PE-related death, adverse outcome (death, clinical deterioration or haemodynamic collapse), VTE, major bleeding and their combinations in ‘both stable and unstable’ PE patient risk groups
| Risk cut-off (author, year) | Development phase | N studies | Type of study | Haemodynamic status | Outcome | Time point | Proportion (95% CI) High-risk group Low-risk group | Event rate (95% CI) High-risk group Low-risk group |
|---|---|---|---|---|---|---|---|---|
| Algorithm≥1 | ||||||||
| (Jakobsson et al 2010)130 | External validation | 1 | Retrospective | Not reported | PE-related death | 30 days | 83.7 (81.3 to 85.9) 16.3 (14.1 to 18.7) | 6.6 (5.1 to 8.5) 0.6 (0.1 to 4.3) |
| Agterof (Herat rate—Ddimer) | ||||||||
| (Agterof et al 2009)67 | Derivation | 1 | Retrospective | Both stable and unstable | Death VTE major bleeding | In-hospital | 67.1 (61.7 to 72.1) 32.9 (27.9 to 38.3) | 5.3 (3.0 to 9.3) 0.5 (0 to 7.3) |
| ESC high | ||||||||
| (Vanni et al 2011)119 | External validation | 1 | Retrospective | Both stable and unstable | PE-related death | In-hospital | 5.6 (3.8 to 8) 94.4 (92 to 96.2) | 29.6 (15.6 to 49) 4.1 (2.7 to 6.4) |
| ESC intermediate–high | ||||||||
| (Vanni et al 2011)119 | External validation | 1 | Retrospective | Both stable and unstable | PE-related death | In-hospital | 60 (55.6 to 64.3) 40 (35.7 to 44.4) | 8.6 (5.9 to 12.4) 1 (0.3 to 4) |
| GPS≥1 | ||||||||
| (Wicki et al 2000)122 | Derivation | 1 | Retrospective | Not reported | Death VTE major bleeding | 3 months | 80.6 (75.4 to 84.9) 19.4 (15.1 to 24.6) | 12.5 (8.7 to 17.6) 0.9 (0.1 to 13.4) |
| (Nendaz et al 2004)97 | External validation | 1 | Retrospective | Unclear | Death VTE major bleeding | 3 months | 71.4 (64.7 to 77.2) 28.6 (22.8 to 35.3) | 12.0 (7.6 to 18.4) 3.5 (0.9 to 13.0) |
| Overall | 2 | Death VTE major bleeding | 3 months | 76.3 (66.1 to 84.2) 23.7 (15.8 to 33.9) | 12.3 (9.3 to 16.1) 2.7 (0.8 to 8.9) | |||
| GPS≥2 | ||||||||
| (Wicki et al 2000)122 | Derivation | 1 | Retrospective | Not reported | Death VTE major bleeding | 3 months | 51.1 (45.1 to 57.1) 48.9 (42.9 to 54.9) | 18.2 (12.6 to 25.6) 1.5 (0.4 to 5.9) |
| (Nendaz et al 2004)97 | External validation | 1 | Retrospective | Unclear | Death VTE major bleeding | 3 months | 44.2 (37.5 to 51.2) 55.8 (48.8 to 62.5) | 18.2 (11.4 to 27.6) 2.7 (0.9 to 8.0) |
| Overall | 2 | Death VTE major bleeding | 3 months | 47.9 (41.2 to 54.7) 52.1 (45.3 to 58.8) | 18.2 (13.7 to 23.8) 2.1 (0.9 to 51) | |||
| GPS≥3 | ||||||||
| (Wicki et al 2000)122 | Derivation | 1 | Retrospective | Not reported | Death VTE major bleeding | 3 months | 32.8 (27.5 to 38.7) 67.2 (61.3 to 72.5) | 26.1 (18.0 to 36.3) 2.2 (0.8 to 5.8) |
| (Nendaz et al 2004)97 | External validation | Retrospective | Unclear | Death VTE major bleeding | 3 months | 20.1 (15.1 to 26.2) 79.9 (73.8 to 84.9) | 27.5 (15.9 to 43.2) 5.0 (2.5 to 9.7) | |
| Overall | 2 | Death VTE major bleeding | 3 months | 26.2 (15.6 to 40.5) 73.8 (59.5 to 84.4) | 26.6 (19.6 to 34.9) 3.6 (1.6 to 7.8) | |||
| GPS≥4 | ||||||||
| (Wicki et al 2000)122 | Derivation | 1 | Retrospective | Not reported | Death VTE major bleeding | 3 months | 11.9 (8.6 to 16.4) 88.1 (83.6 to 91.4) | 40.6 (25.3 to 58.1) 5.9 (3.5 to 9.8) |
