PE-related death, adverse outcome (death, clinical deterioration or haemodynamic collapse), VTE, major bleeding and their combinations in ‘stable’ 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 |
|---|---|---|---|---|---|---|---|---|
| Bova et al risk score | ||||||||
| (Bova et al 2014)135 | Derivation and internal validation | 6 (IPD) | Both | Stable | ||||
| Stage III | PE-related death, collapse, VTE | In-hospital | 5.8 | 28 | ||||
| Stage II | 18.6 | 9.7 | ||||||
| Stage I | 75.5 | 3.6 | ||||||
| Stage III | PE-related death, collapse, VTE | 30 days | 5.8 | 29.2 | ||||
| Stage II | 18.6 | 10.8 | ||||||
| Stage I | 75.5 | 4.2 | ||||||
| Stage III | PE-related death | 30 days | 5.8 | 15.5 | ||||
| Stage II | 18.6 | 5.0 | ||||||
| Stage I | 75.5 | 1.7 | ||||||
| ESC intermediate | ||||||||
| (Vanni et al 2011)119 | External validation | 1 | Retrospective | Stable | PE-related death | In-hospital | 57.6 (53.1 to 62.1) 42.4 (37.9 to 46.9) | 6.4 (4.0 to 10.1) 1.0 (0.3 to 4.0) |
| (Becattini et al 2013)72 | External validation | 1 | Prospective | Stable | PE-related death | In-hospital | 78.3 (75.4 to 80.9) 21.7 (19.1 to 24.6) | 1.8 (1.0 to 3.1) 0.3 (0.00 to 4.1) |
| Overall | 1 | Both | Stable | PE-related death | In-hospital | 68.9 (46.1 to 85.2) 31.1 (14.8 to 53.9) | 3.4 (0.9 to 11.7) 0.8 (0.2 to 2.7) | |
| (Dellas et al 2014)80 | External validation | 1 | Prospective | Stable | Adverse outcome | 30 days | 78.1 (72.2 to 83.1) 21.9 (16.9 to 27.8) | 10.9 (7 to 16.4) 1 (0.1 to 14.1) |
| ESC intermediate–high | ||||||||
| (Vanni et al 2011)119 | External validation | 1 | Retrospective | Stable | PE-related death | In-hospital | 14.8 (11.9 to 18.4) 85.2 (81.6 to 88.1) | 11.8 (6.0 to 21.8) 2.8 (1.6 to 5.0) |
| (Becattini et al 2013)72 | External validation | 1 | Prospective | Stable | PE-related death | In-hospital | 41.8 (38.5 to 45.1) 58.2 (54.9 to 61.5) | 1.9 (0.9 to 4.0) 1.0 (0.4 to 2.4) |
| Overall | 1 | Stable | PE-related death | In-hospital | 26.2 (8.2 to 58.7) 73.8 (41.3 to 91.8) | 4.9 (0.8 to 25.1) 1.8 (0.6 to 4.8) | ||
| (Becattini et al 2013)72 | External validation | 1 | Prospective | Stable | Death adverse outcome | In-hospital | 41.8 (38.5 to 45.1) 58.2 (54.9 to 61.5) | 8.8 (6.3 to 12.2) 3.2 (1.9 to 5.1) |
| (Becattini et al 2013)72 | External validation | 1 | Prospective | Stable | PE-related death adverse outcome | In-hospital | 41.8 (38.5 to 45.1) 58.2 (54.9 to 61.5) | 5 (3.1 to 7.7) 2.4 (1.4 to 4.1) |
| eStiMaTe high | ||||||||
