinical prediction rules, such as Pulmonary Embolism Severity Index (PESI), simplified PESI (sPESI), and/or Hestia criteria, a multimodality approach based also on biomarkers and cardiac imaging is crucial for risk-stratification and for selecting appropriate management of patients. In this review article, we discuss the current methods for predicting short and long-term prognosis in PE patients, focusing on the current guidelines, but also on the most recently proposed clinical prediction rules, biomarkers, and imaging parameters.
  • #4 How to predict prognosis in patients with acute pulmonary embolism? Recent advances | Silva | Polish Heart Journal (Kardiologia Polska)
    https://journals.viamedica.pl/polish_heart_journal/article/view/KP.a2023.0143
    How to predict prognosis in patients with acute pulmonary embolism? Recent advances […] Pulmonary embolism (PE) is the third most frequent cardiovascular disease, characterized by a wide range of presentations and clinical courses. Prognostic assessment is a cornerstone of PE management as it determines the choice of both diagnostic and therapeutic strategies. During the previous decades significant efforts have been made to safely select patients for early discharge or home treatment, but appropriate risk stratification, particularly of intermediate-risk patients, remains challenging. In addition to the guideline-recommended clinical prediction rules, such as Pulmonary Embolism Severity Index (PESI), simplified PESI (sPESI), and/or Hestia criteria, a multimodality approach based also on biomarkers and cardiac imaging is crucial for risk-stratification and for selecting appropriate management of patients. In this review article, we discuss the current methods for predicting short and long-term prognosis in PE patients, focusing on the current guidelines, but also on the most recently proposed clinical prediction rules, biomarkers, and imaging parameters.
  • #5 Prognostic models in acute pulmonary embolism: a systematic review and meta-analysis | BMJ Open
    https://bmjopen.bmj.com/content/6/4/e010324
    Objective To review the evidence for existing prognostic models in acute pulmonary embolism (PE) and determine how valid and useful they are for predicting patient outcomes. […] The most validated models were the PE Severity Index (PESI) and its simplified version (sPESI). […] PESI has proved clinically useful in an impact study. […] We provide evidence-based information about the validity and utility of the existing prognostic models in acute PE that may be helpful for identifying patients at low risk. […] Novel models seem attractive for the high-risk normotensive PE but need to be externally validated then be assessed in impact studies.
  • #6 How to predict prognosis in patients with acute pulmonary embolism? Recent advances | Silva | Polish Heart Journal (Kardiologia Polska)
    https://journals.viamedica.pl/polish_heart_journal/article/view/KP.a2023.0143
    Prognostic assessment is a cornerstone of PE management as it determines the choice of both diagnostic and therapeutic strategies. […] In this article, we discuss the current models for predicting short- and long-term prognosis for PE patients and the decision-making process for PE management, particularly regarding the decision on inpatient vs. outpatient treatment. […] The Pulmonary Embolism Severity Index (PESI) comprises 11 clinical variables and stratifies patients into five severity classes. […] A PESI risk of I or II indicates a low-risk population (as does a simplified PESI [sPESI] of zero), with a 30-day mortality rate of less than 3%. […] The Hestia criteria represent an alternative approach to identifying low-risk patients and selecting those who can be safely treated at home. […] In a prospective study, 90-day mortality was 1% for patients with acute PE and no Hestia criteria for hospitalization who were managed as outpatients.
  • #7 Prediction Models for Pulmonary Embolism – Endovascular Today
    https://evtoday.com/articles/2024-jan/prediction-models-for-pulmonary-embolism
    Once a PE has been diagnosed, the next critical decision is treatment strategy. Given the variation in the presentation and severity of patients with PE, treatment strategies can range from outpatient treatment with direct oral anticoagulants to emergent surgical thromboembolectomy. […] Although useful, these categorizations are not prescriptive, which has led many authors to develop prediction models and rules to help determine which patients may be appropriate for outpatient management or which stable patients are more likely to have acute worsening or hemodynamic collapse that requires advanced therapy. […] The most well-known and utilized of these scores is the PE Severity Index (PESI). The PESI score was derived from a stepwise regression of 24 variables. […] Importantly, these results have been prospectively validated with similar results. Other authors have found that the PESI score can predict mortality and readmission rates. The simplified PESI (sPESI) score was published in 2010 to simplify the required information and outcome. […] The authors found that the all-cause 30-day mortality in the low-risk group was 1.1% compared to 8.9% in the high-risk group, which is not statistically significantly different from the PESI score.
  • #8 Pulmonary embolism – Wikipedia
    https://en.wikipedia.org/wiki/Pulmonary_embolism
    Once anticoagulation is stopped, the risk of a fatal pulmonary embolism is 0.5% per year. […] Mortality from untreated PEs was said to be 26%. […] The PESI and sPESI (= simplified Pulmonary Embolism Severity Index) scoring tools can estimate the mortality of patients. […] The PESI algorithm comprises 11 routinely available clinical variables. […] It puts the subjects into one of five classes (IV), with 30-day mortality ranging from 1.1% to 24.5%. Those in classes I and II are low-risk and those in classes IIIV are high-risk.
  • #9 The Pulmonary Embolism Severity Index in Predicting the Prognosis of Patients With Pulmonary Embolism
    https://pmc.ncbi.nlm.nih.gov/articles/PMC2698620/
    Many prognostic models have been developed to help physicians make medical decisions on treating patients with pulmonary embolism. Among these models, the Pulmonary Embolism Severity Index (PESI) has been shown to be a successful risk stratification tool for patients with acute pulmonary embolism. […] The mortality rate was significantly associated with the PESI class. […] The PESI class was found to be significantly correlated with the 30-day mortality rate, hospital mortality, and overall mortality. Our data indicate that the PESI can be used to predict the prognosis of patients with pulmonary embolism and in making medical decisions regarding the treatment of patients with pulmonary embolism. […] The 30-day mortality rate was 11.1%, whereas the mortality rate during hospitalization was 15.6% and the total mortality rate was 30.0%.
