The value of sPESI for risk stratification in patients with pulmonary embolism
Various risk stratification methods exist for patients with pulmonary embolism (PE). We used the simplified Pulmonary Embolism Severity Index (sPESI) as a risk-stratification method to understand the Veterans Health Administration (VHA) PE population.
Materials and methods
Adult patients with ≥ 1 inpatient PE diagnosis (index date = discharge date) from October 2011–June 2015 as well as continuous enrollment for ≥ 12 months pre- and 3 months post-index date were included. We defined a sPESI score of 0 as low-risk (LRPE) and all others as high-risk (HRPE). Hospital-acquired complications (HACs) during the index hospitalization, 90-day follow-up PE-related outcomes, and health care utilization and costs were compared between HRPE and LRPE patients.
Of 6746 PE patients, 95.4% were men, 67.7% were white, and 22.0% were African American; LRPE occurred in 28.4% and HRPE in 71.6%. Relative to HRPE patients, LRPE patients had lower Charlson Comorbidity Index scores (1.0 vs. 3.4, p < 0.0001) and other baseline comorbidities, fewer HACs (11.4% vs. 20.0%, p < 0.0001), less bacterial pneumonia (10.6% vs. 22.3%, p < 0.0001), and shorter average inpatient lengths of stay (8.8 vs. 11.2 days, p < 0.0001) during the index hospitalization. During follow-up, LRPE patients had fewer PE-related outcomes of recurrent venous thromboembolism (4.4% vs. 6.0%, p = 0.0077), major bleeding (1.2% vs. 1.9%, p = 0.0382), and death (3.7% vs. 16.2%, p < 0.0001). LRPE patients had fewer inpatient but higher outpatient visits per patient, and lower total health care costs ($12,021 vs. $16,911, p < 0.0001) than HRPE patients.
Using the sPESI score identifies a PE cohort with a lower clinical and economic burden.
KeywordsPulmonary embolism Trauma Severity Index Cost of illness Veterans Health Administration
Charlson Comorbidity Index
Computed tomography angiography
Deep vein thrombosis
European Society of Cardiology
High-risk pulmonary embolism
Health care resource utilization
International Classification of Diseases, 9th Revision, Clinical Modification
In-hospital mortality for pulmonary embolism using claims data
Length of stay
Low-risk pulmonary embolism
Novel oral anticoagulant
Statistical analysis software
Simplified Pulmonary Embolism Severity Index
Veterans Health Administration
This study was funded by Janssen Scientific Affairs, LLC.
Compliance with ethical standards
Conflict of interest
WFP has received grants from Abbott, Alere, Banyan, Cardiorentis, Janssen, Portola, Pfizer, Roche, and ZS Pharma; is a consultant to Alere, Beckman, Boehringer-Ingelheim, Cardiorentis, Instrument Labs, Janssen, Phillips, Portola, Prevencio, Singulex, The Medicine’s Company, and ZS Pharma; and also has ownership interests at the Comprehensive Research Associate LLC, Emergencies in Medicine LLC. CIC has received grant funding and consulting fees from Janssen Scientific Affairs, LLC, Raritan, NJ and Bayer Pharma AG, Berlin, Germany. PW receives speaker fees from Bayer Healthcare and Daiichi Sankyo, writing committee fees from Itreas, and grant support fees from Pfizer/BMS. GJF has received research support from Novartis, Siemens, Pfizer, Portola, and PCORI; has advised Janssen Scientific Affairs, LLC; and receives speaker fees from Janssen. CC and JS and are employees of Janssen Scientific Affairs. LW and OB are employees of STATinMED Research, which is a paid consultant to Janssen Scientific Affairs.
- 13.Konstantinides S, Torbicki A, Agnelli G, Task Force for the Diagnosis and Management of Acute Pulmonary Embolism of the European Society of Cardiology (ESC) et al (2014) 2014 ESC guidelines on the diagnosis and management of acute pulmonary embolism. Eur Heart J 35(43):3033–3069. https://doi.org/10.1093/eurheartj/ehu283 CrossRefPubMedGoogle Scholar
- 14.Veterans Health Administration. About VHA. https://www.va.gov/health/aboutVHA.asp. Accessed 6 July 2016
- 15.Fermann GJ, Erkens PM, Prins MH, Wells PS, Pap ÁF, Lensing AW (2015) Treatment of pulmonary embolism with rivaroxaban: outcomes by simplified pulmonary embolism severity index score from a post hoc analysis of the EINSTEIN PE study. Acad Emerg Med 22(3):299–307. https://doi.org/10.1111/acem.12615 CrossRefPubMedGoogle Scholar
- 21.Barco S, Mahmoudpour SH, Planquette B, Sanchez O, Konstantinides SV, Meyer G (2018) Prognostic value of right ventricular dysfunction or elevated cardiac biomarkers in patients with low-risk pulmonary embolism: a systematic review and meta-analysis. Eur Heart J. https://doi.org/10.1093/eurheartj/ehy873.Google Scholar
- 25.Masotti L, Panigada G, Landini G et al (2015) Comparison and combination of a hemodynamics/biomarkers-based model with simplified PESI score for prognostic stratification of acute pulmonary embolism: findings from a real world study. Int J Res Med Sci 3(11):3230–3237. https://doi.org/10.18203/2320-6012.ijrms20151168 CrossRefGoogle Scholar
- 29.Coleman CI, Kohn CG, Crivera C, Schein JR, Peacock WF (2015) Validation of the multivariable in-hospital mortality for pulmonary embolism using claims data (IMPACT) prediction rule within an all-payer inpatient administrative claims database. BMJ Open 5(10):e009251. https://doi.org/10.1136/bmjopen-2015-009251 CrossRefPubMedGoogle Scholar