| (Jiménez et al 2014)87 | Derivation | 1 | Prospective | Stable | Death adverse outcome VTE | 30 days | 3.7 (2.6 to 5.2) 96.3 (94.8 to 97.4) | 25.8 (13.5 to 43.7) 3.4 (2.1 to 5.4) |
| (Jiménez et al 2014)87 | External validation | 1 | Prospective | Stable | Death adverse outcome | 30 days | 6.2 (4.5 to 8.6) 93.8 (91.4 to 95.5) | 21.2 (10.5 to 38.3) 6.7 (5.2 to 8.7) |
| (Jiménezet al 2014)87 | Overall | 2 | Prospective | Stable | Death adverse outcome VTE | 30 days | 4.8 (2.8 to 8) 95.2 (92 to 97.2) | 23.5 (14.7 to 35.4) 5 (2.5 to 9.4) |
| eStiMaTe high–intermediate | ||||||||
| (Jiménez et al 2014)87 | Derivation | 1 | Prospective | Stable | Death adverse outcome VTE | 30 days | 74.5 (71.5 to 77.3) 25.5 (22.7 to 28.5) | 9.7 (7.6 to 12.2) 0.9 (0.2 to 3.6) |
| (Jiménez et al 2014)87 | External validation | 1 | Prospective | Stable | Death adverse outcome | 30 days | 63.5 (59.3 to 37.5) 36.5 (32.5 to 40.7) | 7.1 (4.8 to 10.4) 0.3 (0 to 4) |
| (Jiménez et al 2014)87 | Overall | 2 | Prospective | Stable | Death adverse outcome VTE | 30 days | 69.3 (57.6 to 79) 30.7 (21 to 42.4) | 8.6 (6.5 to 11.4) 0.7 (0.2 to 2.4) |
| FAST=3 | ||||||||
| (Dellas et al 2014)80 | External validation | 1 | Prospective | Stable | Adverse outcome | 30 days | 28.4 (23.4 to 34.1) 71.6 (65.9 to 76.6) | 22.1 (14.2 to 32.7) 1.5 (0.5 to 4.7) |
| GPS≥3 | ||||||||
| (Bova et al 2009)74 | External validation | 1 | Prospective | Stable | PE-related death | In-hospital | 18.9 (14.1 to 24.9) 81.1 (75.1 to 85.9) | 2.6 (0.4 to 16.5) 0.3 (0.0 to 4.7) |
| Kostrubiec et al (NT-proBNP—cTnT) | ||||||||
| (Kostrubiec et al 2005)90 | Derivation | 1 | Prospective | Stable | ||||
| Intermediate | Death | 30 days | 72.0 (62.4 to 79.9) 28.0 (20.1 to 37.6) | 20.8 (13.0 to 31.7) 1.7 (0.1 to 22.3) | ||||
| Intermediate | PE-related death | 30 days | 69.9 (59.8 to 78.3) 30.1 (21.7 to 40.2) | 12.3 (6.3 to 22.7) 1.7 (0.1 to 22.3) | ||||
| Intermediate–high | Death | 30 days | 18.0 (11.6 to 26.8) 82.0 (73.2 to 88.4) | 50.0 (28.4 to 71.6) 7.3 (3.3 to 15.3) | ||||
| Intermediate–high | PE-related death | 30 days | 16.1 (1.0 to 25.0) 83.9 (75.0 to 90.0) | 40.0 (19.2 to 65.2) 2.6 (0.6 to 9.7) | ||||
| PESI≥II | ||||||||
| (Sanchez et al 2013)111 | External validation | 1 | Retrospective (for PESI) | Stable | Adverse outcome | 30 days | 75.2 (71.4 to 78.7) 24.8 (21.3 to 28.6) | 6 (4.1 to 8.8) 0.8 (0 to 5.2) |
| PESI≥III | ||||||||
| (Palmieri et al 2008)104 | External validation | 1 | Prospective | Stable | Death adverse outcome | In-hospital | 69.7 (59.4 to 78.3) 30.3 (21.7 to 40.6) | 53.2 (40.9 to 65.2) 11.1 (3.6 to 29.3) |
