Central clot score at computed tomography as a predictor of 30-day mortality after acute pulmonary embolism

Sudhakar K Venkatesh, Shih Chang Wang

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Abstract

Introduction: The severity of acute pulmonary embolism can be assessed with computed tomography (CT) using clot burden estimation. We compared the existing CT obstruction scores with an in-house developed central clot score for the prediction of 30-day pulmonary embolism (PE)-related mortality. Materials and Methods: In 125 consecutive patients [47 men, 78 women; mean age ± standard deviation (SD, 60.4 years ± 16.6] with acute PE, 2 readers in consensus assessed the severity of PE with 2 existing clot scoring systems (Mastora and Qanadli) and central clot score. The right ventricular dysfunction was assessed by right ventricular diameter (RVD), left ventricular diameter (LVD), ventricular ratio (VR) and septal deviation. Univariate and multivariate regression analysis were performed to correlate these parameters and 30-day PE-related mortality. Results: Ten patients (8%) died of PE within 30 days following CT and 115 patients did not have PE-related death outcome. There was a significant difference in all 3 clot scores, LVD and VR between patients with 30-day PE-related death and those without (P =0.001-0.02). Univariate regression analysis showed that all three clot scores and LVD were predictors of PE death, however with multivariate analysis, only central clot score showed significant correlation with 30-day PE death [Odds ratio (OR), 1.1; 96% CI, 1-1.16; P <0.003]. A central clot index of 53% had 100% sensitivity, 76.5% specificity, 23.5% positive predictive value and 98% negative predictive value for 30-day PE death. Conclusion: Central clot score is a strong predictor of 30-day PE death and may therefore allow therapy and risk stratification in patients with acute PE.

Original languageEnglish (US)
Pages (from-to)442-447
Number of pages6
JournalAnnals of the Academy of Medicine Singapore
Volume39
Issue number6
StatePublished - 2010
Externally publishedYes

Fingerprint

Pulmonary Embolism
Tomography
Mortality
Multivariate Analysis
Regression Analysis
Right Ventricular Dysfunction
Odds Ratio

Keywords

  • Clot burden
  • Pulmonary embolism
  • Severity
  • Short-term outcome
  • Thromboembolism

ASJC Scopus subject areas

  • Medicine(all)

Cite this

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title = "Central clot score at computed tomography as a predictor of 30-day mortality after acute pulmonary embolism",
abstract = "Introduction: The severity of acute pulmonary embolism can be assessed with computed tomography (CT) using clot burden estimation. We compared the existing CT obstruction scores with an in-house developed central clot score for the prediction of 30-day pulmonary embolism (PE)-related mortality. Materials and Methods: In 125 consecutive patients [47 men, 78 women; mean age ± standard deviation (SD, 60.4 years ± 16.6] with acute PE, 2 readers in consensus assessed the severity of PE with 2 existing clot scoring systems (Mastora and Qanadli) and central clot score. The right ventricular dysfunction was assessed by right ventricular diameter (RVD), left ventricular diameter (LVD), ventricular ratio (VR) and septal deviation. Univariate and multivariate regression analysis were performed to correlate these parameters and 30-day PE-related mortality. Results: Ten patients (8{\%}) died of PE within 30 days following CT and 115 patients did not have PE-related death outcome. There was a significant difference in all 3 clot scores, LVD and VR between patients with 30-day PE-related death and those without (P =0.001-0.02). Univariate regression analysis showed that all three clot scores and LVD were predictors of PE death, however with multivariate analysis, only central clot score showed significant correlation with 30-day PE death [Odds ratio (OR), 1.1; 96{\%} CI, 1-1.16; P <0.003]. A central clot index of 53{\%} had 100{\%} sensitivity, 76.5{\%} specificity, 23.5{\%} positive predictive value and 98{\%} negative predictive value for 30-day PE death. Conclusion: Central clot score is a strong predictor of 30-day PE death and may therefore allow therapy and risk stratification in patients with acute PE.",
keywords = "Clot burden, Pulmonary embolism, Severity, Short-term outcome, Thromboembolism",
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T1 - Central clot score at computed tomography as a predictor of 30-day mortality after acute pulmonary embolism

AU - Venkatesh, Sudhakar K

AU - Wang, Shih Chang

PY - 2010

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N2 - Introduction: The severity of acute pulmonary embolism can be assessed with computed tomography (CT) using clot burden estimation. We compared the existing CT obstruction scores with an in-house developed central clot score for the prediction of 30-day pulmonary embolism (PE)-related mortality. Materials and Methods: In 125 consecutive patients [47 men, 78 women; mean age ± standard deviation (SD, 60.4 years ± 16.6] with acute PE, 2 readers in consensus assessed the severity of PE with 2 existing clot scoring systems (Mastora and Qanadli) and central clot score. The right ventricular dysfunction was assessed by right ventricular diameter (RVD), left ventricular diameter (LVD), ventricular ratio (VR) and septal deviation. Univariate and multivariate regression analysis were performed to correlate these parameters and 30-day PE-related mortality. Results: Ten patients (8%) died of PE within 30 days following CT and 115 patients did not have PE-related death outcome. There was a significant difference in all 3 clot scores, LVD and VR between patients with 30-day PE-related death and those without (P =0.001-0.02). Univariate regression analysis showed that all three clot scores and LVD were predictors of PE death, however with multivariate analysis, only central clot score showed significant correlation with 30-day PE death [Odds ratio (OR), 1.1; 96% CI, 1-1.16; P <0.003]. A central clot index of 53% had 100% sensitivity, 76.5% specificity, 23.5% positive predictive value and 98% negative predictive value for 30-day PE death. Conclusion: Central clot score is a strong predictor of 30-day PE death and may therefore allow therapy and risk stratification in patients with acute PE.

AB - Introduction: The severity of acute pulmonary embolism can be assessed with computed tomography (CT) using clot burden estimation. We compared the existing CT obstruction scores with an in-house developed central clot score for the prediction of 30-day pulmonary embolism (PE)-related mortality. Materials and Methods: In 125 consecutive patients [47 men, 78 women; mean age ± standard deviation (SD, 60.4 years ± 16.6] with acute PE, 2 readers in consensus assessed the severity of PE with 2 existing clot scoring systems (Mastora and Qanadli) and central clot score. The right ventricular dysfunction was assessed by right ventricular diameter (RVD), left ventricular diameter (LVD), ventricular ratio (VR) and septal deviation. Univariate and multivariate regression analysis were performed to correlate these parameters and 30-day PE-related mortality. Results: Ten patients (8%) died of PE within 30 days following CT and 115 patients did not have PE-related death outcome. There was a significant difference in all 3 clot scores, LVD and VR between patients with 30-day PE-related death and those without (P =0.001-0.02). Univariate regression analysis showed that all three clot scores and LVD were predictors of PE death, however with multivariate analysis, only central clot score showed significant correlation with 30-day PE death [Odds ratio (OR), 1.1; 96% CI, 1-1.16; P <0.003]. A central clot index of 53% had 100% sensitivity, 76.5% specificity, 23.5% positive predictive value and 98% negative predictive value for 30-day PE death. Conclusion: Central clot score is a strong predictor of 30-day PE death and may therefore allow therapy and risk stratification in patients with acute PE.

KW - Clot burden

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KW - Severity

KW - Short-term outcome

KW - Thromboembolism

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