  • #10 The Pulmonary Embolism Severity Index in Predicting the Prognosis of Patients With Pulmonary Embolism
    https://pmc.ncbi.nlm.nih.gov/articles/PMC2698620/
    The PESI may be useful in predicting the prognosis of Korean patients with pulmonary embolism (30-day mortality: p=0.0016, hospital mortality: p=0.0065, and overall mortality: p=0.0019). […] Risk group classification using the PESI can predict not only the 30-day mortality rate but also the mortality rate during hospitalization and the total mortality rate, indicating that it is a relatively accurate prognostic-predictive index.
  • #11 Prediction Models for Pulmonary Embolism – Endovascular Today
    https://evtoday.com/articles/2024-jan/prediction-models-for-pulmonary-embolism
    Once a PE has been diagnosed, the next critical decision is treatment strategy. Given the variation in the presentation and severity of patients with PE, treatment strategies can range from outpatient treatment with direct oral anticoagulants to emergent surgical thromboembolectomy. […] Although useful, these categorizations are not prescriptive, which has led many authors to develop prediction models and rules to help determine which patients may be appropriate for outpatient management or which stable patients are more likely to have acute worsening or hemodynamic collapse that requires advanced therapy. […] The most well-known and utilized of these scores is the PE Severity Index (PESI). The PESI score was derived from a stepwise regression of 24 variables. […] Importantly, these results have been prospectively validated with similar results. Other authors have found that the PESI score can predict mortality and readmission rates. The simplified PESI (sPESI) score was published in 2010 to simplify the required information and outcome. […] The authors found that the all-cause 30-day mortality in the low-risk group was 1.1% compared to 8.9% in the high-risk group, which is not statistically significantly different from the PESI score.
  • #12 How to predict prognosis in patients with acute pulmonary embolism? Recent advances | Silva | Polish Heart Journal (Kardiologia Polska)
    https://journals.viamedica.pl/polish_heart_journal/article/view/KP.a2023.0143
    Prognostic assessment is a cornerstone of PE management as it determines the choice of both diagnostic and therapeutic strategies. […] In this article, we discuss the current models for predicting short- and long-term prognosis for PE patients and the decision-making process for PE management, particularly regarding the decision on inpatient vs. outpatient treatment. […] The Pulmonary Embolism Severity Index (PESI) comprises 11 clinical variables and stratifies patients into five severity classes. […] A PESI risk of I or II indicates a low-risk population (as does a simplified PESI [sPESI] of zero), with a 30-day mortality rate of less than 3%. […] The Hestia criteria represent an alternative approach to identifying low-risk patients and selecting those who can be safely treated at home. […] In a prospective study, 90-day mortality was 1% for patients with acute PE and no Hestia criteria for hospitalization who were managed as outpatients.
  • #13 Prediction Models for Pulmonary Embolism – Endovascular Today
    https://evtoday.com/articles/2024-jan/prediction-models-for-pulmonary-embolism
    Once a PE has been diagnosed, the next critical decision is treatment strategy. Given the variation in the presentation and severity of patients with PE, treatment strategies can range from outpatient treatment with direct oral anticoagulants to emergent surgical thromboembolectomy. […] Although useful, these categorizations are not prescriptive, which has led many authors to develop prediction models and rules to help determine which patients may be appropriate for outpatient management or which stable patients are more likely to have acute worsening or hemodynamic collapse that requires advanced therapy. […] The most well-known and utilized of these scores is the PE Severity Index (PESI). The PESI score was derived from a stepwise regression of 24 variables. […] Importantly, these results have been prospectively validated with similar results. Other authors have found that the PESI score can predict mortality and readmission rates. The simplified PESI (sPESI) score was published in 2010 to simplify the required information and outcome. […] The authors found that the all-cause 30-day mortality in the low-risk group was 1.1% compared to 8.9% in the high-risk group, which is not statistically significantly different from the PESI score.
  • #14 Prediction Models for Pulmonary Embolism – Endovascular Today
    https://evtoday.com/articles/2024-jan/prediction-models-for-pulmonary-embolism
    The Hestia criteria were designed to identify low-risk PE patients who are suitable for outpatient management. […] Initial evaluation of the Hestia criteria at 3 months postdischarge found that among all discharged patients, the rate of recurrent venous thromboembolism was 2%, occurrence of intracranial bleeding was 0.7%, and all-cause mortality was 1%. A randomized trial comparing the sPESI score versus Hestia criteria in determining appropriateness for outpatient PE management found similar results between the two methods. […] This suggests that the qualitative appropriateness measures included in the Hestia criteria are of significant clinical importance. […] Although all three have been well-validated and can be incorporated into clinical practice, work remains ongoing to continue to develop and improve prediction scores that accurately assess which patients with PE can be safely discharged. […] The most well-known of these scores, known as the Bova score, intends to identify intermediate-risk (hemodynamically stable) PE patients who may benefit from more invasive and risky interventions than anticoagulation alone.
  • #15 How to predict prognosis in patients with acute pulmonary embolism? Recent advances | Silva | Polish Heart Journal (Kardiologia Polska)
    https://journals.viamedica.pl/polish_heart_journal/article/view/KP.a2023.0143
    Prognostic assessment is a cornerstone of PE management as it determines the choice of both diagnostic and therapeutic strategies. […] In this article, we discuss the current models for predicting short- and long-term prognosis for PE patients and the decision-making process for PE management, particularly regarding the decision on inpatient vs. outpatient treatment. […] The Pulmonary Embolism Severity Index (PESI) comprises 11 clinical variables and stratifies patients into five severity classes. […] A PESI risk of I or II indicates a low-risk population (as does a simplified PESI [sPESI] of zero), with a 30-day mortality rate of less than 3%. […] The Hestia criteria represent an alternative approach to identifying low-risk patients and selecting those who can be safely treated at home. […] In a prospective study, 90-day mortality was 1% for patients with acute PE and no Hestia criteria for hospitalization who were managed as outpatients.