| (Sanchez et al 2013)111 | External validation | 1 | Retrospective (for PESI) | Stable | Adverse outcome | 30 days | 37.8 (33.8 to 42) 62.2 (58 to 66.2) | 9 (5.7 to 13.8) 2.1 (1 to 4.4) |
| (Vanni et al 2011)119 | External validation | 1 | Retrospective | Stable | PE-related death | In-hospital | 67 (62.3 to 71.3) 33 (28.7 to 37.7) | 6.1 (3.8 to 9.5) 0.7 (0.1 to 5) |
| PESI≥IV | ||||||||
| (Sanchez et al 2013)111 | External validation | 1 | Retrospective (for PESI) | Stable | Adverse outcome | 30 days | 17.2 (14.2 to 20.7) 82.8 (79.3 to 85.8) | 8.8 (4.5 to 16.6) 3.9 (2.4 to 6.2) |
| PESI=V | ||||||||
| (Sanchez et al 2013)111 | External validation | 1 | Retrospective (for PESI) | Stable | Adverse outcome | 30 days | 4 (2.6 to 6) 96 (94 to 97.4) | 14.3 (4.7 to 36.1) 4.3 (2.9 to 6.5) |
| PESI+biomarkers | ||||||||
| (Sanchez et al 2013)111 | External validation | 1 | Retrospective (for PESI) | Stable | Adverse outcome | 30 days | ||
| PESI I–II—BNP | 32.7 (27.8 to 38.0) 67.3 (62.0 to 72.2) | 4.7 (2.0 to 10.8) 0.9 (0.2 to 3.6) | ||||||
| PESI I–II—cTnI | 13.7 (10.3 to 17.9) 86.3 (82.1 to 89.7) | 9.1 (3.5 to 21.8) 1.1 (0.3 to 3.3) | ||||||
| PESI I–II—TTE-RVD | 12.3 (9.0 to 16.5) 87.7 (83.5 to 91.0) | 10.8 (4.1 to 25.5) 1.1 (0.4 to 3.5) | ||||||
| PESI III–IV—BNP | 56.3 (48.8 to 63.4) 43.8 (36.6 to 51.2) | 10.1 (5.5 to 17.8) 6.5 (2.7 to 14.7) | ||||||
| PESI III–IV—cTnI | 24.0 (18.2 to 30.9) 76.0 (69.1 to 81.8) | 16.7 (8.2 to 31.0) 5.3 (2.5 to 10.6) | ||||||
| PESI III–IV—TTE-RVD | 22.8 (17.0 to 29.9) 77.2 (70.1 to 83.0) | 10.8 (4.1 to 25.5) 8.8 (4.9 to 15.2) | ||||||
| PESI V—BNP | 76.2 (54.0 to 89.7) 23.8 (10.3 to 46.0) | 18.8 (6.2 to 44.7) 8.3 (0.5 to 62.2) | ||||||
| PESI V—cTnI | 30.0 (14.1 to 52.7) 70.0 (47.3 to 85.9) | 16.7 (2.3 to 63.1) 14.3 (3.6 to 42.7) | ||||||
| PESI V—TTE-RVD | 23.8 (10.3 to 46.0) 76.2 (54.0 to 89.7) | 20.0 (2.7 to 69.1) 12.5 (3.1 to 38.6) | ||||||
| PESI+biomarkers | ||||||||
| (Jimenez et al 2011)86 | Update | 1 | Unclear Prospective | Stable | PE-related death | 30 days | ||
| cTnI | 32.1 (28.5 to 36.0) 67.9 (64.0 to 71.5) | 10.5 (6.9 to 15.8) 4.2 (2.7 to 6.7) | ||||||
| TTE-RVD | 20.3 (17.3 to 23.7) 79.7 (76.3 to 82.7) | 11.7 (7.0 to 18.7) 4.9 (3.3 to 7.2) | ||||||
| US-DVT | 38.6 (34.7 to 42.6) 61.4 (57.4 to 65.3) | 9.6 (6.4 to 14.2) 4.1 (2.5 to 6.7) | ||||||
| TTE-RVD—cTnI | 10.0 (7.8 to 12.7) 90.0 (87.3 to 92.2) | 15.3 (8.1 to 26.8) 5.3 (3.7 to 7.5) | ||||||