| (Nendaz et al 2004)97 | External validation | 1 | Retrospective | Unclear | Death VTE major bleeding | 3 months | 8.0 (5.0 to 12.7) 92.0 (87.3 to 95.0) | 31.3 (13.6 to 56.7) 7.7 (4.6 to 12.5) |
| Overall | 2 | Death VTE major bleeding | 3 months | 10.2 (6.9 to 14.7) 89.8 (85.3 to 93.1) | 37.6 (25.1 to 52) 6.7 (4.7 to 9.6) | |||
| GPS≥5 | ||||||||
| (Wicki et al 2000)122 | Derivation | 1 | Retrospective | Not reported | Death VTE major bleeding | 3 months | 3.7 (2.0 to 6.8) 96.3 (93.2 to 98.0) | 70.0 (37.6 to 90.0) 7.8 (5.1 to 11.7) |
| (Nendaz et al 2004)97 | External validation | 1 | Retrospective | Unclear | Death VTE major bleeding | 3 months | 2.5 (1.0 to 5.9) 97.5 (94.1 to 99.0) | 80.0 (30.9 to 97.3) 7.7 (4.7 to 12.4) |
| Overall | 2 | Death VTE major bleeding | 3 months | 3.3 (2.0 to 5.4) 96.7 (94.6 to 98.0) | 73.0 (46.1 to 89.5) 7.7 (5.6 to 10.6) | |||
| GPS=6 | ||||||||
| (Wicki et al 2000)122 | Derivation | 1 | Retrospective | Not reported | Death VTE major bleeding | 3 months | 1 (0.4 to 3.4) 98.9 (96.6 to 99.6) | 87.5 (26.6 to 99.3) 9.1 (6.1 to 13.2) |
| (Nendaz et al 2004)97 | External validation | 1 | Retrospective | Unclear | Death VTE major bleeding | 3 months | 1 0.5 (0.1 to 3.5) 99.5 (96.5 to 99.9) | NA 9.6 (6.2 to 14.6) |
| Overall | 2 | Death VTE major bleeding | 3 months | 0.9 (0.3 to 2.4) 99.1 (97.6 to 99.7) | 87.5 (26.6 to 99.3) 9.3 (7.0 to 12.3) | |||
| PESI≥II | ||||||||
| (Aujesky et al 2007)70 | External validation | 1 | Retrospective | Both stable and unstable | PE-related death | 3 months | 79.5 (76.8 to 82) 20.5 (18 to 23.2) | 2.9 (1.9 to 4.5) 0.3 (0 to 4.2) |
| PESI≥III | ||||||||
| (Vanni et al 2011)119 | External validation | 1 | Retrospective | Both stable and unstable | PE-related death | In-hospital | 68.7 (64.3 to 72.7) 31.3 (27.3 to 35.7) | 7.5 (5.1 to 11) 0.7 (0.1 to 4.7) |
| (Aujesky et al 2007)70 | External validation | 1 | Retrospective | Both stable and unstable | PE-related death | 3 months | 52.6 (49.3 to 55.9) 47.4 (44.1 to 50.7) | 3.8 (2.4 to 6) 0.7 (0.2 to 2.2) |
| PESI≥IV | ||||||||
| (Choi et al 2014)77 | External validation | 1 | Retrospective | Both stable and unstable | Adverse outcome | In-hospital | 18 (15.3 to 21.2) 82 (78.8 to 84.7) | 24.8 (17.8 to 33.4) 7.3 (5.4 to 9.9) |
| (Aujesky et al 2007)70 | External validation | 1 | Retrospective | Both stable and unstable | PE-related death | 3 months | 25 (22.3 to 28) 75 (72 to 77.7) | 6.7 (4.1 to 10.8) 0.9 (0.4 to 2) |
| PESI=V | ||||||||
| (Aujesky et al 2007)70 | External validation | 1 | Retrospective | Both stable and unstable | PE-related death | 3 months | 10.3 (8.5 to 12.5) 89.7 (87.5 to 91.5) | 7.5 (3.6 to 15) 1.7 (1 to 2.9) |
| PESI≥IV and other prognostic factors* | ||||||||
| (Choi et al 2014)77 | External validation | 1 | Retrospective | Both stable and unstable | Adverse outcome | In-hospital | ||
| NT-proBNP≥1136 pg/mL | 34.2 (29.7 to 39.0) 65.8 (61.0 to 70.3) | 22.4 16.1 to 30.2) 4.7 (2.7 to 8.0) | ||||||
| cTnI≥0.05 ng/mL | 39.1 (34.8 to 43.6) 60.9 (56.4 to 65.2) | 21.6 (16.3 to 28.1) 5.2 (3.2 to 8.5) | ||||||
