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Thieme Gruppe, Phlebologie, 4(44), p. 192-199

DOI: 10.12687/phleb2251-4-2015

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Simplified CRB-65 for risk stratification and predicting prognosis in acute pulmonary embolism

This paper was not found in any repository, but could be made available legally by the author.
This paper was not found in any repository, but could be made available legally by the author.

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Abstract

SummaryBackground: Pulmonary embolism (PE) and community acquired pneumonia (CAP) are potentially life-threatening diseases. In CAP CRB-65 is used for risk stratification and prognosis prediction. The aim of this study was to examine a simplified CRB-65 (sCRB-65) for predicting prognosis in PE.Methods: We retrospectively analyzed the data of 182 PE patients. Patients were, according to the score of sCRB-65 (respectively 1 point for dyspnoea, systolic blood pressure < 90 mmHg or diastolic blood pressure60 mmHg, age65years), subdivided in risk-classes 1–4.Risk classes were compared with Kruskal-Wallis test. Logistic multivariable regression and Pearson correlation matrix were calculated for coherence of sCRB-65 and in-hospital death, right ventricular load and PE severity stadium as well as sCRB-65 > 2points and in-hospital death an PE stadium. ROC analysis was performed to evaluate efficiency of sCRB-65 score to predict in-hospital death and PE severity stadium.Results: PE severity stadium, systolic pulmonary artery pressure (sPAP) and frequency of in-hospital death increased with growing risk class.Risk class 1 showed lower PE sever-ity stadium than 2 (P=0.0253), 3 (P=0.0132) and 4 (P=0.00162), lower percentage of patients with sPAP > 30mmHg than 2 (0 % vs. 48.9 %, P=0.0419), 3 (0 % vs. 70.8 %, P=0.00112) and 4 (0 % vs. 75.0 %, P=0.0113). Frequency of in-hospital deaths was higher in risk class 4 than in 1 (P=0.0024), 2 (P=0.00014) and 3 (P=0.000058). Multi-variable logistic regression showed an association between sCRB-65 scored>0 and PE severity stadium (OR 11.42, 95 %CI: 1.35–96.66, P=0.0254), RVD (OR 10.09, 1.16–87.78, P=0.0363) and sPAP (OR 1.08, 1.02–1.15, P=0.0092) as well as a trend towards significance (OR 12.39, 0.90–171.34, P=0.060) between in-hospital death and sCRB-65. sCRB-65 correlated with PE severity stadium (r=0.258, P<0.001) and sPAP (r=0.280, P=0.001). sCRB-65 >2 points was strongly associated with both inhospital death (OR 36.22, 95%CI: 1.59–827.71, P=0.0245) and high-risk PE stadium (OR 57.94, 95%CI: 7.17–468.33, P=0.000141). ROC analysis for CRB-65 predicting in-hospital death and high-risk PE stadium showed AUC values of respectively 0.764 and 0.892 with sCRB-65 cut-off value of 2.5 points, respectively.Conclusions: sCRB-65 is closely correlated with PE severity stadium and load of the right heart as well as prognosis. PE patients with sCRB-65 score >2 points revealed a 36.2-fold risk to die during in-hospital course after acute PE event. Efficiency of sCRB-65 to predict in-hospital death was good.