For patients with COVID-19, the pulmonary embolism severity index (PESI) and simplified PESI (sPESI) can be used to predict in-hospital mortality, even in the absence of documented venous thromboembolism and/or pulmonary embolism, according to study findings published in Journal of Cardiothoracic and Vascular Anesthesia.
Although the PESI and sPESI have been effectively used to assess risk and disease severity in patients with COVID-19 diagnosed with PE/VTE, the ability of these indices to assess risk in those with COVID-19 who are not diagnosed with PE/VTE was yet to be studied. Researchers therefore conducted a retrospective observational study to assess the association between PESI and sPESI scores upon hospital admission and adverse events in patients hospitalized for COVID-19 who were not diagnosed withPE/VTE. Adverse events were defined as the development of acute respiratory distress syndrome, the need for intensive care unit admission, invasive or noninvasive mechanical ventilation, and in-hospital mortality.
Overall, 720 hospitalized patients who did not have document PE or VTE from 2 tertiary hospitals were enrolled in the study. Of these patients, 350 (48.6%) were female and the median age of all participants was 66 years (range 19 to 96 years). In total, 148 patients (20.5%) died during hospitalization.
The investigators found that both the PESI and sPESI scores were independent predictors of all adverse events investigated in the patients studied. Multivariate logistic regression analysis found a significant relationship between PESI and sPESI and all the adverse events investigated (p <.001). An sPESI score of 2 or more predicted in-hospital mortality with a sensitivity of 61.4% and specificity of 83.3% (area under the curve=0.817, 95% CI, 0.787-0.845, P <.001).
Patients were divided into 5 categories based on their PESI score, with class 1 being used as the baseline. PESI class 4 and 5 were found to be independent risk factors for in-hospital mortality (PESI class 4 odds ratio= 2.81, 95% CI, 1.53-5.84, P <.017; PESI class 5 OR= 3.94, 95% CI, 2.13-11.18, P <.001).
The study is limited by its retrospective design, short participation period, the possibility that some study participants had undiagnosed PE or VTE, and the change in treatment protocols that has occurred since the study period, which was prior to the availability of COVID-19 vaccines.
Researchers concluded, “Our study demonstrates that PESI and sPESI scores can successfully determine clinical deterioration, need for ICU admission, and in-hospital mortality of hospitalized COVID-19 patients without clinically documented venous or pulmonary thromboembolism.”
Kalayci S, Köksal BG, Horuz M, et al. Pulmonary embolism severity index predicts adverse events in hospitalized COVID-19 patients: a retrospective observational study: PESI/sPESI and COVID-19 study. J. Cardiothorac. Vasc. Anesth. Published online August 20, 2022. doi:10.1053/j.jvca.2022.08.009