Simplified pulmonary embolism severity index calculated at hospital admission predicts both in-hospital mortality and all cause mortality at follow up in acute pulmonary embolism

Introduction: Simplified Pulmonary Embolism Severity Index (sPESI) is a new friendly-user prognostic assessment tool that successfully predicts 30-day mortality after acute pulmonary embolism (APE). However, sPESI has not yet been tested to predict long term prognosis after APE. Thus, the aim of this study was to assess the impact of sPESI evaluated at hospital admission on both in-hospital and after discharge prognosis in patients with APE diagnosed by multislice computed tomography (MSCT). Methods and population: Retrospective, observational study that included all patients with APE diagnosed by MSCT during emergency room (ER) stay in the year of 2010. Blood tests and clinical data were obtained at hospital admission. The primary endpoint was in-hospital death of all causes. Secondary endpoint was all-cause death at follow-up. Chi-square test was used to test the prediction of sPESI score on all cause in-hospital mortality. A Cox regression model was used to compare all cause mortality at 18 months of follow up between the different scores of sPESI. Results: Between January and December 2010, 218 patients were diagnosed APE by MSCT [age 73±16 years, 102 (49%) males]. 189 patients had reliable clinical data enabling calculation of sPESI score at hospital admission. 45 (23,8%) patients had a sPESI of 0, 77 (40,7%) patients had a sPESI of 1, 50 (26,4%) patients had a sPESI of 2, 14 (7%) patients had a sPESI of 3, 2 (1%) patients had a sPESI of 4 and just 1 (0,5%) patient had a sPESI of 5. Comparing with the group of patients with sPESI 0 we found the following odds ratios (OR): sPESI group 1 OR 4,400 [95% confidence interval (CI) 0,523 – 36,987, p value = 0,139], sPESI group 2 OR 7,163 [95% CI 0,845 – 60,699, p value= 0,04], sPESI group 3 OR 12,000 [95% CI 1,136 – 126,792, p value = 0,013]. For the outcome of all cause mortality after discharge, it was found that the higher the score of sPESI the lower the event-free survival (for each unit increase in sPESI score, the hazard ratio (HR) was 2,645 (CI 1,644 – 4,255, p value ≤ 0,01). Conclusion: sPESI score calculated at hospital admission predicts not only in-hospital all-cause mortality but also all-cause mortality at 18 months after discharge.