Pulmonary embolism in elderly patients: Prognostic impact of the Cumulative Illness Rating Scale (CIRS) on short-term mortality

Roberto Castelli, Paolo Bucciarelli, Fernando Porro, Federica Depetri, Massimo Cugno

Research output: Contribution to journalArticle

Abstract

Background Pulmonary embolism (PE) is associated with high short-term mortality in elderly patients, even when hemodynamically stable. Methods One hundred and seventy hemodynamically stable patients with confirmed PE (41 <65 years and 129 ≥ 65 years) were prospectively followed for one month in order to assess whether comorbidities can predict short-term mortality in elderly patients. Upon admission, patients' clinical characteristics (including instrumental and laboratory parameters) were evaluated, and two clinical scores were calculated: the Cumulative Illness Rating Scale (CIRS), commonly used to evaluate comorbidities in elderly patients, and the Pulmonary Embolism Severity Index (PESI). Results Fifteen patients (all elderly) died within one month from their PE diagnosis (mortality rate = 8.8%; 95%CI:4.6-13.1%). In these non survivors, arterial partial oxygen pressure (p <0.0001) and saturation (p <0.0001), pH (p = 0.001) and systolic blood pressure (p = 0.017) at admission were significantly lower than in survivors, whereas their respiratory rate (p <0.0001), white blood cells (p <0.0001), lactate dehydrogenase (p <0.0001), troponin T (p = 0.001) and D-dimer (p = 0.023) were significantly higher. CIRS correlated with PESI (rho = 0.54, p <0.0001), and was higher in non-survivors (p = 0.002). The age- and sex-adjusted odds ratio of 1-month mortality was 1.91 (95%CI:1.24-2.95) for every 1-point increase in CIRS. The AUC was 0.78 (95%CI:0.67-0.89) for the logistic model containing CIRS, and 0.88 (95%CI:0.79-0.96) for that containing PESI (p = 0.059). Conclusions In elderly patients with PE, CIRS demonstrated a fairly good performance in predicting short-term mortality. Its easiness and suitability for use in common clinical practice make CIRS a potentially useful prognostic score for short-term mortality in these patients.

Original languageEnglish
Pages (from-to)326-330
Number of pages5
JournalThrombosis Research
Volume134
Issue number2
DOIs
Publication statusPublished - 2014

Fingerprint

Pulmonary Embolism
Mortality
Survivors
Comorbidity
Blood Pressure
Troponin T
Partial Pressure
Respiratory Rate
L-Lactate Dehydrogenase
Area Under Curve
Leukocytes
Logistic Models
Odds Ratio
Oxygen

Keywords

  • Age groups
  • Clinical probability
  • Pulmonary embolism
  • Spiral computed tomography
  • Thromboembolism

ASJC Scopus subject areas

  • Hematology
  • Medicine(all)

Cite this

Pulmonary embolism in elderly patients : Prognostic impact of the Cumulative Illness Rating Scale (CIRS) on short-term mortality. / Castelli, Roberto; Bucciarelli, Paolo; Porro, Fernando; Depetri, Federica; Cugno, Massimo.

In: Thrombosis Research, Vol. 134, No. 2, 2014, p. 326-330.

Research output: Contribution to journalArticle

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title = "Pulmonary embolism in elderly patients: Prognostic impact of the Cumulative Illness Rating Scale (CIRS) on short-term mortality",
abstract = "Background Pulmonary embolism (PE) is associated with high short-term mortality in elderly patients, even when hemodynamically stable. Methods One hundred and seventy hemodynamically stable patients with confirmed PE (41 <65 years and 129 ≥ 65 years) were prospectively followed for one month in order to assess whether comorbidities can predict short-term mortality in elderly patients. Upon admission, patients' clinical characteristics (including instrumental and laboratory parameters) were evaluated, and two clinical scores were calculated: the Cumulative Illness Rating Scale (CIRS), commonly used to evaluate comorbidities in elderly patients, and the Pulmonary Embolism Severity Index (PESI). Results Fifteen patients (all elderly) died within one month from their PE diagnosis (mortality rate = 8.8{\%}; 95{\%}CI:4.6-13.1{\%}). In these non survivors, arterial partial oxygen pressure (p <0.0001) and saturation (p <0.0001), pH (p = 0.001) and systolic blood pressure (p = 0.017) at admission were significantly lower than in survivors, whereas their respiratory rate (p <0.0001), white blood cells (p <0.0001), lactate dehydrogenase (p <0.0001), troponin T (p = 0.001) and D-dimer (p = 0.023) were significantly higher. CIRS correlated with PESI (rho = 0.54, p <0.0001), and was higher in non-survivors (p = 0.002). The age- and sex-adjusted odds ratio of 1-month mortality was 1.91 (95{\%}CI:1.24-2.95) for every 1-point increase in CIRS. The AUC was 0.78 (95{\%}CI:0.67-0.89) for the logistic model containing CIRS, and 0.88 (95{\%}CI:0.79-0.96) for that containing PESI (p = 0.059). Conclusions In elderly patients with PE, CIRS demonstrated a fairly good performance in predicting short-term mortality. Its easiness and suitability for use in common clinical practice make CIRS a potentially useful prognostic score for short-term mortality in these patients.",
keywords = "Age groups, Clinical probability, Pulmonary embolism, Spiral computed tomography, Thromboembolism",
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T1 - Pulmonary embolism in elderly patients