| CT RV/LV diameter ratio≥1 | 36.1 (32.5 to 39.9) 63.9 (60.1 to 67.5) | 20.1 (15.4 to 25.7) 5.1 (3.3 to 7.7) | ||||||
| PESI≥IV—NT-proBNP≥1136 pg/mL | 6.2 (4.2 to 9.1) 93.8 (90.9 to 95.8) | 50.0 (31.0 to 69.0) 8.0 (5.6 to 11.3) | ||||||
| PESI≥IV—cTnI≥0.05 ng/mL | 10.3 (7.8 to 13.4) 89.7 (86.6 to 92.2) | 41.7 (28.7 to 55.9) 8.1 (5.9 to 11.1) | ||||||
| PESI≥IV—CT RV/LV ratio≥1 | 7.9 (6.0 to 10.2) 92.1 (89.8 to 94.0) | 43.1 (30.4 to 56.9) 7.7 (5.8 to 10.2) | ||||||
| PESI≥IV—NT-proBNP—cTnI | 4.6 (2.9 to 7.3) 95.4 (92.7 to 97.1) | 64.7 (40.4 to 83.2) 8.2 (5.8 to 11.6) | ||||||
| PESI≥IV—NT-proBNP—RV/LV | 4.2 (2.6 to 6.7) 95.8 (93.3 to 97.4) | 62.5 (37.7 to 82.1) 8.4 (6.0 to 11.7) | ||||||
| PESI≥IV—cTnI—RV/LV | 6.0 (4.2 to 8.6) 94.0 (91.4 to 95.8) | 60.7 (42.0 to 76.7) 8.5 (6.2 to 11.5) | ||||||
| PESI≥IV—NT-proBNP—cTnI—RV/LV | 3.8 (2.3 to 6.3) 96.2 (93.7 to 97.7) | 71.4 (43.9 to 88.9) 8.5 (6.0 to 11.9) | ||||||
| PREP | ||||||||
| (Sanchez et al 2010)110 | Derivation | 1 | Prospective | Both stable and unstable | Death VTE | 30 days | ||
| PREP—Clin≥II | 37.3 (33.2 to 41.5) 62.7 (58.5 to 66.8) | 17.7 (12.9 to 23.8) 1.9 (0.8 to 4.1) | ||||||
| PREP—Clin≥III | 7.2 (5.2 to 9.8) 92.8 (90.2 to 94.8) | 43.2 (28.4 to 59.4) 5.4 (3.7 to 7.9) | ||||||
| PREP—Clin≥II—BNP—RVD | 34.8 (30.8 to 39) 65.2 (61 to 69.2) | 18.4 (13.4 to 24.8) 2.1 (1 to 4.3) | ||||||
| PREP—Clin≥III—BNP—RVD | 5.6 (3.9 to 8) 94.4 (92 to 96.1) | 44.8 (28.1 to 62.8) 5.6 (3.8 to 8) | ||||||
| Shock Index | ||||||||
| (Toosi et al 2008)117 | External validation | 1 | Retrospective | Not reported | Adverse outcome | In-hospital | 17.6 (12.4 to 24.5) 82.4 (75.5 to 87.6) | 25.9 (12.9 to 45.3) 10.3 (6.1 to 17) |
| sPESI≥1 | ||||||||
| (Righini et al 2011)106 | External validation | 1 | Retrospective | Unclear | PE-related death | 30 days | 53.8 (48.6 to 58.9) 46.2 (41.1 to 51.4) | 3.1 (1.4 to 6.8) 0.6 (0.1 to 4.2) |
| (Spirk et al 2011)115 | External validation | 1 | Retrospective | Both stable and unstable | Death VTE | 30 days | 70.8 (65.7 to 75.4) 29.2 (24.6 to 34.3) | 8.1 (5.2 to 12.3) 1 (0.1 to 7) |
| (Righini et al 2011)106 | External validation | 1 | Retrospective | Unclear | PE-related death | 3 months | 53.8 (48.6 to 58.9) 46.2 (41.1 to 51.4) | 4.2 (2.1 to 8.1) 0.6 (0.1 to 4.2) |
| sPESI≥1—cTn | ||||||||
| (Spirk et al 2011)115 | Update | 1 | Retrospective | Both stable and unstable | Death VTE | 30 days | ||
| cTn | 28.3 (65.7 to 75.4) 71.7 (66.6 to 76.3) | 12.8 (7.4 to 21.1) 3.4 (1.7 to 6.6) | ||||||
| sPESI≥1—cTn | 24.4 (20.1 to 29.3) 75.6 (70.7 to 79.9) | 13.6 (7.7 to 22.9) 3.6 (1.9 to 6.7) | ||||||
In the first column, the cut-off is indicated by the corresponding higher risk group for the cut-off.
*Information from authors.
BNP, brain natriuretic peptide; cTnI, cardiac troponin I; ESC, European Society of Cardiology; GPS, Geneva prognostic score; LV, left ventricle; NT-proBNP, N-terminal proBNP; PE, pulmonary embolism; PESI, Pulmonary Embolism Severity Index; PREP, Facteurs PRonostiques dans l'Embolie Pulmonaire; RV, right ventricle; RVD, right ventricular dysfunction; sPESI, simplified PESI; VTE, venous thromboembolism.