Original Articles
A Clinical Prediction Rule for Identifying Short-Term Risk of Adverse Events in Patients With Pulmonary Thromboembolism
Fernando Uresandia,
, Remedios Oterob, Aurelio Cayuelac, Miguel Ángel Cabezudod, David Jiméneze, Elena Lasernaf, Francisco Congetg, Miquel Oribeh, Dolores Nauffali
Corresponding author
fern2148@separ.es
Correspondence: Dr. F. Uresandi. Servicio de Neumología. Hospital de Cruces. Barrio Labeaga, s/n. 48903 Barakaldo. Bizkaia. España
Correspondence: Dr. F. Uresandi. Servicio de Neumología. Hospital de Cruces. Barrio Labeaga, s/n. 48903 Barakaldo. Bizkaia. España
a Servicio de Neumología, Hospital de Cruces, Barakaldo, Bizkaia, Spain
b Servicio de Neumología, Hospital Virgen del Rocío, Sevilla, Spain
c Unidad de Apoyo a la Investigación, Hospital Virgen del Rocío, Sevilla, Spain
d Servicio de Neumología, Hospital Central de Asturias, Oviedo, Asturias, Spain
e Servicio de Neumología, Hospital Ramón y Cajal, Madrid, Spain
f Sección de Neumología, Servicio de Medicina Interna, Hospital San Juan de Dios, Bormujos, Sevilla, Spain
g Servicio de Neumología, Hospital Clínico Lozano Blesa, Zaragoza, Spain
h Servicio de Neumología, Hospital de Galdakao, Galdakao, Bizkaia, Spain
i Servicio de Neumología, Hospital La Fe, Valencia, Spain
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Uresandi. Servicio de Neumología. Hospital de Cruces. Barrio Labeaga, s/n. 48903 Barakaldo. Bizkaia. España" ] ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "fechaRecibido" => "2006-10-05" "fechaAceptado" => "2007-04-03" "PalabrasClave" => array:2 [ "en" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Key words" "identificador" => "xpalclavsec154666" "palabras" => array:3 [ 0 => "Pulmonary thromboembolism" 1 => "Clinical prediction rule" 2 => "Short-term complications" ] ] ] "es" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Palabras clave" "identificador" => "xpalclavsec154667" "palabras" => array:3 [ 0 => "Tromboembolia pulmonar" 1 => "Escala clínica de predicción" 2 => "Complicaciones a corto plazo" ] ] ] ] "tieneResumen" => true "resumen" => array:2 [ "en" => array:1 [ "resumen" => "<span class="elsevierStyleSectionTitle">Objetive</span><p class="elsevierStyleSimplePara elsevierViewall">To identify patients with a low short-term risk of complications following acute pulmonary thromboembolism.</p> <span class="elsevierStyleSectionTitle">Patients and methods</span><p class="elsevierStyleSimplePara elsevierViewall">A prospective multicenter study was conducted in 8 Spanish hospitals; 681 consecutive outpatients diagnosed with pulmonary thromboembolism were enrolled. Clinically significant variables were weighted using coefficients derived from a logistic regression model in order to optimize the diagnostic performance of a clinical prediction rule to predict the following complications within 10 days of acute pulmonary thromboembolism: death, recurrent thromboembolism, and major or minor bleeding.</p> <span class="elsevierStyleSectionTitle">Results</span><p class="elsevierStyleSimplePara elsevierViewall">Forty-three patients (6.3%) had 51 complications. These included 33 deaths, 12 major bleeding episodes, and 6 minor bleeding episodes. The clinical variables used in the prediction rule were assigned the following scores: recent major bleeding episode and cancer with metastasis, 4 points each; creatinine levels of over 2 mg/dL, 3 points; cancer without metastasis and immobility due to a recent medical condition, 2 points each; and absence of surgery in the past 2 months and an age of over 60 years, 1 point each. A risk score of 2 or less, obtained by 47.8% of patients, indicated a low short-term risk of developing complications following pulmonary thromboembolism. The area under the receiver operating characteristic curve for the prediction rule was 0.75 (95% confidence interval [CI], 0.67–0.83). For this cutoff point, sensitivity was 82.9% (95% CI, 68.7–91.5) and the likelihood ratios for a positive and negative test result were 1.63 (95% CI, 1.39–1.92), and 0.35 (95% CI, 0.18–0.69), respectively.