  • #16 Prediction Models for Pulmonary Embolism – Endovascular Today
    https://evtoday.com/articles/2024-jan/prediction-models-for-pulmonary-embolism
    The Hestia criteria were designed to identify low-risk PE patients who are suitable for outpatient management. […] Initial evaluation of the Hestia criteria at 3 months postdischarge found that among all discharged patients, the rate of recurrent venous thromboembolism was 2%, occurrence of intracranial bleeding was 0.7%, and all-cause mortality was 1%. A randomized trial comparing the sPESI score versus Hestia criteria in determining appropriateness for outpatient PE management found similar results between the two methods. […] This suggests that the qualitative appropriateness measures included in the Hestia criteria are of significant clinical importance. […] Although all three have been well-validated and can be incorporated into clinical practice, work remains ongoing to continue to develop and improve prediction scores that accurately assess which patients with PE can be safely discharged. […] The most well-known of these scores, known as the Bova score, intends to identify intermediate-risk (hemodynamically stable) PE patients who may benefit from more invasive and risky interventions than anticoagulation alone.
  • #17 How to predict prognosis in patients with acute pulmonary embolism? Recent advances | Silva | Polish Heart Journal (Kardiologia Polska)
    https://journals.viamedica.pl/polish_heart_journal/article/view/KP.a2023.0143
    Prognostic assessment is a cornerstone of PE management as it determines the choice of both diagnostic and therapeutic strategies. […] In this article, we discuss the current models for predicting short- and long-term prognosis for PE patients and the decision-making process for PE management, particularly regarding the decision on inpatient vs. outpatient treatment. […] The Pulmonary Embolism Severity Index (PESI) comprises 11 clinical variables and stratifies patients into five severity classes. […] A PESI risk of I or II indicates a low-risk population (as does a simplified PESI [sPESI] of zero), with a 30-day mortality rate of less than 3%. […] The Hestia criteria represent an alternative approach to identifying low-risk patients and selecting those who can be safely treated at home. […] In a prospective study, 90-day mortality was 1% for patients with acute PE and no Hestia criteria for hospitalization who were managed as outpatients.
  • #18 Prediction Models for Pulmonary Embolism – Endovascular Today
    https://evtoday.com/articles/2024-jan/prediction-models-for-pulmonary-embolism
    The Hestia criteria were designed to identify low-risk PE patients who are suitable for outpatient management. […] Initial evaluation of the Hestia criteria at 3 months postdischarge found that among all discharged patients, the rate of recurrent venous thromboembolism was 2%, occurrence of intracranial bleeding was 0.7%, and all-cause mortality was 1%. A randomized trial comparing the sPESI score versus Hestia criteria in determining appropriateness for outpatient PE management found similar results between the two methods. […] This suggests that the qualitative appropriateness measures included in the Hestia criteria are of significant clinical importance. […] Although all three have been well-validated and can be incorporated into clinical practice, work remains ongoing to continue to develop and improve prediction scores that accurately assess which patients with PE can be safely discharged. […] The most well-known of these scores, known as the Bova score, intends to identify intermediate-risk (hemodynamically stable) PE patients who may benefit from more invasive and risky interventions than anticoagulation alone.
  • #19 How to predict prognosis in patients with acute pulmonary embolism? Recent advances | Silva | Polish Heart Journal (Kardiologia Polska)
    https://journals.viamedica.pl/polish_heart_journal/article/view/KP.a2023.0143
    The shock index (SI) includes information about the patients HR and SBP (shock index = HR/SBP) to assess hemodynamic status. […] The shock index was demonstrated to be an independent predictor of 30-day mortality, and it performed better than SBP alone for discrimination of low-risk patients. […] Biomarkers were traditionally included as part of the risk stratification of PE patients. […] The current guidelines recommend employing NT-proBNP to identify normotensive patients with an expected benign disease course. […] Right ventricular (RV) dysfunction has been associated with increased risk of death. […] A multicenter prospective cohort study including 490 normotensive PE patients managed according to the current ESC guidelines proposed an optimal definition of RV dysfunction for prognostic assessment.
  • #20 How to predict prognosis in patients with acute pulmonary embolism? Recent advances | Silva | Polish Heart Journal (Kardiologia Polska)
    https://journals.viamedica.pl/polish_heart_journal/article/view/KP.a2023.0143
    The shock index (SI) includes information about the patients HR and SBP (shock index = HR/SBP) to assess hemodynamic status. […] The shock index was demonstrated to be an independent predictor of 30-day mortality, and it performed better than SBP alone for discrimination of low-risk patients. […] Biomarkers were traditionally included as part of the risk stratification of PE patients. […] The current guidelines recommend employing NT-proBNP to identify normotensive patients with an expected benign disease course. […] Right ventricular (RV) dysfunction has been associated with increased risk of death. […] A multicenter prospective cohort study including 490 normotensive PE patients managed according to the current ESC guidelines proposed an optimal definition of RV dysfunction for prognostic assessment.
  • #21 Pulmonary Embolism (PE): Practice Essentials, Background, Anatomy
    https://emedicine.medscape.com/article/300901-overview
    The risk of recurrent pulmonary embolism is due to the recurrence of proximal venous thrombosis; approximately 17% of patients with recurrent pulmonary embolism were found to have proximal DVT. In a small proportion of patients, pulmonary embolism does not resolve; hence, chronic thromboembolic pulmonary arterial hypertension results. […] Elevated plasma levels of natriuretic peptides (brain natriuretic peptide and N-terminal pro-brain natriuretic peptide) have been associated with higher mortality in patients with pulmonary embolism. In one study, levels of N-terminal pro-brain natriuretic peptide greater than 500 ng/L were independently associated with central pulmonary embolism and were a possible predictor of death from pulmonary embolism. […] The 30-day mortality rates for high-, intermediate- and low-risk PE are approximately 65%, 5% to 25% and 1% respectively.
  • #22 How to predict prognosis in patients with acute pulmonary embolism? Recent advances | Silva | Polish Heart Journal (Kardiologia Polska)
    https://journals.viamedica.pl/polish_heart_journal/article/view/KP.a2023.0143
    The shock index (SI) includes information about the patients HR and SBP (shock index = HR/SBP) to assess hemodynamic status. […] The shock index was demonstrated to be an independent predictor of 30-day mortality, and it performed better than SBP alone for discrimination of low-risk patients. […] Biomarkers were traditionally included as part of the risk stratification of PE patients. […] The current guidelines recommend employing NT-proBNP to identify normotensive patients with an expected benign disease course. […] Right ventricular (RV) dysfunction has been associated with increased risk of death. […] A multicenter prospective cohort study including 490 normotensive PE patients managed according to the current ESC guidelines proposed an optimal definition of RV dysfunction for prognostic assessment.
