Prognosis

The Pulmonary Embolism Severity Index (PESI) and simplified Pulmonary Embolism Severity Index (sPESI) classify patients with confirmed PE without shock or hypotension into categories associated with increasing 30-day mortality. Studies indicate that PESI and sPESI predict short-term mortality with comparable accuracy, but the latter is easier to use.[249][250] Using sPESI, patients in the high-risk category have a short-term mortality of 10.9%, while patients in the low-risk category have 30-day mortality of 1%.

Mortality is often due to cardiogenic shock secondary to right ventricular (RV) collapse. One systematic review and meta-analysis of 3283 haemodynamically stable patients with acute PE found that the risk of short-term mortality was significantly greater in those with RV dysfunction than those without RV dysfunction (odds ratio 2.29, 95% CI 1.61 to 3.26).[251] In-hospital or 30-day mortality was reported in 167 of 1223 patients (13.7%) with RV dysfunction and in 134 of 2060 patients (6.5%) without RV dysfunction.[251]

Registry data confirm that, in patients with acute PE, hypotension (systolic BP <90 mmHg) is associated with increased mortality.[252] Of the 1875 patients enrolled in the prospective observational Emergency Medicine Pulmonary Embolism in the Real World Registry, all-cause inpatient mortality (13.8% vs 3.0%, P <0.001) and 30-day mortality (14.0% vs 1.8%, P <0.001) were significantly greater among the 58 patients with hypotension than those without.[252] In the international prospective Registro Informatizado de la Enfermedad TromboEmbolica venosa (RIETE) registry, the 90-day mortality rate for the 248 patients with symptomatic PE with hypotension (systolic BP <90 mmHg) was 9.27%, compared with 2.99% for patients with symptomatic non-massive PE.[92]

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