Pulmonary Embolism Severity Index (PESI) Score
The Pulmonary Embolism Severity Index (PESI) is a risk stratification tool to determine the mortality of patients with newly diagnosed pulmonary embolism (PE). It supports physicians in indentifying those patients who could potentially be treated as out-patient (c-index: 0.77-0.79).

NOTE: A simplified PESI score (sPESI) requiring less variables (6 vs 11) is also available with similar accuracy for predicting the short-term death and adverse outcome events in patients with acute pulmonary embolism.
Research authors: Aujesky D, Obrosky DS, Stone RA, Auble TE, Perrier A, Cornuz J, Roy PM, Fine MJ.
Version: 1.21
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  • Pulmonology
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Total PESI score: points

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How this model should be interpreted:
The PESI reliably identifies patients with PE who are at low risk of death and who are potential candidates for outpatient care. The PESI may help physicians make more rational decisions about hospitalization for patients with PE.

Model performance:

  • Aujesky et al (2005) performed an external validation in 221 patients.1 The models' discriminatory power for 30-day mortality in the derivation, internal, and external validation samples was comparable, with an area under the ROC curve (c-index) of 0.78, 0.77, and 0.79, respectively.
 
  • A prospective validation was performed by Donzé et al (2008) in 357 patients with PE.2 The 186 (52%) low-risk patients had an overall mortality of 1.1% (95% CI: 0.1-3.8%) compared to 11.1% (95% CI: 6.8-16.8%) in the 171 (48%) higher-risk patients. The area under the ROC curve (c-index) was 0.78 (95% CI: 0.70-0.86).
 
  • In a non-inferiority study, Aujesky et al (2011) showed that in selected low-risk patients with pulmonary embolism, outpatient care can safely and effectively be used in place of inpatient care.3

Comparison of simplified PESI score to the original PESI score:
In a meta-analysis of twenty-one studies by Zhou et al (2012), the accuracy of the PESI and a simplified PESI (requiring 6 instead of 11 variables) to predict prognostic outcomes (all-cause and PE-related mortality, serious adverse events) in patients with acute pulmonary embolism (PE) were compared (figure blow).4 The areas under the curve (c-index) for predicting all-cause mortality, PE-related mortality, and serious adverse events were 0.79, 0.83 and 0.65 for the sPESI score and 0.79, 0.82, and 0.66 for the PESI score, respectively. In conclusion, the PESI and the sPESI have similar accuracy for predicting the short-term death and adverse outcome events in patients with acute pulmonary embolism, while sPESI is easier to use.


Source:
1 Aujesky D, Obrosky DS, Stone RA, et al. Derivation and validation of a prognostic model for pulmonary embolism. Am J Respir Crit Care Med. 2005;172(8):1041-1046.
2 Donzé J, Le Gal G, Fine MJ, et al. Prospective validation of the Pulmonary Embolism Severity Index. A clinical prognostic model for pulmonary embolism. Thromb Haemost. 2008;100(5):943-948
3 Aujesky D, Roy PM, Verschuren F, et al. Outpatient versus inpatient treatment for patients with acute pulmonary embolism: an international, open-label, randomised, non-inferiority trial. Lancet. 2011;378(9785):41-48.
4Zhou X-Y, Ben S-Q, Chen H-L, Ni S-S. The prognostic value of pulmonary embolism severity index in acute pulmonary embolism: a meta-analysis. Respiratory Research. 2012;13(1):111.
 

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