  • #23 How to predict prognosis in patients with acute pulmonary embolism? Recent advances | Silva | Polish Heart Journal (Kardiologia Polska)
    https://journals.viamedica.pl/polish_heart_journal/article/view/KP.a2023.0143
    The shock index (SI) includes information about the patients HR and SBP (shock index = HR/SBP) to assess hemodynamic status. […] The shock index was demonstrated to be an independent predictor of 30-day mortality, and it performed better than SBP alone for discrimination of low-risk patients. […] Biomarkers were traditionally included as part of the risk stratification of PE patients. […] The current guidelines recommend employing NT-proBNP to identify normotensive patients with an expected benign disease course. […] Right ventricular (RV) dysfunction has been associated with increased risk of death. […] A multicenter prospective cohort study including 490 normotensive PE patients managed according to the current ESC guidelines proposed an optimal definition of RV dysfunction for prognostic assessment.
  • #24 Pulmonary embolism – Wikipedia
    https://en.wikipedia.org/wiki/Pulmonary_embolism
    Fewer than 5 to 10% of symptomatic PEs are fatal within the first hour of symptoms. […] There are several markers used for risk stratification and these are also independent predictors of adverse outcomes. These include hypotension, cardiogenic shock, syncope, evidence of right heart dysfunction, and elevated cardiac enzymes. […] Some ECG changes including S1Q3T3 also correlate with a worse short-term prognosis. […] Prognosis depends on the amount of lung that is affected and on the co-existence of other medical conditions; chronic embolisation to the lung can lead to pulmonary hypertension. […] After a massive PE, the embolus must be resolved somehow if the patient is to survive. […] There is controversy over whether small subsegmental PEs need treatment at all and some evidence exists that patients with subsegmental PEs may do well without treatment.
  • #25 How to predict prognosis in patients with acute pulmonary embolism? Recent advances | Silva | Polish Heart Journal (Kardiologia Polska)
    https://journals.viamedica.pl/polish_heart_journal/article/view/KP.a2023.0143
    Identifying a high risk of mortality in patients should be the first step in PE risk stratification. […] This subgroup of patients corresponds to 4% of PE patients, with documented short-term mortality of 16% to 19%. […] Low-risk PE corresponds to about 40% of acute PE patients. […] The incidence of recurrent VTE, major bleeding, or death in patients who were qualified for home treatment by the Hestia or sPESI strategy and were treated at home was as low as 1.3% and 1.1%, respectively. […] The intermediate-risk patients represent a highly heterogenous group of patients, with a 30-day mortality risk varying between 5% and 15%. […] The TELOS score was derived from a prospective cohort of 496 patients and includes RV dysfunction, troponin, and plasma lactate elevation as predictors of death or hemodynamic collapse at 7 days.
  • #26 How to predict prognosis in patients with acute pulmonary embolism? Recent advances | Silva | Polish Heart Journal (Kardiologia Polska)
    https://journals.viamedica.pl/polish_heart_journal/article/view/KP.a2023.0143
    Identifying a high risk of mortality in patients should be the first step in PE risk stratification. […] This subgroup of patients corresponds to 4% of PE patients, with documented short-term mortality of 16% to 19%. […] Low-risk PE corresponds to about 40% of acute PE patients. […] The incidence of recurrent VTE, major bleeding, or death in patients who were qualified for home treatment by the Hestia or sPESI strategy and were treated at home was as low as 1.3% and 1.1%, respectively. […] The intermediate-risk patients represent a highly heterogenous group of patients, with a 30-day mortality risk varying between 5% and 15%. […] The TELOS score was derived from a prospective cohort of 496 patients and includes RV dysfunction, troponin, and plasma lactate elevation as predictors of death or hemodynamic collapse at 7 days.
  • #27 Pulmonary Embolism (PE): Practice Essentials, Background, Anatomy
    https://emedicine.medscape.com/article/300901-overview
    The risk of recurrent pulmonary embolism is due to the recurrence of proximal venous thrombosis; approximately 17% of patients with recurrent pulmonary embolism were found to have proximal DVT. In a small proportion of patients, pulmonary embolism does not resolve; hence, chronic thromboembolic pulmonary arterial hypertension results. […] Elevated plasma levels of natriuretic peptides (brain natriuretic peptide and N-terminal pro-brain natriuretic peptide) have been associated with higher mortality in patients with pulmonary embolism. In one study, levels of N-terminal pro-brain natriuretic peptide greater than 500 ng/L were independently associated with central pulmonary embolism and were a possible predictor of death from pulmonary embolism. […] The 30-day mortality rates for high-, intermediate- and low-risk PE are approximately 65%, 5% to 25% and 1% respectively.
  • #28 How to predict prognosis in patients with acute pulmonary embolism? Recent advances | Silva | Polish Heart Journal (Kardiologia Polska)
    https://journals.viamedica.pl/polish_heart_journal/article/view/KP.a2023.0143
    Identifying a high risk of mortality in patients should be the first step in PE risk stratification. […] This subgroup of patients corresponds to 4% of PE patients, with documented short-term mortality of 16% to 19%. […] Low-risk PE corresponds to about 40% of acute PE patients. […] The incidence of recurrent VTE, major bleeding, or death in patients who were qualified for home treatment by the Hestia or sPESI strategy and were treated at home was as low as 1.3% and 1.1%, respectively. […] The intermediate-risk patients represent a highly heterogenous group of patients, with a 30-day mortality risk varying between 5% and 15%. […] The TELOS score was derived from a prospective cohort of 496 patients and includes RV dysfunction, troponin, and plasma lactate elevation as predictors of death or hemodynamic collapse at 7 days.
