SUMMARY AND COMMENT | GENERAL MEDICINE, EMERGENCY MEDICINE, HOSPITAL MEDICINE
September 14, 2017

Prognosis Wars: A New HOPPE to Identify Low-Risk Pulmonary Embolism
Mikhail Akbashev, MD and Daniel D. Dressler, MD, MSc, SFHM, FACP reviewing Subramanian M et al. Am J Cardiol 2017 Aug 15.

The HOPPE score is an alternate prognostic measure to the pulmonary embolism severity index for identifying low-risk PE.

A subset of patients with acute pulmonary embolism (PE), are at low risk for short-term complications and can be discharged safely from the hospital or emergency department (ED). To determine how to identify such patients, investigators retrospectively studied a cohort of 400 consecutive patients with radiographically confirmed pulmonary embolism at a single tertiary care center in India.

Multivariate analysis identified five independent predictors of 30-day mortality:

Heart rate

PaO2 (arterial partial pressure of oxygen)

Systolic blood pressure

Diastolic blood pressure

Electrocardiographic score

The HOPPE score stratified patients into low-risk (0% risk for PE-related 30-day mortality), intermediate-risk (8%), and high-risk (19%) groups, each comprising approximately one third of PE patients. Among patients who died within 30 days of PE diagnoses, fewer than 2% had low HOPPE scores, although right ventricular dysfunction occurred in 20% of patients in the low-risk group.