</p> <span class="elsevierStyleSectionTitle">Conclusions</span><p class="elsevierStyleSimplePara elsevierViewall">Our clinical prediction rule could be useful for identifying patients with a low risk of complications in the 10 days following acute pulmonary thromboembolism. Those patients would be eligible for consideration for outpatient treatment.</p>" ] "es" => array:1 [ "resumen" => "<span class="elsevierStyleSectionTitle">Objetivo</span><p class="elsevierStyleSimplePara elsevierViewall">Identificar a pacientes con riesgo bajo de complicaciones a corto plazo tras un episodio agudo de tromboembolia pulmonar (TEP).</p> <span class="elsevierStyleSectionTitle">Pacientes y métodos</span><p class="elsevierStyleSimplePara elsevierViewall">Se trata de un estudio multicéntrico y prospectivo, realizado en 8 hospitales españoles, en el que se incluyó a un total de 681 pacientes ambulatorios consecutivos con diagnóstico de TEP. Las variables con significación clínica se ponderaron a partir de los coeficientes del modelo logístico, con el objetivo de maximizar las características diagnósticas de la escala clínica de predicción de eventos a corto plazo: muertes, recidivas tromboembólicas o complicaciones hemorrágicas graves y no graves en los 10 primeros días.</p> <span class="elsevierStyleSectionTitle">Resultados</span><p class="elsevierStyleSimplePara elsevierViewall">Hubo 51 complicaciones en 43 pacientes (6,3%): un total de 33 fallecimientos, 12 hemorragias graves y 6 no graves. La puntuación clínica asignada a las variables de la escala de predicción fue la siguiente: hemorragia grave reciente y cáncer con metástasis, 4 puntos cada una; valores de creatinina mayores de 2 mg/dl, 3 puntos; cáncer sin metástasis e inmovilización por enfermedad médica reciente, 2 puntos cada una, y ausencia de cirugía en los últimos 2 meses y edad superior a 60 años, 1 punto cada una. Una puntuación de 2 o menor, que obtuvo el 47,8% de nuestros pacientes, indica un riesgo bajo de presentar complicaciones a corto plazo tras la TEP. El área bajo la curva de eficacia diagnóstica de la escala es de 0,75 (intervalo de confianza [IC] del 95%, 0,67–0,83). Para ese punto de corte la sensibilidad es del 82,9% (IC del 95%, 68,7–91,5), el cociente de probabilidad positiva del 1,63 (IC del 95%, 1,39–1,92) y el cociente de probabilidad negativa de 0,35 (IC del 95%, 0,18–0,69).</p> <span class="elsevierStyleSectionTitle">Conclusiones</span><p class="elsevierStyleSimplePara elsevierViewall">Nuestra escala clínica de puntuación podría ser útil para identificar a pacientes con riesgo bajo de presentar complicaciones durante los 10 primeros días tras un episodio de TEP aguda. Estos pacientes serían los candidatos sobre los que plantear un estudio que avale el tratamiento domiciliario de la TEP.</p>" ] ] "NotaPie" => array:1 [ 0 => array:1 [ "nota" => "<p class="elsevierStyleNotepara">This study was funded by grants from the Instituto de Salud Carlos III of the Spanish Ministry of Health and Consumer Affairs (2003-2006) and from the Spanish Society of Pulmonology and Thoracic Surgery (SEPAR) (2005).</p>" ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:1 [ "bibliografiaReferencia" => array:18 [ 0 => array:3 [ "identificador" => "bib1" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Clinical, laboratory, roentgenographic, and electrocardiographic findings in patients with acute pulmonary embolism and no pre-existing cardiac or pulmonary disease" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "PD Stein" 1 => "ML Terrin" 2 => "CA Hales" 3 => "HI Palevsky" 4 => "AH Satzman" 5 => "T Thompson" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Chest" "fecha" => "1991" "volumen" => "100" "paginaInicial" => "598" "paginaFinal" => "603" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/1909617" "web" => "Medline" ] ] ] ] ] ] ] ] 1 => array:3 [ "identificador" => "bib2" "etiqueta" => "2" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "The epidemiology of venous thromboembolism" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:1 [ 0 => "RH White" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "Circulation" "fecha" => "2003" "volumen" => "107" "paginaInicial" => "4" "paginaFinal" => "8" ] ] ] ] ] ] 2 => array:3 [ "identificador" => "bib3" "etiqueta" => "3" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Antithrombotic therapy for venous thromboembolic disease. 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| Year/Month | Html | Total | |