  • #29 Pulmonary Embolism (PE): Practice Essentials, Background, Anatomy
    https://emedicine.medscape.com/article/300901-overview
    The risk of recurrent pulmonary embolism is due to the recurrence of proximal venous thrombosis; approximately 17% of patients with recurrent pulmonary embolism were found to have proximal DVT. In a small proportion of patients, pulmonary embolism does not resolve; hence, chronic thromboembolic pulmonary arterial hypertension results. […] Elevated plasma levels of natriuretic peptides (brain natriuretic peptide and N-terminal pro-brain natriuretic peptide) have been associated with higher mortality in patients with pulmonary embolism. In one study, levels of N-terminal pro-brain natriuretic peptide greater than 500 ng/L were independently associated with central pulmonary embolism and were a possible predictor of death from pulmonary embolism. […] The 30-day mortality rates for high-, intermediate- and low-risk PE are approximately 65%, 5% to 25% and 1% respectively.
  • #30 How to predict prognosis in patients with acute pulmonary embolism? Recent advances | Silva | Polish Heart Journal (Kardiologia Polska)
    https://journals.viamedica.pl/polish_heart_journal/article/view/KP.a2023.0143
    Identifying a high risk of mortality in patients should be the first step in PE risk stratification. […] This subgroup of patients corresponds to 4% of PE patients, with documented short-term mortality of 16% to 19%. […] Low-risk PE corresponds to about 40% of acute PE patients. […] The incidence of recurrent VTE, major bleeding, or death in patients who were qualified for home treatment by the Hestia or sPESI strategy and were treated at home was as low as 1.3% and 1.1%, respectively. […] The intermediate-risk patients represent a highly heterogenous group of patients, with a 30-day mortality risk varying between 5% and 15%. […] The TELOS score was derived from a prospective cohort of 496 patients and includes RV dysfunction, troponin, and plasma lactate elevation as predictors of death or hemodynamic collapse at 7 days.
  • #31 Pulmonary Embolism (PE): Practice Essentials, Background, Anatomy
    https://emedicine.medscape.com/article/300901-overview
    The risk of recurrent pulmonary embolism is due to the recurrence of proximal venous thrombosis; approximately 17% of patients with recurrent pulmonary embolism were found to have proximal DVT. In a small proportion of patients, pulmonary embolism does not resolve; hence, chronic thromboembolic pulmonary arterial hypertension results. […] Elevated plasma levels of natriuretic peptides (brain natriuretic peptide and N-terminal pro-brain natriuretic peptide) have been associated with higher mortality in patients with pulmonary embolism. In one study, levels of N-terminal pro-brain natriuretic peptide greater than 500 ng/L were independently associated with central pulmonary embolism and were a possible predictor of death from pulmonary embolism. […] The 30-day mortality rates for high-, intermediate- and low-risk PE are approximately 65%, 5% to 25% and 1% respectively.
  • #32 How to predict prognosis in patients with acute pulmonary embolism? Recent advances | Silva | Polish Heart Journal (Kardiologia Polska)
    https://journals.viamedica.pl/polish_heart_journal/article/view/KP.a2023.0143
    Identifying a high risk of mortality in patients should be the first step in PE risk stratification. […] This subgroup of patients corresponds to 4% of PE patients, with documented short-term mortality of 16% to 19%. […] Low-risk PE corresponds to about 40% of acute PE patients. […] The incidence of recurrent VTE, major bleeding, or death in patients who were qualified for home treatment by the Hestia or sPESI strategy and were treated at home was as low as 1.3% and 1.1%, respectively. […] The intermediate-risk patients represent a highly heterogenous group of patients, with a 30-day mortality risk varying between 5% and 15%. […] The TELOS score was derived from a prospective cohort of 496 patients and includes RV dysfunction, troponin, and plasma lactate elevation as predictors of death or hemodynamic collapse at 7 days.
  • #33 Acute pulmonary embolism in adults: Treatment overview and prognosis – UpToDate
    https://www.uptodate.com/contents/acute-pulmonary-embolism-in-adults-treatment-overview-and-prognosis
    Acute pulmonary embolism (PE) is a common and sometimes fatal disease with variable clinical presentation. It is critical that therapy be administered in a timely fashion to avoid fatalities. […] The treatment, prognosis, and follow-up of patients with acute PE are reviewed here. […] Prognostic factors include shock and right ventricular dysfunction, right ventricle thrombus, and deep vein thrombosis. […] High-risk factors in pulmonary embolism that predict poor prognosis are identified.
  • #34 Pulmonary embolism – Wikipedia
    https://en.wikipedia.org/wiki/Pulmonary_embolism
    Fewer than 5 to 10% of symptomatic PEs are fatal within the first hour of symptoms. […] There are several markers used for risk stratification and these are also independent predictors of adverse outcomes. These include hypotension, cardiogenic shock, syncope, evidence of right heart dysfunction, and elevated cardiac enzymes. […] Some ECG changes including S1Q3T3 also correlate with a worse short-term prognosis. […] Prognosis depends on the amount of lung that is affected and on the co-existence of other medical conditions; chronic embolisation to the lung can lead to pulmonary hypertension. […] After a massive PE, the embolus must be resolved somehow if the patient is to survive. […] There is controversy over whether small subsegmental PEs need treatment at all and some evidence exists that patients with subsegmental PEs may do well without treatment.
  • #35 Signs and symptoms of acute pulmonary embolism and their predictive value for all-cause hospital death in respect of severity of the disease, age, sex and body mass index: retrospective analysis of the Regional PE Registry (REPER) | BMJ Open Respiratory R
    https://bmjopenrespres.bmj.com/content/10/1/e001559
    The incidence of the signs and symptoms of acute pulmonary embolism (PE) according to mortality risk, age and sex has been partly explored. […] The incidence of the signs and symptoms of acute PE varies depending on disease severity, sex, age and body mass index (BMI). […] Awareness that the signs and symptoms of acute PE depend on disease severity, sex, age, and BMI might contribute to its prompt diagnosis and treatment. […] Recent advances in the diagnosis and treatment of acute pulmonary embolism (PE) have significantly improved patient prognoses. […] The correlation between clinical presentation and PE severity has not been investigated, and this relationship may change over time. […] A better understanding of the association of some important patient characteristics, such as age, sex and body mass index (BMI), with the clinical presentation of acute PE of different severity, is needed for better diagnosis of the disease.
