Validity of mortality risk prediction scores in critically ill patients with secondary pulmonary embolism

Martin J. Ryll; Toby N.  Weingarten; Darrel R. Schroeder; Juraj Sprung

doi:10.17305/bb.2024.10202

Authors

Martin J. Ryll Faculty of Medicine, Ludwig Maximilian University of Munich, Munich, Germany https://orcid.org/0009-0002-4245-9461
Toby N. Weingarten Department of Anesthesiology and Perioperative Medicine, Mayo Clinic College of Medicine and Science, Rochester, Minnesota, USA https://orcid.org/0000-0002-8405-1328
Darrel R. Schroeder Health Sciences Research, Division of Epidemiology, Mayo Clinic College of Medicine and Science, Rochester, Minnesota, USA https://orcid.org/0000-0001-8591-5936
Juraj Sprung Department of Anesthesiology and Perioperative Medicine, Mayo Clinic College of Medicine and Science, Rochester, Minnesota, USA https://orcid.org/0000-0002-0320-0230

DOI:

https://doi.org/10.17305/bb.2024.10202

Keywords:

critical care, pulmonary embolism, PESI, sPESI, ICU-sPESI, APACHE-IV, intensive care unit, mortality

Abstract

Pulmonary embolism (PE) is a feared complication in the ICU, significantly impacting morbidity and mortality of the patients affected.
Herein, we assess the use of the Acute Physiology and Chronic Health Evaluation-IV (APACHE-IV) and PE-specific risk scores to predict
mortality among intensive care unit (ICU) patients who developed secondary PE. This retrospective cohort study used information from 208 United States critical care units recorded in the eICU Collaborative Research Database during 2014 and 2015. We calculated APACHE-IV, Pulmonary Embolism Severity Index (PESI), simplified PESI (sPESI), and ICU-sPESI scores and compared their predicting performance using the area under the receiver operating characteristic (AUROC) curve. Of 812 patients included in our study, 150 died (mortality, 18.5% [95% CI, 15.8%-21.1%]). Compared to survivors, non-survivors had higher APACHE-IV (86 vs 52, P<0.001), PESI (170 vs 129, P<0.001), sPESI (2 vs 2, P<0.001), and ICU-sPESI (4 vs 2, P<0.001) scores. AUROCs were 0.790 (APACHE-IV); 0.737 (PESI); 0.726 (ICU-sPESI); and 0.620 (sPESI). APACHE-IV performed significantly better than all 3 PE-specific mortality scores (APACHE-IV vs PESI, P=0.041; APACHE-IV vs sPESI, P=0.001; and APACHE-IV vs ICU-sPESI, P=0.021). Both the PESI and ICU-sPESI outperformed the sPESI (PESI vs sPESI, P=0.001; ICU-sPESI vs sPESI, P<0.001). APACHE-IV score was found to be the best instrument for predicting mortality risk, but PESI and ICU-sPESI scores may be used when APACHE-IV is unavailable. sPESI AUROC suggests absence of sufficient discriminative value to be used as a predictor of mortality in patients with secondary PE.