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.

COMMENT

The HOPPE risk score identified the one third of PE patients with 1% to 2% risk of 30-day mortality — a valuable tool that could aide in early discharge from the hospital or ED. Compared with the currently used pulmonary embolism severity index (PESI; Am J Respir Crit Care Med 2005; 172:1041), HOPPE has better sensitivity and diagnostic discrimination; however, PESI was validated in >15,000 patients in 186 hospitals, whereas HOPPE has been validated in fewer than 500 patients in a single institution. If HOPPE is validated at multiple locations, it could serve as a new prognostic tool to supplement clinical decision making in low-risk patients.