Prognostic scores in pulmonary embolism: PESI, simplified PESI or PREP?

INTRODUCTION When evaluating the prognosis of hemodinamically stable pulmonary embolism (HSPE), clinical scores (PESI, sPESI) have demonstrated their useful to select low risk patients, but are insufficient to classify high risk patients that could benefit from fibrinolytic treatment. Recently, the PREP score, that includes not only clinical variables but also BNP and echocardiographic RV/LV ratio, has been described and could be useful to select both low and high risk patients AIMS 1 Validate the PREP score in a wide sample of patients with HSPE 2 Compare the prognostic value of the PREP score with PESI and sPESI METHODS PROTECT is a prospective multicentre study that has included patients with HSEP. Clinical and echocardiographic variables have been measured along with ventricular diameter in angioTC, I troponin and BNP levels. Patients were followed up 30 days. PESI, sPESI and PREP were calculated with these data RESULTS 848 patients were included (50.9% female, mean age 67,5 ± 16.7) Global mortality at day 30 was 4.5% (n=38) CONCLUSIONS 1 Although the NPV for mortality of the three scores were high, it may due to the low prevalence because the respective sensibilities of PESI and sPESI compared with PREP score resulted significantly different 2 Although PPV is limited because of the low frecuency of events, the specifity of PREP score is very high and could be valid for the selection of patients susceptible to fibrinolytic treatment.