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This study received funding: SEPAR (1/2016) grupo GeCIR. We express our gratitude to Sanofi Spain for supporting this Registry with an unrestricted educational grant. We also wish to thank Bayer Pharma AG for supporting this Registry. Bayer Pharma AG's support was limited to the part of RIETE outside Spain, which accounts for a 25.20% of the total patients included in the RIETE Registry. We also thank the RIETE Registry Coordinating Center, S&H Medical Science Service, for their quality control data, logistic and administrative support. We acknowledge the statistical support of Prof. Salvador Ortiz (Universidad Autonoma de Madrid) and Silvia Galindo -who both acted as both Statistical Advisors in the S&H Medical Science Service.

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Comparison of seven prognostic tools to identify low-risk pulmonary embolism in patients aged <50 years

Publicated to:Scientific Reports. 9 (1): - 2019-12-27 9(1), DOI: 10.1038/s41598-019-55213-8

Authors: Jara-Palomares, Luis; Alfonso, Maria; Maestre, Ana; Jimenez, David; Garcia-Bragado, Fernando; Font, Carme; Lopez Reyes, Raquel; Hernandez Blasco, Luis; Vidal, Gemma; Otero, Remedios; Monreal, Manuel; Adarraga, Ma Dolores; Angel Aibar, Miguel; Aibar, Jesus; Amado, Cristina; Ignacio Arcelus, Juan; Ballaz, Aitor; Barba, Raquel; Barron, Manuel; Barron-Andres, Belen; Bascunana, Jose; Blanco-Molina, Angeles; Maria Camon, Ana; Canas, Inmaculada; Carrasco, Cristina; Castro, Joaquin; de Ancos, Cristina; Del Toro, Jorge; Demelo, Pablo; Antonio Diaz-Peromingo, Jose; Diaz-Simon, Raquel; Falga, Conxita; Isabel Farfan, Ana; Fernandez-Capitan, Carmen; Del Carmen Fernandez-Criado, Maria; Fernandez-Nunez, Sandra; Fidalgo, Angeles; Font, Llorenc; Angelina Garcia, Maria; Garcia-Morillo, Marcial; Garcia-Raso, Aranzzu; Gavin-Sebastian, Olga; del Carmen Gayol, Maria; Gil-Diaz, Aida; Gomez, Vicente; Gomez-Cuervo, Covadonga; Gonzalez-Martinez, Jose; Grau, Enric; Gutierrez, Javier; Gutierrez-Gonzalez, Sara; Iglesias, Marina; Jaras, Ma Jesus; Jou, Ines; Dolores Joya, Maria; Lalueza, Antonio; Lima, Jorge; Llamas, Pilar; Luis Lobo, Jose; Lopez-Jimenez, Luciano; Lopez-Miguel, Patricia; Jose Lopez-Nunez, Juan; Bosco Lopez-Saez, Juan; Alejandro Lorente, Manuel; Lorenzo, Alicia; Loring, Monica; Madridano, Olga; Javier Marchena, Pablo; Miguel Martin, Javier; Mellado, Meritxell; del Valle Morales, Ma; Luisa Nieto, Maria; Antonio Nieto, Jose; Jesus Nunez, Manuel; Carmen Olivares, Maria; Maria Pedrajas, Jose; Pellejero, Galadriel; Prez-Rus, Gloria; Peris, Ma Luisa; Antonio Porras, Jose; Rivas, Agustina; Angeles Rodriguez-Davila, Ma; Adela Rodriguez-Hernandez, A.; Rubio, Carmen Ma; Ruiz-Artacho, Pedro; Ruiz-Ruiz, Justo; Ruiz-Sada, Pablo; Carles Sahuquillo, Joan; Salazar, Vladimir; Samperiz, Angel; Sanchez Munoz-Torrero, Juan Francisco; Sancho, Teresa; Soler, Silvia; Maria Surinach, Jose; Tapia, Elena; Tolosa, Caries; Isabel Torres, Maria; Trujillo-Santos, Javier; Uresandi, Fernando; Valle, Reina; Villares, Paula; Gutierrez, Paula; Javier Vazquez, Fernando; Vilaseca, Alicia; Vanassche, Thomas; Vandenbriele, Christophe; Verhamme, Peter; Hirmerova, Jana; Maly, Radovan; Celis, Gregory; del Pozo, Gustavo; Salgado, Estuardo; Benzidia, Ilham; Bertoletti, Laurent; Bura-Riviere, Alessandra; Debourdeau, Philippe; Farge-Bancel, Dominique; Hij, Adrian; Mahe, Isabelle; Moustafa, Fares; Schellong, Sebastian; Braester, Andrei; Brenner, Benjamin; Tzoran, Inna; Sharif-Kashani, Babak; Barillari, Giovanni; Bilora, Franca; Bortoluzzi, Cristiano; Brandolin, Barbara; Bucherini, Eugenio; Ciammaichella, Maurizio; Dentali, Francesco; Di Micco, Pierpaolo; Maida, Rosa; Mastroiacovo, Daniela; Mumoli, Nicola; Pace, Federica; Parisi, Roberto; Pesavento, Raffaelle; Prandoni, Paolo; Quintavalla, Roberto; Rocci, Anna; Romualdi, Roberta; Sinicalchi, Carmine; Tufano, Antonella; Visona, Adriana; Hong, Ngoc Vo; Zalunardo, Beniamino; Gibietis, Valdis; Kigitovica, Dana; Skride, Andris; Bosevski, Marijan; Bounameaux, Henri; Mazzolai, Lucia; Caprini, Joseph A.; Hanh My Bui; Khanh Quoc Pham; Reis, Abilio;RIETE Investigators

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Abstract

In young patients with acute pulmonary embolism (PE), the predictive value of currently available prognostic tools has not been evaluated. Our objective was to compare prognostic value of 7 available tools (GPS, PESI, sPESI, Prognostic Algorithm, PREP, shock index and RIETE) in patients aged <50 years. We used the RIETE database, including PE patients from 2001 to 2017. The major outcome was 30-day all-cause mortality. Of 34,651 patients with acute PE, 5,822 (17%) were aged <50 years. Of these, 83 (1.4%) died during the first 30 days. Number of patients deemed low risk with tools was: PREP (95.9%), GPS (89.6%), PESI (87.2%), Shock index (70.9%), sPESI (59.4%), Prognostic algorithm (58%) and RIETE score (48.6%). The tools with a highest sensitivity were: Prognostic Algorithm (91.6%; 95% CI: 85.6-97.5), RIETE score (90.4%; 95%CI: 84.0-96.7) and sPESI (88%; 95% CI: 81-95). The RIETE, Prognostic Algorithm and sPESI scores obtained the highest overall sensitivity estimates for also predicting 7- and 90-day all-cause mortality, 30-day PE-related mortality, 30-day major bleeding and 30-day VTE recurrences. The proportion of low-risk patients who died within the first 30 days was lowest using the Prognostic Algorithm (0.2%), RIETE (0.3%) or sPESI (0.3%) scores. In PE patients less 50 years, 30-day mortality was low. Although sPESI, RIETE and Prognostic Algorithm scores were the most sensitive tools to identify patients at low risk to die, other tools should be evaluated in this population to obtain more efficient results.

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