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European Heart Journal Advance Access published online on October 5, 2005
European Heart Journal, doi:10.1093/eurheartj/ehi588
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European Heart Journal © The European Society of Cardiology 2005; all rights reserved
Received July 22, 2005
Revised September 9, 2005
Accepted September 22, 2005

Clinical research

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

Drahomir Aujesky 1*, Pierre-Marie Roy 2, Cédric Petit Le Manach 2, Franck Verschuren 3, Guy Meyer 4, David Scott Obrosky 5, Roslyn A. Stone 6, Jacques Cornuz 1, and Michael J. Fine 5

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

* To whom correspondence should be addressed.
Drahomir Aujesky, E-mail: drahomir.aujesky{at}chuv.ch


  Abstract

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.

Keywords: Pulmonary embolism; Prognosis; Mortality.
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