PESI Score
Assessment of 30-day severity and mortality in pulmonary embolism.
Understanding the PESI Score in Pulmonary Embolism
The Pulmonary Embolism Severity Index (PESI) is a globally validated clinical tool used to stratify the 30-day mortality risk in patients with objectively diagnosed pulmonary embolism (PE). Unlike diagnostic scores (like the Geneva or Wells score), PESI is used after the diagnosis is confirmed to guide therapeutic management.
Clinical Utility and Therapeutic Guidance
The PESI score calculation is based on 11 simple clinical parameters. It classifies patients into 5 risk levels (Class I to V). Its main asset is to reliably identify very low-risk patients:
- Classes I and II (Low risk): These patients have a very low 30-day mortality (< 3.5%). According to international guidelines (ESC, ACCP), they are ideal candidates for outpatient anticoagulant treatment (at home) and early discharge from the emergency department.
- Class III (Intermediate risk): Require standard hospitalization for monitoring and treatment.
- Classes IV and V (High risk): Associated with severe mortality (up to 25%). These patients often require admission to intensive care, aggressive treatment (thrombolysis), and strict hemodynamic monitoring.
Clinical Warning
The original PESI score includes the patient's exact age in points (1 year = 1 point). Although a simplified version exists (sPESI), the original PESI remains the most validated model for fine stratification. Note: this score does not replace the evaluation of right ventricular dysfunction (via echocardiography or biomarkers like BNP/Troponin) which remains essential in intermediate to high-risk forms.
Interpretation of Risk Classes
| Total Score | Class | 30-day Mortality |
|---|---|---|
| ≤ 65 pts | Class I (Very low) | 0 - 1.6 % |
| 66 - 85 pts | Class II (Low) | 1.7 - 3.5 % |
| 86 - 105 pts | Class III (Intermediate) | 3.2 - 7.1 % |
| 106 - 125 pts | Class IV (High) | 4.0 - 11.4 % |
| > 125 pts | Class V (Very high) | 10.0 - 24.5 % |
References:
1. Aujesky D, et al. Derivation and validation of a prognostic model for pulmonary embolism. Am J Respir Crit Care Med. 2005.
[ATS Journals]
2. Konstantinides SV, et al. 2019 ESC Guidelines for the diagnosis and management of acute pulmonary embolism developed in collaboration with the ERS. Eur Heart J. 2020.
[ESC Guidelines]
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