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  1. Article ; Online: Prediction of mortality in patients with secondary pulmonary embolism based on primary admission indication: A short communication.

    Ryll, Martin J / Weingarten, Toby N / Sprung, Juraj

    Biomolecules & biomedicine

    2024  

    Abstract: We evaluated the prediction of mortality in patients admitted to the intensive care unit (ICU) who subsequently developed a pulmonary embolism (PE) (i.e., secondary PE) using three PE-specific scores, the Pulmonary Embolism Severity Index (PESI), ... ...

    Abstract We evaluated the prediction of mortality in patients admitted to the intensive care unit (ICU) who subsequently developed a pulmonary embolism (PE) (i.e., secondary PE) using three PE-specific scores, the Pulmonary Embolism Severity Index (PESI), simplified PESI (sPESI), and modified sPESI (ICU-sPESI) and compared them to the gold standard for the assessment of ICU all-cause mortality, the Acute Physiology and Chronic Health Evaluation-IV (APACHE-IV). All critical care admission indications were grouped into four major categories: post-operative, cardiovascular, infectious (sepsis), and other. The APACHE-IV displayed better discriminative ability to predict in-hospital mortality than the PESI and ICU-sPESI, but these two scores still performed fair for the ICU admissions related to postoperative, cardiovascular, and other admission types. Meanwhile, the sPESI displayed poor predictive performance across all four admission categories. Notably, discriminatory performance for patients with an infection-related admission was consistently low regardless of which score was used.
    Language English
    Publishing date 2024-03-23
    Publishing country Bosnia and Herzegovina
    Document type Journal Article
    ISSN 2831-090X
    ISSN (online) 2831-090X
    DOI 10.17305/bb.2024.10481
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  2. Article ; Online: Validity of mortality risk prediction scores in critically ill patients with secondary pulmonary embolism.

    Ryll, Martin J / Weingarten, Toby N / Schroeder, Darrel R / Sprung, Juraj

    Biomolecules & biomedicine

    2024  

    Abstract: Herein, we assess the use of the Acute Physiology and Chronic Health Evaluation-IV (APACHE-IV) and pulmonary embolism (PE)-specific risk scores to predict mortality among intensive care unit (ICU) patients who developed secondary PE. This retrospective ... ...

    Abstract Herein, we assess the use of the Acute Physiology and Chronic Health Evaluation-IV (APACHE-IV) and pulmonary embolism (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.
    Language English
    Publishing date 2024-02-28
    Publishing country Bosnia and Herzegovina
    Document type Journal Article
    ISSN 2831-090X
    ISSN (online) 2831-090X
    DOI 10.17305/bb.2024.10202
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  3. Article ; Online: Predicting Hospital Survival in Patients Admitted to ICU with Pulmonary Embolism.

    Ryll, Martin J / Zodl, Aurelia / Weingarten, Toby N / Rabinstein, Alejandro A / Warner, David O / Schroeder, Darrell R / Sprung, Juraj

    Journal of intensive care medicine

    2023  Volume 39, Issue 5, Page(s) 455–464

    Abstract: Objective: The Pulmonary Embolism Severity Index (PESI) and simplified PESI (sPESI) predict mortality for patients with PE. We compared PESI/sPESI to the Acute Physiology and Chronic Health Evaluation IV (APACHE-IV) in predicting mortality in patients ... ...

    Abstract Objective: The Pulmonary Embolism Severity Index (PESI) and simplified PESI (sPESI) predict mortality for patients with PE. We compared PESI/sPESI to the Acute Physiology and Chronic Health Evaluation IV (APACHE-IV) in predicting mortality in patients with PE admitted to the intensive care unit (ICU). Additionally, we assessed the performance of a novel ICU-sPESI score created by adding three clinical variables associated with acuity of PE presentation (intubation, confusion [altered mental status], use of vasoactive infusions) to sPESI.
    Materials and methods: Using the eICU Collaborative Research Database from 2014 to 2015, we conducted a large retrospective cohort study of adult patients admitted to the ICU with a primary diagnosis of PE. We calculated APACHE-IV, PESI, sPESI, and ICU-sPESI scores and compared their performance for predicting in-hospital mortality using area under the receiver operating characteristic (AUROC) curve. Score thresholds for >99% negative predictive values (NPV) were calculated for each score. Survival was estimated using the Kaplan-Meier method.
    Results: We included 1424 PE cases. In-hospital mortality was 6.3% [95% CI: 5.1%-7.6%]. AUROC for APACHE-IV, PESI, and sPESI were 0.870, 0.848, and 0.777, respectively. APACHE-IV and PESI outperformed sPESI (P < 0.01 for both comparisons), while APACHE-IV and PESI demonstrated similar performance (P = 0.322). The ICU-sPESI performance was similar to APACHE-IV and PESI (AUROC = 0.847; AUROC comparison: APACHE-IV vs ICU-sPESI: P = 0.396; PESI vs ICU-sPESI: P = 0.945). Hospital mortality for ICU-sPESI scores 0-2 was 1.1%, and for scores 3, 4, 5, 6, and ≥7 was 8.6%, 11.7%, 29.2%, 37.5%, and 76.9%, respectively. Score thresholds for >99% NPV were ≤48 for APACHE-IV, ≤115 for PESI, and 0 points for sPESI and ICU-sPESI.
    Conclusions: By accounting for severity of PE presentation, our newly proposed ICU-sPESI score provided improved PE mortality prediction compared to the original sPESI score and offered excellent discrimination of mortality risk.
    MeSH term(s) Adult ; Humans ; Risk Assessment ; Retrospective Studies ; Prognosis ; Severity of Illness Index ; Intensive Care Units ; Hospitals ; Pulmonary Embolism/complications ; Predictive Value of Tests
    Language English
    Publishing date 2023-11-15
    Publishing country United States
    Document type Journal Article
    ZDB-ID 632828-3
    ISSN 1525-1489 ; 0885-0666
    ISSN (online) 1525-1489
    ISSN 0885-0666
    DOI 10.1177/08850666231212875
    Database MEDical Literature Analysis and Retrieval System OnLINE

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