Your browser doesn't support javascript.
loading
Derivation and external validation of the SHIeLD score for predicting outcome in normotensive pulmonary embolism.
Freitas, Pedro; Santos, Ana Rita; Ferreira, António Miguel; Oliveira, Afonso; Gonçalves, Mariana; Corte-Real, Ana; Lameiras, Catarina; Maurício, Joana; Ornelas, Énia; Matos, Clara; Faria, Daniel; Augusto, João; Simões, Joana; Ferreira, Inês; Pedroso, Ana; Santos, Ana Coutinho; Gago, Miguel; Oliveira, João Diogo; Antunes, Ricardo Mamede; Correia, David; Lynce, Ana; Brito, João; Aguiar, Carlos; Ferreira, Jorge; Morais, Carlos; Campos, Luís; Raposo, Luís; Mendes, Miguel.
Afiliación
  • Freitas P; Cardiology Department, Hospital de Santa Cruz, Centro Hospitalar Lisboa Ocidental, Lisbon, Portugal. Electronic address: pnfreitas@chlo.min-saude.pt.
  • Santos AR; Internal Medicine Department, Hospital de São Francisco Xavier, Centro Hospitalar Lisboa Ocidental, Lisbon, Portugal.
  • Ferreira AM; Cardiology Department, Hospital de Santa Cruz, Centro Hospitalar Lisboa Ocidental, Lisbon, Portugal.
  • Oliveira A; Cardiology Department, Hospital de Santa Cruz, Centro Hospitalar Lisboa Ocidental, Lisbon, Portugal.
  • Gonçalves M; Cardiology Department, Hospital de Santa Cruz, Centro Hospitalar Lisboa Ocidental, Lisbon, Portugal.
  • Corte-Real A; Internal Medicine Department III, Hospital Prof. Doutor Fernando Fonseca, Lisbon, Portugal.
  • Lameiras C; Internal Medicine Department III, Hospital Prof. Doutor Fernando Fonseca, Lisbon, Portugal.
  • Maurício J; Internal Medicine Department III, Hospital Prof. Doutor Fernando Fonseca, Lisbon, Portugal.
  • Ornelas É; Internal Medicine Department III, Hospital Prof. Doutor Fernando Fonseca, Lisbon, Portugal.
  • Matos C; Internal Medicine Department III, Hospital Prof. Doutor Fernando Fonseca, Lisbon, Portugal.
  • Faria D; Cardiology Department, Hospital Professor Doutor Fernando Fonseca, Lisbon, Portugal.
  • Augusto J; Cardiology Department, Hospital Professor Doutor Fernando Fonseca, Lisbon, Portugal.
  • Simões J; Cardiology Department, Hospital Professor Doutor Fernando Fonseca, Lisbon, Portugal.
  • Ferreira I; Internal Medicine Department, Hospital de São Francisco Xavier, Centro Hospitalar Lisboa Ocidental, Lisbon, Portugal.
  • Pedroso A; Internal Medicine Department, Hospital de São Francisco Xavier, Centro Hospitalar Lisboa Ocidental, Lisbon, Portugal.
  • Santos AC; Radiology Department, Centro Hospitalar Lisboa Ocidental, Lisbon, Portugal.
  • Gago M; Radiology Department, Centro Hospitalar Lisboa Ocidental, Lisbon, Portugal.
  • Oliveira JD; Radiology Department, Centro Hospitalar Lisboa Ocidental, Lisbon, Portugal.
  • Antunes RM; Radiology Department, Centro Hospitalar Lisboa Ocidental, Lisbon, Portugal.
  • Correia D; Radiology Department, Centro Hospitalar Lisboa Ocidental, Lisbon, Portugal.
  • Lynce A; Internal Medicine Department, Hospital de São Francisco Xavier, Centro Hospitalar Lisboa Ocidental, Lisbon, Portugal.
  • Brito J; Cardiology Department, Hospital de Santa Cruz, Centro Hospitalar Lisboa Ocidental, Lisbon, Portugal.
