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Comorbidity assessment as predictor of short and long-term mortality in elderly patients with hemodynamically stable acute pulmonary embolism

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Abstract

Elderly patients presenting with acute pulmonary embolism (PE) frequently have significant underlying comorbidities which may condition the prognosis. The current study aimed to determine the ability of Charlson comorbidity index (CCI) score to predict short and long-term mortality in elderly patients with hemodynamically stable acute PE. All hemodynamically stable patients aged >65 years with acute PE, evaluated in the Emergency Department since 2010 through 2014, were included in this retrospective cohort study. CCI, simplified pulmonary embolism severity index (sPESI) scores and vital status were recorded. Were included 162 patients with confirmed PE, out of 657 suspected cases (24.7%). Median age: 79.2 years, 74.1% presented an sPESI > 1 and 61.1% a CCI > 1. The overall 30, 90-day and 2-year mortality was 11.7% (95%CI 6.6–16.6), 19.8% (95%CI 13.4–25.7) and 31.8% (95%CI 24.1–38.8). For 30-day mortality sPESI showed an AUC 0.642 (95%CI 0.511–0.772) and adding CCI as covariate did not increase its prognostic performance. For 90-day mortality, in an adjusted model including sPESI and CCI, CCI showed a HR 1.282 (95%CI 1.151–1.429, p-value < 0.001), and sPESI a HR = NS(p-value = 0.267). For 2-year mortality, in an adjusted model including sPESI and CCI, CCI showed a HR 1.295 (95%CI 1.180–1.421, p-value < 0.001) and sPESI a HR = NS(p-value = 0.353). In elderly patients with hemodynamically stable PE, the CCI score was found to be an independent predictor of mortality. CCI shows a significantly better ability to predict 90-day and 2-year mortality than sPESI. The assessment of comorbidity burden by using the CCI score may be proposed as an useful tool to predict mortality in these patients.

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Funding

This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.

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Authors and Affiliations

  1. Internal Medicine, Department of Medicine, Vimercate Hospital, Azienda Ospedaliera di Desio e Vimercate, via Santi Cosma e Damiano 10, 20871, Vimercate, Italy

    Hernan Polo Friz, Valeria Corno, Chiara Buzzini, Chiara Crivellari, Francesco Petri, Melisa Polo Friz, Veronica Punzi, Daniela Teruzzi & Giuseppe Vighi

  2. Research and Study Center of the Italian Society of Angiology and Vascular Pathology (Società Italiana di Angiologia e Patologia Vascolare, SIAPAV), Milan, Italy

    Hernan Polo Friz & Claudio Cimminiello

  3. Laboratory of Medical Statistics, Epidemiology and Biometry G. A. Maccacaro, Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy

    Annalisa Orenti & Patrizia Boracchi

  4. Epidemiology Unit - Local Health Authority of Monza and Brianza province, Monza, Italy

    Luca Cavalieri d’Oro

  5. School of Medicine Department, Milano-Bicocca University, Milan, Italy

    Cristina Giannattasio

  6. Cardiologia IV, Dipartimento A. De Gasperis, Ospedale Niguarda Ca Granda, Milan, Italy

    Cristina Giannattasio

Authors
  1. Hernan Polo Friz
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  2. Valeria Corno
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  3. Annalisa Orenti
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  4. Chiara Buzzini
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  7. Melisa Polo Friz
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  9. Daniela Teruzzi
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  10. Luca Cavalieri d’Oro
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  11. Cristina Giannattasio
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  12. Giuseppe Vighi
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  13. Claudio Cimminiello
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Contributions

All authors, namely HPF, VC, AO, CB, CC, FP, MPF, VP, DT, LCO, PB, CG, GV, CC certify that they have participated sufficiently in the work to take public responsibility for the content, including participation in the concept, design, analysis, writing, and revision of the manuscript. All authors have read and approved the submission of the manuscript. The manuscript has not been published and is not being considered for publication elsewhere, in whole or in part, in any language.

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Correspondence to Hernan Polo Friz.

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Polo Friz, H., Corno, V., Orenti, A. et al. Comorbidity assessment as predictor of short and long-term mortality in elderly patients with hemodynamically stable acute pulmonary embolism. J Thromb Thrombolysis 44, 316–323 (2017). https://doi.org/10.1007/s11239-017-1540-y

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