PT - JOURNAL ARTICLE AU - Kevin Solverson AU - Christopher Humphreys AU - Zhiying Liang AU - Graeme Prosperi-Porta AU - James E. Andruchow AU - Paul Boiteau AU - Andre Ferland AU - Eric Herget AU - Doug Helmersen AU - Jason Weatherald TI - Rapid prediction of adverse outcomes for acute normotensive pulmonary embolism: derivation of the Calgary Acute Pulmonary Embolism (CAPE) score AID - 10.1183/23120541.00879-2020 DP - 2021 Jan 01 TA - ERJ Open Research PG - 00879-2020 4099 - http://openres.ersjournals.com/content/early/2021/02/18/23120541.00879-2020.short 4100 - http://openres.ersjournals.com/content/early/2021/02/18/23120541.00879-2020.full AB - Background Acute pulmonary embolism (PE) has a wide spectrum of outcomes but the best method to risk stratify normotensive patients for adverse outcomes remains unclear.Methods A multicenter retrospective cohort study of acute PE patients admitted from emergency departments in Calgary, Canada, between 2012–2017 was used to develop a refined acute PE risk score. The composite primary outcome of in-hospital PE-related death or hemodynamic decompensation. The model was internally validated using bootstrapping and the prognostic value of the derived risk score was compared to the Bova score.Results Of 2067 patients with normotensive acute PE, the primary outcome (hemodynamic decompensation or PE related death) occurred in 32 patients (1.5%). In sPESI high-risk patients (n=1498, 78%), a multivariable model used to predict the primary outcome retained computed tomography (CT) right-left ventricular diameter ratio ≥1.5, systolic blood pressure 90–100 mmHg, central pulmonary artery clot, & heart rate ≥100 BMP with a C-statistic of 0.89 (95%CI, 0.82–0.93). Three risk groups were derived using a weighted score (score, prevalence, primary outcome event rate): group 1 (0–3, 73.8%, 0.34%), group 2 (4–6, 17.6%, 5.8%), group 3 (7–9, 8.7%, 12.8%) with a C-statistic 0.85 (95%CI, 0.78–0.91). In comparison the prevalence (primary outcome) by Bova risk stages (n=1179) were: stage I, 49.8% (0.2%); stage II, 31.9% (2.7%); and stage III, 18.4% (7.8%) with a C-statistic 0.80 (95%CI, 0.74–0.86).Conclusions A simple 4-variable risk score using clinical data immediately available after CT diagnosis of acute PE predicts in-hospital adverse outcomes. External validation of the CAPE score is required.FootnotesThis manuscript has recently been accepted for publication in the ERJ Open Research. It is published here in its accepted form prior to copyediting and typesetting by our production team. After these production processes are complete and the authors have approved the resulting proofs, the article will move to the latest issue of the ERJOR online. Please open or download the PDF to view this article.Conflict of interest: K. Solverson reports travel grants from Bayer outside the submitted work.Conflict of interest: Dr. Humphreys has nothing to disclose.Conflict of interest: Mrs. Liang has nothing to disclose.Conflict of interest: Dr. Prosperi-Porta has nothing to disclose.Conflict of interest: J.E. Andruchow reports an unrestricted grant for high-sensitivity troponin research from Roche Diagnostics outside the submitted work.Conflict of interest: Dr. Boiteau has nothing to disclose.Conflict of interest: Dr. Ferland has nothing to disclose.Conflict of interest: Dr. Herget has nothing to disclose.Conflict of interest: Dr. Helmersen reports grants and non-financial support from Actelion Pharmaceuticals, grants from Bayer Pharmaceuticals, grants from Gilead, grants from Janssen Inc., grants from United Therapeutics, outside the submitted work.Conflict of interest: Dr. Weatherald reports grants, personal fees and non-financial support from Janssen Inc., grants, personal fees and non-financial support from Actelion, personal fees and non-financial support from Bayer, personal fees from Novartis, grants from Alberta Lung Association, grants from Canadian Vascular Network, grants from European Respiratory Society, grants from Canadian Thoracic Society, outside the submitted work.