  • #36 Signs and symptoms of acute pulmonary embolism and their predictive value for all-cause hospital death in respect of severity of the disease, age, sex and body mass index: retrospective analysis of the Regional PE Registry (REPER) | BMJ Open Respiratory R
    https://bmjopenrespres.bmj.com/content/10/1/e001559
    The incidence of dyspnoea, syncope and tachycardia increased with the risk of PE in all subgroups. […] The presence of symptomatic DVT was associated with lower hospital mortality. […] The presence of pneumonia at presentation was more distinct in younger men with low-risk and intermediate-risk PE than in the other cohorts. […] Among all the analysed symptoms and signs, only the presence of pneumonia was associated with higher hospital death, whereas symptomatic DVT was associated with a lower mortality risk, independent of age, sex and ESC mortality risk score.
  • #37 How to predict prognosis in patients with acute pulmonary embolism? Recent advances | Silva | Polish Heart Journal (Kardiologia Polska)
    https://journals.viamedica.pl/polish_heart_journal/article/view/KP.a2023.0143
    Identifying a high risk of mortality in patients should be the first step in PE risk stratification. […] This subgroup of patients corresponds to 4% of PE patients, with documented short-term mortality of 16% to 19%. […] Low-risk PE corresponds to about 40% of acute PE patients. […] The incidence of recurrent VTE, major bleeding, or death in patients who were qualified for home treatment by the Hestia or sPESI strategy and were treated at home was as low as 1.3% and 1.1%, respectively. […] The intermediate-risk patients represent a highly heterogenous group of patients, with a 30-day mortality risk varying between 5% and 15%. […] The TELOS score was derived from a prospective cohort of 496 patients and includes RV dysfunction, troponin, and plasma lactate elevation as predictors of death or hemodynamic collapse at 7 days.
  • #38 How to predict prognosis in patients with acute pulmonary embolism? Recent advances | Silva | Polish Heart Journal (Kardiologia Polska)
    https://journals.viamedica.pl/polish_heart_journal/article/view/KP.a2023.0143
    In addition to minimizing short-term mortality, PE management should focus on long-term prognosis and reducing the risk of VTE recurrence. […] The provoked (e.g., by a transient risk factor such as major surgery) or unprovoked nature of PE also impacts prognosis, as patients with unprovoked PE are at higher risk of recurrence and represent a heterogenous subgroup of patients, in which further risk-stratification is needed.
  • #39 Prediction of pulmonary embolism by an explainable machine learning approach in the real world | Scientific Reports
    https://www.nature.com/articles/s41598-024-75435-9
    In this study, we demonstrated the efficacy of machine learning models in preemptively identifying patients at high risk of experiencing PE before its occurrence. […] More importantly, to date, there is no literature evidence of using SHAP values to explain PE prediction models. […] The MLA developed in our study offers distinct advantages over alternative risk stratification methods, such as adjusted D-dimer and scoring systems. […] In contrast, our MLA model not only enhances future PE prediction but also facilitates early detection preceding the confirmatory diagnostic process, consequently reducing unnecessary CTPA. […] Our prediction model based on MLA was executed within a premier hospital setting, showcasing enhanced performance in identifying PE risk within suspected patient population. […] Our machine learning-based predictive model can not only help doctors to detect suspicious patients in time and decrease unnecessary CTPA, but also improve the clinical outcome of PE patients.
  • #40
    https://pmc.ncbi.nlm.nih.gov/articles/PMC9558887/
    To determine the prediction ability of the National Early Warning Score (NEWS), National Early Warning Score 2 (NEWS2), and quick Sequential Organ Failure Assessment (qSOFA) score for the prognosis of pulmonary embolism (PE) in the emergency department. […] The NEWS2 more accurately predicts 1-week mortality than do the NEWS and qSOFA score in patients with PE. […] The primary outcome of this study was mortality. […] The NEWS2 seems to be more effective than the NEWS and qSOFA score and may be used to predict the severity, 1-week mortality, ICU admission, and hospitalization length of patients with PE.
  • #41 Prediction Models for Pulmonary Embolism – Endovascular Today
    https://evtoday.com/articles/2024-jan/prediction-models-for-pulmonary-embolism
    The Hestia criteria were designed to identify low-risk PE patients who are suitable for outpatient management. […] Initial evaluation of the Hestia criteria at 3 months postdischarge found that among all discharged patients, the rate of recurrent venous thromboembolism was 2%, occurrence of intracranial bleeding was 0.7%, and all-cause mortality was 1%. A randomized trial comparing the sPESI score versus Hestia criteria in determining appropriateness for outpatient PE management found similar results between the two methods. […] This suggests that the qualitative appropriateness measures included in the Hestia criteria are of significant clinical importance. […] Although all three have been well-validated and can be incorporated into clinical practice, work remains ongoing to continue to develop and improve prediction scores that accurately assess which patients with PE can be safely discharged. […] The most well-known of these scores, known as the Bova score, intends to identify intermediate-risk (hemodynamically stable) PE patients who may benefit from more invasive and risky interventions than anticoagulation alone.
  • #42 Prediction Models for Pulmonary Embolism – Endovascular Today
    https://evtoday.com/articles/2024-jan/prediction-models-for-pulmonary-embolism
    Despite classifying patients as intermediate-high, intermediate-low, and low risk, the ESC guidelines only recommend management variations based on these classifiers when pertaining to early discharge versus hospitalization and monitoring. […] Unfortunately, the rate of clinical decompensation for intermediate-risk PE is estimated to be as high as 5%; however, to date, there has not been a validated predictive model to identify the subpopulation of intermediate-risk PE patients most likely to clinically decompensate or die. […] The current predictive models for estimating pretest probability for PE (the PERC rule, Wells criteria, YEARS algorithm, revised Geneva score, and 4PEPS) are robust. Additionally, while the models for determining low-risk PE (PESI score, sPESI score, Hestia criteria) are clinically applicable, the models for determining the probability of clinical decompensation (Bova score) are still being clinically validated. […] The mainstay of PE management remains hemodynamic support when needed, systemic anticoagulation, and systemic thrombolysis, if indicated based on severity.
