Rapid prediction of adverse outcomes for acute normotensive pulmonary embolism: derivation of the Calgary Acute Pulmonary Embolism score

Abstract

Background Acute pulmonary embolism (PE) has a wide spectrum of outcomes but the best method to risk stratify normotensive patients for adverse outcomes remains unclear. Methods A multicenter retrospective cohort study of acute PE patients admitted from emergency departments in Calgary, Canada, between 2012–2017 was used to develop a refined acute PE risk score. The composite primary outcome of in-hospital PE-related death or hemodynamic decompensation. The model was internally validated using bootstrapping and the prognostic value of the derived risk score was compared to the Bova score. Results Of 2067 patients with normotensive acute PE, the primary outcome (hemodynamic decompensation or PE related death) occurred in 32 patients (1.5%). In sPESI high-risk patients (n=1498, 78%), a multivariable model used to predict the primary outcome retained computed tomography (CT) right-left ventricular diameter ratio ≥1.5, systolic blood pressure 90–100 mmHg, central pulmonary artery clot, & heart rate ≥100 BMP with a C-statistic of 0.89 (95%CI, 0.82–0.93). Three risk groups were derived using a weighted score (score, prevalence, primary outcome event rate): group 1 (0–3, 73.8%, 0.34%), group 2 (4–6, 17.6%, 5.8%), group 3 (7–9, 8.7%, 12.8%) with a C-statistic 0.85 (95%CI, 0.78–0.91). In comparison the prevalence (primary outcome) by Bova risk stages (n=1179) were: stage I, 49.8% (0.2%); stage II, 31.9% (2.7%); and stage III, 18.4% (7.8%) with a C-statistic 0.80 (95%CI, 0.74–0.86). Conclusions A simple 4-variable risk score using clinical data immediately available after CT diagnosis of acute PE predicts in-hospital adverse outcomes. External validation of the CAPE score is required.