| PESI≥IV—TTE-RVD—cTnI | 12.7 (9.0 to 17.7) 87.3 (82.3 to 91.0) | 20.7 (9.6 to 39.0) 8.0 (5.0 to 12.7) | ||||||
| cTnI—US-DVT | 13.9 (11.3 to 16.9) 86.1 (83.1 to 88.7) | 17.1 (10.4 to 26.8) 4.5 (3.0 to 6.7) | ||||||
| PESI≥IV—cTnI—US-DVT | 18.0 (13.5 to 23.5) 82.0 (76.5 to 86.5) | 24.4 (13.7 to 39.7) 6.4 (3.7 to 11.0) | ||||||
| TTE-RVD—US-DVT | 8.6 (6.6 to 11.2) 91.4 (88.8 to 93.4) | 19.6 (10.9 to 32.7) 5.0 (3.5 to 7.2) | ||||||
| TTE-RVD—cTnI—US-DVT | 4.1 (2.7 to 6.0) 95.9 (94.0 to 97.3) | 20.8 (8.9 to 41.3) 5.6 (4.0 to 7.9) | ||||||
| PESI≥IV—TTE-RVD—US-DVT | 10.5 (7.2 to 15.2) 89.5 (84.8 to 92.8) | 25.0 (11.7 to 45.6) 7.8 (4.9 to 12.4) | ||||||
| PREP—Clin≥II | ||||||||
| (Sanchez et al 2010)110 | Derivation | 1 | Prospective | Stable | Death VTE | 30 days | 32.3 (28.2 to 36.6) 67.7 (63.4 to 71.8) | 12.3 (8 to 18.5) 2.5 (1.2 to 4.9) |
| PREP—Clin≥III | ||||||||
| (Sanchez et al 2010)110 | Derivation | 1 | Prospective | Stable | Death VTE | 30 days | 1.9 (1 to 3.6) 98.1 (96.4 to 99) | 22.2 (5.6 to 57.9) 4.9 (3.3 to 7.3) |
| sPESI≥1 | ||||||||
| (Dellas et al 2014)80 | External validation | 1 | Prospective | Stable | Adverse outcome | 30 days | 66.1 (60.2 to 71.4) 33.9 (28.6 to 39.8) | 11.2 (7.3 to 16.7) 0.5 (0 to 8) |
| (Lankeit et al 2011)94 | External validation | 1 | Prospective | Stable | Death adverse outcome | 30 days | 62.4 (58.1 to 66.4) 37.6 (33.6 to 41.9) | 8.8 (6.2 to 12.4) 1 (0.3 to 3.9) |
| sPESI≥1-hscTnT | ||||||||
| (Lankeit et al 2011)94 | External validation | 1 | Prospective | Stable | Death adverse outcome | 30 days | ||
| hscTnT | 59.3 (55.1 to 63.4) 40.7 (36.6 to 44.9) | 8.7 (6.0 to 12.3) 1.9 (0.7 to 4.9) | ||||||
| sPESI≥1-hscTnT | 75.9 (72.0 to 79.3) 24.1 (20.7 to 28.0) | 7.8 (5.5 to 10.8) 0.4 (0.0 to 5.9) | ||||||
In the first column, the cut-off is indicated by the corresponding higher risk group for the cut-off except for the Bova et al135 and Sanchez et al111 (PESI+biomarkers) studies which are displayed in risk categories. Bova's study combined IPD from six studies.
BNP, brain natriuretic peptide; cTnI, cardiac troponin I; cTnT, cardiac troponin T; DVT, deep vein thrombosis; GPS, Geneva prognostic score; hscTnT, high-sensitive cardiac troponin T; IPD, individual patient data; NT-proBNP, N-terminal proBNP; PE, pulmonary embolism; PESI, Pulmonary Embolism Severity Index; PREP, Facteurs PRonostiques dans l'Embolie Pulmonaire; sPESI, simplified PESI; TTE-RVD, transthoracic echocardiography-right ventricular dysfunction; US-DVT, ultrasound-detected DVT; VTE, venous thromboembolism.