  • #43 Pulmonary embolism – Wikipedia
    https://en.wikipedia.org/wiki/Pulmonary_embolism
    Once anticoagulation is stopped, the risk of a fatal pulmonary embolism is 0.5% per year. […] Mortality from untreated PEs was said to be 26%. […] The PESI and sPESI (= simplified Pulmonary Embolism Severity Index) scoring tools can estimate the mortality of patients. […] The PESI algorithm comprises 11 routinely available clinical variables. […] It puts the subjects into one of five classes (IV), with 30-day mortality ranging from 1.1% to 24.5%. Those in classes I and II are low-risk and those in classes IIIV are high-risk.
  • #44 Pulmonary Embolism (PE): Practice Essentials, Background, Anatomy
    https://emedicine.medscape.com/article/300901-overview
    The prognosis of patients with PE depends on two factors: the underlying disease state and appropriate diagnosis and treatment. According to the CDC, sudden death will occur in 25% of individuals with a PE. Mortality for acute pulmonary embolism can be broken down into three categories: high-risk pulmonary embolism and low- or moderate-risk pulmonary embolism. […] Anticoagulant treatment decreases mortality to less than 5%. At 5 days of anticoagulant therapy, 36% of lung scan defects are resolved; at 2 weeks, 52% are resolved; and at 3 months, 73% are resolved. Most patients treated with anticoagulants do not develop long-term sequelae upon follow-up evaluation. The mortality in patients with undiagnosed pulmonary embolism is 30%. […] In the PIOPED study, the 1-year mortality rate was 24%. The deaths occurred due to cardiac disease, recurrent pulmonary embolism, infection, and cancer.
  • #45 Pulmonary Embolism (PE): Practice Essentials, Background, Anatomy
    https://emedicine.medscape.com/article/300901-overview
    The risk of recurrent pulmonary embolism is due to the recurrence of proximal venous thrombosis; approximately 17% of patients with recurrent pulmonary embolism were found to have proximal DVT. In a small proportion of patients, pulmonary embolism does not resolve; hence, chronic thromboembolic pulmonary arterial hypertension results. […] Elevated plasma levels of natriuretic peptides (brain natriuretic peptide and N-terminal pro-brain natriuretic peptide) have been associated with higher mortality in patients with pulmonary embolism. In one study, levels of N-terminal pro-brain natriuretic peptide greater than 500 ng/L were independently associated with central pulmonary embolism and were a possible predictor of death from pulmonary embolism. […] The 30-day mortality rates for high-, intermediate- and low-risk PE are approximately 65%, 5% to 25% and 1% respectively.
  • #46 Pulmonary Embolism (PE): Practice Essentials, Background, Anatomy
    https://emedicine.medscape.com/article/300901-overview
    The prognosis of patients with PE depends on two factors: the underlying disease state and appropriate diagnosis and treatment. According to the CDC, sudden death will occur in 25% of individuals with a PE. Mortality for acute pulmonary embolism can be broken down into three categories: high-risk pulmonary embolism and low- or moderate-risk pulmonary embolism. […] Anticoagulant treatment decreases mortality to less than 5%. At 5 days of anticoagulant therapy, 36% of lung scan defects are resolved; at 2 weeks, 52% are resolved; and at 3 months, 73% are resolved. Most patients treated with anticoagulants do not develop long-term sequelae upon follow-up evaluation. The mortality in patients with undiagnosed pulmonary embolism is 30%. […] In the PIOPED study, the 1-year mortality rate was 24%. The deaths occurred due to cardiac disease, recurrent pulmonary embolism, infection, and cancer.
  • #47 Pulmonary Embolism (PE): Practice Essentials, Background, Anatomy
    https://emedicine.medscape.com/article/300901-overview
    The prognosis of patients with PE depends on two factors: the underlying disease state and appropriate diagnosis and treatment. According to the CDC, sudden death will occur in 25% of individuals with a PE. Mortality for acute pulmonary embolism can be broken down into three categories: high-risk pulmonary embolism and low- or moderate-risk pulmonary embolism. […] Anticoagulant treatment decreases mortality to less than 5%. At 5 days of anticoagulant therapy, 36% of lung scan defects are resolved; at 2 weeks, 52% are resolved; and at 3 months, 73% are resolved. Most patients treated with anticoagulants do not develop long-term sequelae upon follow-up evaluation. The mortality in patients with undiagnosed pulmonary embolism is 30%. […] In the PIOPED study, the 1-year mortality rate was 24%. The deaths occurred due to cardiac disease, recurrent pulmonary embolism, infection, and cancer.
  • #48 Prediction of pulmonary embolism by an explainable machine learning approach in the real world | Scientific Reports
    https://www.nature.com/articles/s41598-024-75435-9
    In recent years, large amounts of researches showed that pulmonary embolism (PE) has become a common disease, and PE remains a clinical challenge because of its high mortality, high disability, high missed and high misdiagnosed rates. […] Regarding the efficacy of the single model that most accurately predicted the outcome, RF demonstrated the highest efficacy in predicting outcomes, with an AUC of 0.776 (95% CI 0.7740.778). […] In this study, PE prediction model was successfully established and designed as a web page, facilitating the optimization of early diagnosis and timely treatment strategies to enhance PE patient outcomes. […] Acute pulmonary embolism (PE) stands as the third leading cause of cardiovascular death globally, following coronary heart disease and stroke. Statistics indicate that the short-term mortality rate for untreated PE reaches as high as 30%.
  • #49 The Pulmonary Embolism Severity Index in Predicting the Prognosis of Patients With Pulmonary Embolism
    https://pmc.ncbi.nlm.nih.gov/articles/PMC2698620/
    Many prognostic models have been developed to help physicians make medical decisions on treating patients with pulmonary embolism. Among these models, the Pulmonary Embolism Severity Index (PESI) has been shown to be a successful risk stratification tool for patients with acute pulmonary embolism. […] The mortality rate was significantly associated with the PESI class. […] The PESI class was found to be significantly correlated with the 30-day mortality rate, hospital mortality, and overall mortality. Our data indicate that the PESI can be used to predict the prognosis of patients with pulmonary embolism and in making medical decisions regarding the treatment of patients with pulmonary embolism. […] The 30-day mortality rate was 11.1%, whereas the mortality rate during hospitalization was 15.6% and the total mortality rate was 30.0%.