  • Aguiar C; Cardiology Department, Hospital de Santa Cruz, Centro Hospitalar Lisboa Ocidental, Lisbon, Portugal.
  • Ferreira J; Cardiology Department, Hospital de Santa Cruz, Centro Hospitalar Lisboa Ocidental, Lisbon, Portugal.
  • Morais C; Cardiology Department, Hospital Professor Doutor Fernando Fonseca, Lisbon, Portugal.
  • Campos L; Internal Medicine Department, Hospital de São Francisco Xavier, Centro Hospitalar Lisboa Ocidental, Lisbon, Portugal.
  • Raposo L; Cardiology Department, Hospital de Santa Cruz, Centro Hospitalar Lisboa Ocidental, Lisbon, Portugal.
  • Mendes M; Cardiology Department, Hospital de Santa Cruz, Centro Hospitalar Lisboa Ocidental, Lisbon, Portugal.
Int J Cardiol ; 281: 119-124, 2019 Apr 15.
Article en En | MEDLINE | ID: mdl-30638984
BACKGROUND: Identifying patients with normotensive pulmonary embolism (PE) who may benefit from thrombolysis remains challenging. We sought to develop and validate a score to predict 30-days PE-related mortality and/or rescue thrombolysis. METHODS: We retrospectively assessed 554 patients with normotensive PE. Independent predictors of the studied endpoint were identified from variables available at admission in the emergency department and were used to create a score. The model was validated in 308 patients from a separate hospital. RESULTS: A total of 64 patients died or needed rescue thrombolysis (44 in the derivation cohort). Four independent prognostic factors were identified: Shock index ≥ 1.0 (OR 3.33; 95% CI 1.40-7.93; P = 0.006), HypoxaemIa by the PaO2/FiO2 ratio (OR 0.92 per 10 units; 95% CI 0.88-0.97; P < 0.001), Lactate (OR 1.38 per mmol/L; 95% CI 1.09-1.75; P = 0.008) and cardiovascular Dysfunction (OR 5.67; 95% CI 2.60-12.33; P < 0.001) - SHIeLD score. In the development cohort, event rates for each risk tercile were 0.0%, 2.2%, and 21.6%. In the validation cohort, corresponding rates were 0.0%, 1.9%, and 14.3%. The C-statistic was 0.90 (95% CI 0.86-0.94, P < 0.001) in the derivation cohort and 0.82 (95% CI 0.75-0.89, P < 0.001) in the validation cohort. Decision curve analysis showed that the SHIeLD score is able to accurately identify more true positive cases than the European Society of Cardiology decision criteria. CONCLUSIONS: A risk score to predict 30-days PE-related mortality and/or rescue thrombolysis in patients with normotensive PE was developed and validated. This score may assist physicians in selecting patients for closer monitoring or aggressive treatment strategy.
Asunto(s)
Palabras clave
Texto completo
Añadir a Mi BVS
Imprimir
XML
PubMed Links
Buscar en Google

Texto completo: 1 Colección: 01-internacional Base de datos: MEDLINE Asunto principal: Embolia Pulmonar / Índice de Severidad de la Enfermedad Tipo de estudio: Etiology_studies / Incidence_studies / Observational_studies / Prognostic_studies / Risk_factors_studies Límite: Aged / Aged80 / Female / Humans / Male / Middle aged Idioma: En Revista: Int J Cardiol Año: 2019 Tipo del documento: Article Pais de publicación: Países Bajos
Texto completo
Añadir a Mi BVS
Imprimir
XML
PubMed Links
Buscar en Google

Texto completo: 1 Colección: 01-internacional Base de datos: MEDLINE Asunto principal: Embolia Pulmonar / Índice de Severidad de la Enfermedad Tipo de estudio: Etiology_studies / Incidence_studies / Observational_studies / Prognostic_studies / Risk_factors_studies Límite: Aged / Aged80 / Female / Humans / Male / Middle aged Idioma: En Revista: Int J Cardiol Año: 2019 Tipo del documento: Article Pais de publicación: Países Bajos