Predictive ability of the REMS and HOTEL scoring systems for mortality in geriatric patients with pulmonary embolism.

Abuzer Özkan, Serdar Özdemir
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Abstract

Background: Pulmonary embolism (PE) is an important cause of mortality and morbidity in the geriatric population. We aimed to compare the ability of the pulmonary embolism severity index (PESI), rapid emergency medicine score (REMS), and hypotension, oxygen saturation, low temperature, electrocardiogram change, and loss of independence (HOTEL) to predict prognosis and intensive care requirement in geriatric patient with PE.

Results: The median age of 132 patients was 77 (71-82) years. PESI was higher in the non-survivor group [132 (113-172)] (P =0.001). The median REMS was 8 (7-10), and it was higher in the non-survivor group [10 (7.5-12.0)] (p = 0.005). The median HOTEL score was 1 (0-2) in the whole cohort and 2 (1-3) in the non-survivor group, indicating significant difference compared to the survivor group (P = 0.001). The area under the curve (AUC) values of HOTEL, REMS, and PESI were determined as 0.72, 0.65, and 0.71, respectively. For the prediction of intensive care requirement, the AUC values of HOTEL, REMS, and PESI were 0.76, 0.75, and 0.76, respectively, with no significant difference in pairwise comparisons (PESI vs. REMS: p = 0.520, HOTEL vs. PESI: P = 0.526, REMS vs. HOTEL: P = 0.669, overall test: P = 0.96, DeLong's test). The risk ratios of HOTEL and PESI were parallel to each other [5.31 (95% confidence interval (CI): 2.53-11.13) and 5.34 (95% CI: 2.36-12.08), respectively].

Conclusion: HOTEL and REMS were as successful as PESI in predicting short-term mortality and intensive care requirement in geriatric patients with PE. These scores are also more practical since they have fewer parameters than PESI.

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REMS 和 HOTEL 评分系统对老年肺栓塞患者死亡率的预测能力。
背景:肺栓塞(PE)是导致老年人死亡和发病的重要原因。我们旨在比较肺栓塞严重程度指数(PESI)、快速急救医学评分(REMS)以及低血压、血氧饱和度、低体温、心电图变化和丧失独立性(HOTEL)预测老年肺栓塞患者预后和重症监护需求的能力:132名患者的中位年龄为77(71-82)岁。非幸存者组的PESI更高[132(113-172)](P =0.001)。REMS 中位数为 8(7-10),非幸存者组更高[10(7.5-12.0)](P = 0.005)。整个组群的 HOTEL 评分中位数为 1(0-2),非幸存者组为 2(1-3),与幸存者组相比差异显著(P = 0.001)。HOTEL、REMS和PESI的曲线下面积(AUC)值分别为0.72、0.65和0.71。在预测重症监护需求方面,HOTEL、REMS 和 PESI 的 AUC 值分别为 0.76、0.75 和 0.76,在配对比较中无显著差异(PESI vs. REMS:P = 0.520,HOTEL vs. PESI:P = 0.526,REMS vs. HOTEL:P = 0.669,总体检验:P = 0.96,DeLeLeLeLeLeLeLeLeLeLeLeL):P = 0.96,DeLong 检验)。HOTEL和PESI的风险比[分别为5.31(95%置信区间(CI):2.53-11.13)和5.34(95%置信区间(CI):2.36-12.08)]:在预测老年 PE 患者的短期死亡率和重症监护需求方面,HOTEL 和 REMS 与 PESI 一样成功。这些评分也更实用,因为它们的参数比 PESI 少。
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