# Development of the Pulmonary Embolism Progression (PEP) score for predicting short-term clinical deterioration in intermediate-risk pulmonary embolism: a single-center retrospective study

## TL;DR

This study developed the PEP score to predict which intermediate-risk pulmonary embolism patients will worsen within 72 hours, using clinical, lab, and imaging data.

## Contribution

The PEP score is a novel risk stratification tool for predicting short-term deterioration in intermediate-risk pulmonary embolism patients.

## Key findings

- The PEP score includes five variables: oxygen use, lactate, hs-cTnT, TAPSE, and clot distribution.
- A PEP score of 4 points achieved 93% sensitivity and 65% specificity for predicting clinical deterioration.
- The score showed strong predictive accuracy with AUROC of 0.8671 in derivation and 0.9264 in validation cohorts.

## Abstract

Accurate risk stratification in acute intermediate-risk pulmonary embolism (PE) is essential. Current prediction scores lack the ability to forecast impending clinical decline. The Pulmonary Embolism Progression (PEP) score aims to predict short-term clinical deterioration (respiratory failure or hemodynamic instability within 72 h) in patients with intermediate-risk PE. This single-center retrospective cohort study analyzed patients with intermediate PE. The outcome of interest was respiratory failure or hemodynamic instability within 72 h. A multivariate logistic regression identified five predictive variables for the final PEP score: use of > 4 L/min of supplemental oxygen above baseline, lactate > 2.0 mmol/L, high-sensitivity cardiac troponin T (hs-cTnT) > 40 ng/L, tricuspid annular plane systolic excursion (TAPSE) < 13 mm, and the combination of central and subsegmental clot. The derivation cohort included 117 patients, and the validation cohort included 70 patients. The area under the receiver operating characteristic (AUROC) curve for the derivation cohort was 0.8671 (95% CI: 0.7946, 0.9292), and for the validation cohort, it was 0.9264 (95% CI: 0.8680, 0.9847). A PEP score of 4 points yielded the highest combination of sensitivity (93%) and specificity (65%). Each incremental point increase in the PEP score raised the probability of clinical deterioration by a factor of 1.933. The PEP score is a reliable tool for predicting the likelihood of clinical deterioration in intermediate-risk PE patients within 72 h, potentially aiding in timely clinical decision-making and improving patient outcomes.

The online version contains supplementary material available at 10.1007/s11239-024-03051-5.

Study question: To develop and validate a risk score to determine clinical deterioration of intermediate-risk pulmonary embolism patients.

Results: Using multivariate regression, we identified 5 variables that reliably predict clinical deterioration in patients with intermediate-risk PE.

Interpretation: The PEP score incorporates clinical, laboratory, and radiographic variables to predict which intermediate-risk PE patients will clinically deteriorate within 72 h of diagnosis of pulmonary embolism.

The online version contains supplementary material available at 10.1007/s11239-024-03051-5.