|---|---|---|---|
| 2024 November | 4 | 4 | 8 |
| 2024 October | 27 | 18 | 45 |
| 2024 September | 30 | 20 | 50 |
| 2024 August | 39 | 30 | 69 |
| 2024 July | 30 | 24 | 54 |
| 2024 June | 31 | 21 | 52 |
| 2024 May | 32 | 23 | 55 |
| 2024 April | 18 | 19 | 37 |
| 2024 March | 19 | 16 | 35 |
| 2024 February | 24 | 24 | 48 |
| 2023 March | 4 | 3 | 7 |
| 2023 February | 19 | 19 | 38 |
| 2023 January | 21 | 26 | 47 |
| 2022 December | 24 | 27 | 51 |
| 2022 November | 19 | 25 | 44 |
| 2022 October | 17 | 28 | 45 |
| 2022 September | 15 | 24 | 39 |
| 2022 August | 18 | 35 | 53 |
| 2022 July | 18 | 40 | 58 |
| 2022 June | 20 | 31 | 51 |
| 2022 May | 17 | 29 | 46 |
| 2022 April | 14 | 28 | 42 |
| 2022 March | 16 | 38 | 54 |
| 2022 February | 17 | 26 | 43 |
| 2022 January | 16 | 30 | 46 |
| 2021 December | 85 | 39 | 124 |
| 2021 November | 63 | 44 | 107 |
| 2021 October | 40 | 34 | 74 |
| 2021 September | 31 | 65 | 96 |
| 2021 August | 10 | 25 | 35 |
| 2021 July | 17 | 22 | 39 |
| 2021 June | 10 | 31 | 41 |
| 2021 May | 11 | 27 | 38 |
| 2021 April | 26 | 46 | 72 |
| 2021 March | 21 | 15 | 36 |
| 2021 February | 6 | 11 | 17 |
| 2021 January | 7 | 9 | 16 |
| 2020 December | 10 | 9 | 19 |
| 2020 November | 10 | 10 | 20 |
| 2020 October | 15 | 14 | 29 |
| 2020 September | 46 | 3 | 49 |
| 2020 August | 55 | 11 | 66 |
| 2020 July | 50 | 12 | 62 |
| 2020 June | 14 | 2 | 16 |
| 2020 May | 27 | 14 | 41 |
| 2020 April | 35 | 15 | 50 |
| 2020 March | 46 | 11 | 57 |
| 2020 February | 63 | 15 | 78 |
| 2020 January | 47 | 18 | 65 |
| 2019 December | 37 | 9 | 46 |
| 2019 November | 13 | 9 | 22 |
| 2019 October | 3 | 3 | 6 |
| 2019 September | 7 | 21 | 28 |
| 2019 August | 8 | 8 | 16 |
| 2019 July | 11 | 17 | 28 |
| 2019 June | 4 | 5 | 9 |
| 2019 May | 7 | 10 | 17 |
| 2019 April | 21 | 32 | 53 |
| 2019 March | 10 | 23 | 33 |
| 2019 February | 6 | 11 | 17 |
| 2019 January | 4 | 14 | 18 |
| 2018 December | 10 | 13 | 23 |
| 2018 November | 27 | 16 | 43 |
| 2018 October | 25 | 18 | 43 |
| 2018 September | 12 | 14 | 26 |
| 2018 May | 2 | 0 | 2 |
| 2018 April | 5 | 8 | 13 |
| 2018 March | 3 | 5 | 8 |
| 2018 February | 4 | 5 | 9 |
| 2018 January | 1 | 5 | 6 |
| 2017 December | 5 | 6 | 11 |
| 2017 November | 4 | 5 | 9 |
| 2017 October | 9 | 21 | 30 |
| 2017 September | 6 | 9 | 15 |
| 2017 August | 5 | 13 | 18 |
| 2017 July | 1 | 8 | 9 |
| 2017 June | 9 | 8 | 17 |
| 2017 May | 6 | 10 | 16 |
| 2017 April | 3 | 3 | 6 |
| 2017 March | 2 | 6 | 8 |
| 2017 February | 2 | 6 | 8 |
| 2017 January | 2 | 3 | 5 |
| 2016 December | 8 | 8 | 16 |
| 2016 November | 10 | 6 | 16 |
| 2016 October | 7 | 9 | 16 |
| 2016 September | 5 | 11 | 16 |
| 2016 August | 6 | 4 | 10 |
| 2016 July | 3 | 6 | 9 |
| 2016 March | 2 | 0 | 2 |
| 2015 December | 2 | 0 | 2 |
| 2015 October | 37 | 11 | 48 |
| 2015 September | 35 | 16 | 51 |
| 2015 August | 32 | 18 | 50 |
| 2015 July | 50 | 9 | 59 |
| 2015 June | 36 | 13 | 49 |
| 2015 May | 39 | 21 | 60 |
| 2015 April | 44 | 18 | 62 |
| 2015 March | 26 | 16 | 42 |
| 2015 February | 34 | 12 | 46 |
| 2015 January | 25 | 6 | 31 |
| 2014 December | 28 | 4 | 32 |
| 2014 November | 24 | 7 | 31 |
| 2014 October | 42 | 12 | 54 |
| 2014 September | 19 | 11 | 30 |
| 2014 August | 30 | 8 | 38 |
| 2014 July | 35 | 9 | 44 |
| 2014 June | 49 | 4 | 53 |
| 2014 May | 36 | 10 | 46 |
| 2014 April | 42 | 6 | 48 |
| 2014 March | 47 | 11 | 58 |
| 2014 February | 44 | 9 | 53 |
| 2014 January | 33 | 5 | 38 |
| 2013 December | 41 | 8 | 49 |
| 2013 November | 27 | 7 | 34 |
| 2013 October | 49 | 13 | 62 |
| 2013 September | 45 | 10 | 55 |
| 2013 August | 40 | 8 | 48 |
| 2013 July | 55 | 15 | 70 |
| 2013 June | 41 | 9 | 50 |
| 2013 May | 35 | 5 | 40 |
| 2013 April | 16 | 6 | 22 |
| 2013 March | 8 | 1 | 9 |
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