# Prediction of mortality in patients with secondary pulmonary embolism based on primary admission indication: A short communication

## TL;DR

This study compares different scores to predict mortality in ICU patients who develop secondary pulmonary embolism, finding that APACHE-IV performs best overall.

## Contribution

The study evaluates the performance of PE-specific scores and APACHE-IV in predicting mortality for ICU patients with secondary PE.

## Key findings

- APACHE-IV outperformed PESI and ICU-sPESI in predicting in-hospital mortality for ICU patients with secondary PE.
- sPESI showed poor predictive performance across all ICU admission categories.
- Mortality prediction was consistently weak for patients admitted due to infections, regardless of the score used.

## Abstract

Secondary pulmonary embolism (PE) may significantly complicate the clinical course of intensive care unit (ICU) patients, creating the need for reliable stratification of severity and mortality risk in these patients. We evaluated the prediction of mortality in patients admitted to the ICU who subsequently developed a PE (i.e., secondary PE) using three PE-specific scores, the Pulmonary Embolism Severity Index (PESI), simplified PESI (sPESI), and modified sPESI (ICU-sPESI) and compared them to the gold standard for the assessment of ICU all-cause mortality, the Acute Physiology and Chronic Health Evaluation-IV (APACHE-IV). All critical care admission indications were grouped into four major categories: post-operative, cardiovascular, infectious (sepsis), and other. The APACHE-IV displayed better discriminative ability to predict in-hospital mortality than the PESI and ICU-sPESI, but these two scores still performed fair for the ICU admissions related to postoperative, cardiovascular, and other admission types. Meanwhile, the sPESI displayed poor predictive performance across all four admission categories. Notably, discriminatory performance for patients with an infection-related admission was consistently low regardless of which score was used.