Wells Score and Poor Outcomes Among Adult Patients With Subsegmental Pulmonary Embolism: A Cohort Study.

ANGRIMAN F; FERREYRO BL; MARIA LOURDES POSADAS MARTINEZ; DIEGO GIUNTA; FERNANDO VAZQUEZ; WILLIAM M. VOLLMER

CLINICAL APPLIED THROMB/HEMOST.

SAGE PUBLICATIONS INC

Lugar: Thousand Oaks, California.; Año: 2015

1076-0296

Clin Appl Thromb Hemost. 2015 Sep;21(6):539-45. doi: 10.1177/1076029614559772. Epub 2014 Nov 25.Wells Score and Poor Outcomes Among Adult Patients With Subsegmental Pulmonary Embolism: A Cohort Study.Angriman F1, Ferreyro BL2, Posadas-Martinez ML3, Giunta D3, Vazquez FJ4, Vollmer WM5.Author information1Internal Medicine Department, Hospital Italiano de Buenos Aires, Buenos Aires University, Buenos Aires, Argentina federico.angriman@hospitalitaliano.org.ar.2Internal Medicine Department, Hospital Italiano de Buenos Aires, Buenos Aires University, Buenos Aires, Argentina.3Internal Medicine Research Unit, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina.4Internal Medicine Department, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina.5Kaiser Permanente Center for Health Research, Portland, OR, USA.AbstractINTRODUCTION:Since the introduction of computed tomography pulmonary angiography, isolated subsegmental pulmonary embolism has become a commonly recognized clinical problem, but its clinical relevance remains unclear. The objective of the present study was to evaluate the extent to which the simplified Wells score discriminates between patients with varying levels of risk of complications after presenting with subsegmental pulmonary embolism.MATERIALS AND METHODS:Retrospective cohort study. Patients included had subsegmental pulmonary embolism (1 or multiple emboli limited to subsegmental arteries). Primary explanatory variable was the simplified Wells score, categorized as high (>4) or low (≤4). The primary outcome was time to death or new venous thromboembolism. Kaplan-Meier techniques and Cox regression analysis were used to compare the survival experience of patients with high versus low Wells score with and without adjustment for active malignancy, age, Charlson score, previous venous thromboembolism, and previous major surgery in the last 30 days.MAIN RESULTS:Seventy-nine patients with subsegmental pulmonary embolism were included. Patients with a high Wells score had a 4-fold increased risk of the composite outcome (hazard ratio = 4.2, 95% confidence interval [CI] = 2.0-8.9, P < .001). Other covariates significantly associated with increased risk in univariate analyses included active malignancy, a low serum albumin, and an increased Charlson score. In multivariate Cox regression analyses adjusting for these other factors, a high Wells score remained significant (hazard ratio 5.5, 95% CI 2.4-12.6, P < .001).CONCLUSION:High Wells score is associated with death or new venous thromboembolism during follow-up among patients with subsegmental pulmonary embolism.CLINICAL TRIAL REGISTRATION:ClinicalTrials.gov number, NCT01372514.