T2 - Prognostic impact of the Cumulative Illness Rating Scale (CIRS) on short-term mortality

AU - Castelli, Roberto

AU - Bucciarelli, Paolo

AU - Porro, Fernando

AU - Depetri, Federica

AU - Cugno, Massimo

PY - 2014

Y1 - 2014

N2 - Background Pulmonary embolism (PE) is associated with high short-term mortality in elderly patients, even when hemodynamically stable. Methods One hundred and seventy hemodynamically stable patients with confirmed PE (41 <65 years and 129 ≥ 65 years) were prospectively followed for one month in order to assess whether comorbidities can predict short-term mortality in elderly patients. Upon admission, patients' clinical characteristics (including instrumental and laboratory parameters) were evaluated, and two clinical scores were calculated: the Cumulative Illness Rating Scale (CIRS), commonly used to evaluate comorbidities in elderly patients, and the Pulmonary Embolism Severity Index (PESI). Results Fifteen patients (all elderly) died within one month from their PE diagnosis (mortality rate = 8.8%; 95%CI:4.6-13.1%). In these non survivors, arterial partial oxygen pressure (p <0.0001) and saturation (p <0.0001), pH (p = 0.001) and systolic blood pressure (p = 0.017) at admission were significantly lower than in survivors, whereas their respiratory rate (p <0.0001), white blood cells (p <0.0001), lactate dehydrogenase (p <0.0001), troponin T (p = 0.001) and D-dimer (p = 0.023) were significantly higher. CIRS correlated with PESI (rho = 0.54, p <0.0001), and was higher in non-survivors (p = 0.002). The age- and sex-adjusted odds ratio of 1-month mortality was 1.91 (95%CI:1.24-2.95) for every 1-point increase in CIRS. The AUC was 0.78 (95%CI:0.67-0.89) for the logistic model containing CIRS, and 0.88 (95%CI:0.79-0.96) for that containing PESI (p = 0.059). Conclusions In elderly patients with PE, CIRS demonstrated a fairly good performance in predicting short-term mortality. Its easiness and suitability for use in common clinical practice make CIRS a potentially useful prognostic score for short-term mortality in these patients.

AB - Background Pulmonary embolism (PE) is associated with high short-term mortality in elderly patients, even when hemodynamically stable. Methods One hundred and seventy hemodynamically stable patients with confirmed PE (41 <65 years and 129 ≥ 65 years) were prospectively followed for one month in order to assess whether comorbidities can predict short-term mortality in elderly patients. Upon admission, patients' clinical characteristics (including instrumental and laboratory parameters) were evaluated, and two clinical scores were calculated: the Cumulative Illness Rating Scale (CIRS), commonly used to evaluate comorbidities in elderly patients, and the Pulmonary Embolism Severity Index (PESI). Results Fifteen patients (all elderly) died within one month from their PE diagnosis (mortality rate = 8.8%; 95%CI:4.6-13.1%). In these non survivors, arterial partial oxygen pressure (p <0.0001) and saturation (p <0.0001), pH (p = 0.001) and systolic blood pressure (p = 0.017) at admission were significantly lower than in survivors, whereas their respiratory rate (p <0.0001), white blood cells (p <0.0001), lactate dehydrogenase (p <0.0001), troponin T (p = 0.001) and D-dimer (p = 0.023) were significantly higher. CIRS correlated with PESI (rho = 0.54, p <0.0001), and was higher in non-survivors (p = 0.002). The age- and sex-adjusted odds ratio of 1-month mortality was 1.91 (95%CI:1.24-2.95) for every 1-point increase in CIRS. The AUC was 0.78 (95%CI:0.67-0.89) for the logistic model containing CIRS, and 0.88 (95%CI:0.79-0.96) for that containing PESI (p = 0.059). Conclusions In elderly patients with PE, CIRS demonstrated a fairly good performance in predicting short-term mortality. Its easiness and suitability for use in common clinical practice make CIRS a potentially useful prognostic score for short-term mortality in these patients.

KW - Age groups

KW - Clinical probability

KW - Pulmonary embolism

KW - Spiral computed tomography

KW - Thromboembolism

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