Acute pulmonary embolism: a multimarker calculator to predict short-term outcomes

Abstract Background and Aims Risk stratification of patients with acute pulmonary embolism (PE) is critical to provide targeted interventions aimed at improving patients’ outcomes. The objective of this study was to validate a multimarker prognostic calculator and compare its performance with that of the European Society of Cardiology (ESC) model. Methods The multimarker calculator estimates absolute risk of key outcomes for an individual patient based on the individual variables of the simplified Pulmonary Embolism Severity Index, natriuretic peptide levels, troponin levels, and concomitant lower limb deep vein thrombosis. Using data for haemodynamically stable patients with acute PE from the Registro Informatizado de la Enfermedad TromboEmbólica registry, the study compared the performance of the multimarker calculator and the ESC model using measures of discrimination and calibration. The primary outcome was 30-day all-cause mortality. Results A total of 60 042 stable patients with PE (mean age: 67 years, 51.8% female) were included. Compared with the ESC model, the multimarker calculator provided significant C-statistic improvement in the whole cohort (0.79 vs. 0.56; P < .001), in the group of 16 648 participants with available data for right ventricular function/size and troponin (0.78 vs. 0.66; P < .001), and after imputation of missing data (0.79 vs. 0.66; P < .001). At a calculator estimated risk of >10% to identify intermediate-high risk PE, the positive predictive value for mortality was 15.7% (vs. 5.0% for the ESC model; P < .001). Conclusions In stable patients with acute PE, the use of a multimarker calculator substantially improved the risk stratification for mortality beyond that of the ESC model.