PESI scale (Pulmonary Embolism severity index) online calculator

The PESI is designed to risk stratify patients who have been diagnosed with a PE in order to determine the severity of their disease. This can help physicians make decisions on the management of those patients who could potentially be treated as out-patient, as well as raise concern for those who are determined to be high-risk and could benefit from higher levels of care.

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(disorientation, lethargy, stupor, or coma)


0
* Required
Age, years:

Gender:
Male
Female

History of cancer:
Yes
No

History of heart failure:
Yes
No

History of chronic lung disease:
Yes
No

Heart rate ≥110:
Yes
No

Systolic BP <100 mmHg:
Yes
No

Respiratory rate ≥30:
Yes
No

Temperature˂360C/96.80F:
Yes
No

Altered mental status (disorientation, lethargy, stupor, or coma):
Yes
No

О2saturation ˂90%:
Yes
No



Patient’s score Risk classes 30-day mortality
0 0 0

ParametersOriginal scaleSimplified version
Age yearsAge years1 point (if age˃80 years)
Male gender+10 points
History of cancer+30 points1 point
History of heart failure+10 points 1 point
History of chronic lung disease+10 points
Heart rate ≥110+20 points1 point
Systolic BP <100 mmHg+30 points1 point
Respiratory rate ≥30+20 points
Temperature <36°C/96.8°F+20 points
Altered mental status (disorientation, lethargy, stupor, or coma)+60 points
O2 saturation <90%+20 points1 point

Interpretation of results:

Evaluation of the result. If the PESI score is> 85 (risk classes III – V) or the sPESI score is ≥ 1, the risk is considered high and the patient is evaluated for right ventricular function (EchoCG). With an index <85 points, the risk of death is low and PE therapy can be performed on an outpatient basis.

Risk stratificationScores Risk 30-day mortalityRisk 30-day mortality
Class I≤65very low risk0.0-1.6%
Class II66-85low risk1.7-3.5%
Class III86-105intermediate risk3.2-7.1%
Class IV106-125high risk4.0-11.4%
Class V˃125high risk10-24.5%

Classification of patients with acute PE according to the risk of early mortality

Early mortality risk Risk criteria   
  Unstable hemodynamics (shock, hypotension)PESI * class III-IV or simplified PESI≥1 pointSigns of right ventricular dysfunction according to imaging examinationsElevated cardiac troponins
High +(+)+(+)
AverageHigh+++
 Low++/‒+/‒
Low 

One of the criteria for assessing the risk of early mortality due to PE is its class according to the PESI scale, which provides for the assessment of clinical parameters and comorbid conditions that affect the 30-day prognosis.

The Pulmonary Embolism Severity Index (PESI) is a risk stratification tool that has been externally validated to determine the mortality and outcome of patients with newly diagnosed pulmonary embolism (PE).

In the setting of a patient with renal failure or severe comorbidities, clinical judgment should be used over the PESI, as these patients were excluded in the validation study.

The PESI score determines the risk of mortality and severity of complications.

The score does not require laboratory variables.

It is meant to aid in decision-making, not replace it. Clinical judgment should always take precedence.

The PESI score determines clinical severity and can influence treatment settings for the management of PE.

Class I and II patients may possibly be safely treated as outpatients in the right clinical setting.

Resources:

  1. Aujesky D, Obrosky DS, Stone RA, Auble TE, Perrier A, Cornuz J, Roy PM, Fine MJ. Derivation and validation of a prognostic model for pulmonary embolism. Am J Respir Crit Care Med. 2005 Oct 15;172(8):1041-6. doi: 10.1164/rccm.200506-862OC. Epub 2005 Jul 14. PMID: 16020800; PMCID: PMC2718410.
  2. Donzé J, Le Gal G, Fine MJ, Roy PM, Sanchez O, Verschuren F, Cornuz J, Meyer G, Perrier A, Righini M, Aujesky D. Prospective validation of the Pulmonary Embolism Severity Index. A clinical prognostic model for pulmonary embolism. Thromb Haemost. 2008 Nov;100(5):943-8. doi: 10.1160/th08-05-0285. PMID: 18989542.
  3. Aujesky D, Roy PM, Verschuren F, Righini M, Osterwalder J, Egloff M, Renaud B, Verhamme P, Stone RA, Legall C, Sanchez O, Pugh NA, N’gako A, Cornuz J, Hugli O, Beer HJ, Perrier A, Fine MJ, Yealy DM. Outpatient versus inpatient treatment for patients with acute pulmonary embolism: an international, open-label, randomised, non-inferiority trial. Lancet. 2011 Jul 2;378(9785):41-8. doi: 10.1016/S0140-6736(11)60824-6. Epub 2011 Jun 22. PMID: 21703676.
  4. Jiménez D. et al. Simplifi cation of the pulmonary embolism severity index for prognostication in patients with acute symptomatic pulmonary embolism. Arch Intern Med. 2010; 170(15): 1383–1389.
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