#Pulmonary_Embolism_6 #PE Risk stratification of PE #_ESC | "لعلي أفيدك" Clinical discussion

#Pulmonary_Embolism_6 #PE
Risk stratification of PE #_ESC

بعد ما وصلنا لل PE Diagnosis , ال management تبعنا هيعتمد على تقييم لل PE Prognosis هل هو High mortality Risk ولا Intermediate ولا Low risk

كيف بنحدد ال Prognosis Risk ??
باستخدام حاجتين :
PESI Score

other parameter ( RV dysfunction ,Elevated cardiac troponin levels.. )


ال PESI Score (مرفق بالصور )
في منه Original Version من عدد النقاط بنقسم المريض ل :

Very low Risk , Class I: ≤65 points

Low Mortality Risk , Class II: 66-85 point

Class III: 86-105 points , Moderate Risk

Class IV: 106-125 points ,high mortality risk

Class V: >125 points very high mortality risk

وفي من ال PESI Score نسخة مبسطة Simplified Version
0 point Low risk
>=1 point risk is 10.9%

بعد ما نحسب للمريض ال PESI Score بنشوف Parameter تانيه
زي ال RV Dysfunctiona بال Echo وال Troponin level


هنقسم ال pt ل 4 category بناء على ال Risk stratification :

High Risk mortality :
أي مريض PE وجاي ب Hemodynamic Unstable يعتبر High Risk من البداية
وهيكون عنده التلات نقاط التالية Positive :

Clinical parameters of PE severity and/ or comorbidity: PESI class III-V or sPESI >=1
+
Elevated cardiac troponin levels
+
RV dysfunction on TTE or CTPA

Intermediate- High Risk
لو كان Hemo stable والنقاط التالته اللي فوق كلها Positive

Intermediate - Low risk
يكون المريض Hemo stable وال
PISA Score class III-V or sPESI >=1
وعنده إما RV dysfunction او Elevated Troponin ( وليس كلاهما)
او معندوش RV dysfunction ولا Elevated Troponin

Low Risk pt :
هيكون Hemo stable ومعندوش RV dysfunction
ولا عنده Elevated troponin
وال sPESA Score يساوي صفر
او ال PESA Original version كانت calss 1or2

To summarize :

•At the stage of clinical suspicion of PE, haemodynamically unstable patients with shock or hypotension should immediately be identified as high-risk patients.

• Normotensive patients in Pulmonary Embolism Severity Index (PESI) Class Ill or a simplified (s)PESI of >=1 constitute an intermediate-risk group.
Of these, patients who have both evidence of RV dysfunction (by echocardiography or CT angiography) and elevated cardiac biomarker levels in the circulation should be classified into an intermediate-high-risk category and monitored for early detection of haemodynamic decompensation.

A PESI Class I or II, or a SPESI of O, indicates a low risk of an early adverse outcome.
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