  • #50 Prediction Models for Pulmonary Embolism – Endovascular Today
    https://evtoday.com/articles/2024-jan/prediction-models-for-pulmonary-embolism
    Despite classifying patients as intermediate-high, intermediate-low, and low risk, the ESC guidelines only recommend management variations based on these classifiers when pertaining to early discharge versus hospitalization and monitoring. […] Unfortunately, the rate of clinical decompensation for intermediate-risk PE is estimated to be as high as 5%; however, to date, there has not been a validated predictive model to identify the subpopulation of intermediate-risk PE patients most likely to clinically decompensate or die. […] The current predictive models for estimating pretest probability for PE (the PERC rule, Wells criteria, YEARS algorithm, revised Geneva score, and 4PEPS) are robust. Additionally, while the models for determining low-risk PE (PESI score, sPESI score, Hestia criteria) are clinically applicable, the models for determining the probability of clinical decompensation (Bova score) are still being clinically validated. […] The mainstay of PE management remains hemodynamic support when needed, systemic anticoagulation, and systemic thrombolysis, if indicated based on severity.
  • #51 Prognostic models in acute pulmonary embolism: a systematic review and meta-analysis | BMJ Open
    https://bmjopen.bmj.com/content/6/4/e010324
    Objective To review the evidence for existing prognostic models in acute pulmonary embolism (PE) and determine how valid and useful they are for predicting patient outcomes. […] The most validated models were the PE Severity Index (PESI) and its simplified version (sPESI). […] PESI has proved clinically useful in an impact study. […] We provide evidence-based information about the validity and utility of the existing prognostic models in acute PE that may be helpful for identifying patients at low risk. […] Novel models seem attractive for the high-risk normotensive PE but need to be externally validated then be assessed in impact studies.
  • #52 Signs and symptoms of acute pulmonary embolism and their predictive value for all-cause hospital death in respect of severity of the disease, age, sex and body mass index: retrospective analysis of the Regional PE Registry (REPER) | BMJ Open Respiratory R
    https://bmjopenrespres.bmj.com/content/10/1/e001559
    The incidence of the signs and symptoms of acute pulmonary embolism (PE) according to mortality risk, age and sex has been partly explored. […] The incidence of the signs and symptoms of acute PE varies depending on disease severity, sex, age and body mass index (BMI). […] Awareness that the signs and symptoms of acute PE depend on disease severity, sex, age, and BMI might contribute to its prompt diagnosis and treatment. […] Recent advances in the diagnosis and treatment of acute pulmonary embolism (PE) have significantly improved patient prognoses. […] The correlation between clinical presentation and PE severity has not been investigated, and this relationship may change over time. […] A better understanding of the association of some important patient characteristics, such as age, sex and body mass index (BMI), with the clinical presentation of acute PE of different severity, is needed for better diagnosis of the disease.
  • #53 Prognostic models in acute pulmonary embolism: a systematic review and meta-analysis | BMJ Open
    https://bmjopen.bmj.com/content/6/4/e010324
    Objective To review the evidence for existing prognostic models in acute pulmonary embolism (PE) and determine how valid and useful they are for predicting patient outcomes. […] The most validated models were the PE Severity Index (PESI) and its simplified version (sPESI). […] PESI has proved clinically useful in an impact study. […] We provide evidence-based information about the validity and utility of the existing prognostic models in acute PE that may be helpful for identifying patients at low risk. […] Novel models seem attractive for the high-risk normotensive PE but need to be externally validated then be assessed in impact studies.
  • #54 Prediction Models for Pulmonary Embolism – Endovascular Today
    https://evtoday.com/articles/2024-jan/prediction-models-for-pulmonary-embolism
    Despite classifying patients as intermediate-high, intermediate-low, and low risk, the ESC guidelines only recommend management variations based on these classifiers when pertaining to early discharge versus hospitalization and monitoring. […] Unfortunately, the rate of clinical decompensation for intermediate-risk PE is estimated to be as high as 5%; however, to date, there has not been a validated predictive model to identify the subpopulation of intermediate-risk PE patients most likely to clinically decompensate or die. […] The current predictive models for estimating pretest probability for PE (the PERC rule, Wells criteria, YEARS algorithm, revised Geneva score, and 4PEPS) are robust. Additionally, while the models for determining low-risk PE (PESI score, sPESI score, Hestia criteria) are clinically applicable, the models for determining the probability of clinical decompensation (Bova score) are still being clinically validated. […] The mainstay of PE management remains hemodynamic support when needed, systemic anticoagulation, and systemic thrombolysis, if indicated based on severity.
  • #55 Prediction of pulmonary embolism by an explainable machine learning approach in the real world | Scientific Reports
    https://www.nature.com/articles/s41598-024-75435-9
    In recent years, large amounts of researches showed that pulmonary embolism (PE) has become a common disease, and PE remains a clinical challenge because of its high mortality, high disability, high missed and high misdiagnosed rates. […] Regarding the efficacy of the single model that most accurately predicted the outcome, RF demonstrated the highest efficacy in predicting outcomes, with an AUC of 0.776 (95% CI 0.7740.778). […] In this study, PE prediction model was successfully established and designed as a web page, facilitating the optimization of early diagnosis and timely treatment strategies to enhance PE patient outcomes. […] Acute pulmonary embolism (PE) stands as the third leading cause of cardiovascular death globally, following coronary heart disease and stroke. Statistics indicate that the short-term mortality rate for untreated PE reaches as high as 30%.

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dysfunkcja prawej komory skurczowe ciśnienie tętnicze wstrząs kardiogenny NT-proBNP przewlekłe zakrzepowo-zatorowe nadciśnienie płucne żylna choroba zakrzepowo-zatorowa peptyd natriuretyczny typu B zakrzepica żył głębokich enzym sercowy peptyd natriuretyczny troponina udar mózgu choroba niedokrwienna serca zatorowość płucna N-końcowy pro-peptyd natriuretyczny typu B skala qSOFA tachykardia zmiany w EKG