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European Heart Journal Advance Access originally published online on October 5, 2005
European Heart Journal 2006 27(4):476-481; doi:10.1093/eurheartj/ehi588
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© The European Society of Cardiology 2005. All rights reserved. For Permissions, please e-mail: journals.permissions@oxfordjournals.org

Validation of a model to predict adverse outcomes in patients with pulmonary embolism

Drahomir Aujesky1,*, Pierre-Marie Roy2, Cédric Petit Le Manach2, Franck Verschuren3, Guy Meyer4, David Scott Obrosky5,6, Roslyn A. Stone6,7, Jacques Cornuz1 and Michael J. Fine5,6

1Division of General Internal Medicine, The University Outpatient Clinic and The Clinical Epidemiology Center, University of Lausanne, Lausanne, Switzerland
2Department of Emergency Medicine, University of Angers, Angers, France
3Department of Emergency Medicine, Cliniques Universitaires Saint Luc, Université Catholique de Louvain, Brussels, Belgium
4Department of Respiratory Care, Hôpital Européen Georges Pompidou, Université Paris V, Paris, France
5Division of General Internal Medicine, Department of Medicine, University of Pittsburgh, Pittsburgh, PA, USA
6VA Center for Health Equity Research and Promotion and VA Pittsburgh Healthcare System, Pittsburgh, PA, USA
7Department of Biostatistics, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA, USA

Received 22 July 2005; revised 9 September 2005; accepted 22 September 2005; online publish-ahead-of-print 5 October 2005.

* Corresponding author: Service de Médecine Interne, BH10-622, Centre Hospitalier Universitaire Vaudois, 1011 Lausanne, Switzerland. Tel: +41 21 314 04 81; fax: +41 21 314 08 71. E-mail address: drahomir.aujesky{at}chuv.ch

Aims To validate a model for quantifying the prognosis of patients with pulmonary embolism (PE). The model was previously derived from 10 534 US patients.

Methods and results We validated the model in 367 patients prospectively diagnosed with PE at 117 European emergency departments. We used baseline data for the model's 11 prognostic variables to stratify patients into five risk classes (I–V). We compared 90-day mortality within each risk class and the area under the receiver operating characteristic curve between the validation and the original derivation samples. We also assessed the rate of recurrent venous thrombo-embolism and major bleeding within each risk class. Mortality was 0% in Risk Class I, 1.0% in Class II, 3.1% in Class III, 10.4% in Class IV, and 24.4% in Class V and did not differ between the validation and the original derivation samples. The area under the curve was larger in the validation sample (0.87 vs. 0.78, P=0.01). No patients in Classes I and II developed recurrent thrombo-embolism or major bleeding.

Conclusion The model accurately stratifies patients with PE into categories of increasing risk of mortality and other relevant complications. Patients in Risk Classes I and II are at low risk of adverse outcomes and are potential candidates for outpatient treatment.

Key Words: Pulmonary embolism • Prognosis • Mortality


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