Pulmonary Embolism Obstruction Model to Evaluate Clinical Deterioration

Hemodynamic instability may develop in patients with acute pulmonary embolism (PE) days after the emboli event. Simplified methods to predict clinical deterioration are currently lacking. This retrospective cohort study included patients diagnosed with acute. The aim is to develop a simplified imaging model with good clinical accessibility to predict the clinical deterioration of patients with acute PE. This study included patients with acute PE under the International Classification of Disease, ninth or tenth revision. Seven models based on computed tomography pulmonary angiography (CTPA) were developed based on the location (central versus peripheral) and the degree (nearly total versus partial) of obstruction. The outcome includes clinical deterioration, which is defined as death from PE, cardiopulmonary resuscitation, mechanical ventilation, vasopressor therapy, thrombolysis, catheter-directed therapy, and surgical embolectomy. Logistic regression analysis was used to test the association between different models and clinical deterioration. The area under the receiver operating characteristic curve (AUC) was used to test the predictive ability. The category-free net reclassification improvement (NRI) and integrated discrimination improvement (IDI) were used to quantify the improvement of the proposed models plus the simplified Pulmonary Severity Index (sPESI) compared with the sPESI alone. Calculating the nearly totally obstructed 20 peripheral arteries provides good predictive ability in the seven models (AUC: 0.77). Calculating nearly totally obstructed 20 peripheral segments can predict clinical deterioration. Obstruction on CTPA combined with the sPESI increased the ability to predict clinical deterioration compared to the sPESI alone and may be used as guidance in clinical decision-making. Clinical perspectiveA simple model based on computed tomography pulmonary angiography (CTPA) to predict clinical deterioration in patients with acute pulmonary embolism (PE) is currently lacking. This retrospective study included 210 patients and used the model for calculating the nearly totally obstructed segmental pulmonary arteries as an efficient and simple method to predict clinical deterioration. This model added to the simplified PE severity index (sPESI) has an increased predictive ability compared to the sPESI alone. CTPA images can predict the clinical deterioration of patients with acute PE and may assist in clinical decision-making.