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Cardiology · Pulmonology · Emergency Medicine · ICU and Critical Care

Composite Pulmonary Embolism Shock (CPES) Score calculator

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0

Low score (0 to 2)

Band: Low score (0 to 2)

Interpretation. Low score (0 to 2)

Suggested management. In the outcome study, a score below 3 had in-hospital death, resuscitated cardiac arrest or hemodynamic decompensation in 2.4%. In the derivation registry no patient with a score of 0 had normotensive shock.

Composite Pulmonary Embolism Shock (CPES) Score: 0 — Low score (0 to 2). Interpretation: Low score (0 to 2) What to do: In the outcome study, a score below 3 had in-hospital death, resuscitated cardiac arrest or hemodynamic decompensation in 2.4%. In the derivation registry no patient with a score of 0 had normotensive shock. Inputs: Elevated troponin: false; Elevated B-type natriuretic peptide: false; Moderately or severely reduced right ventricular function: false; Saddle pulmonary embolism: false; Concomitant deep vein thrombosis: false; Heart rate 100 beats/min or more: false Source: Bangalore S, Horowitz JM, Beam D, Jaber WA, Khandhar S, Toma C, Weinberg MD, Mina B. Prevalence and predictors of cardiogenic shock in intermediate-risk pulmonary embolism: insights from the FLASH registry. JACC Cardiovasc Interv. 2023;16:958-972. DOI: 10.1016/j.jcin.2023.02.004. PMID: 37100559. Statistical analysis and Table 1 footnote d: the composite shock score is elevated troponin, elevated B-type natriuretic peptide, moderately or severely reduced right ventricular function, saddle pulmonary embolism, concomitant deep vein thrombosis, and tachycardia of 100 beats/min or more, with 1 point for each positive component, all weighted equally, maximum 6. Normotensive shock (cardiac index 2.2 L/min/m2 or less) was 0% at a score of 0 and 58.3% at a score of 6; a score of 6 was a significant predictor of normotensive shock (odds ratio 5.84, 95% CI 2.00-17.04). Outcome cutoff from Zhang RS, Yuriditsky E, et al. Composite Pulmonary Embolism Shock Score and Risk of Adverse Outcomes in Patients With Pulmonary Embolism. Circ Cardiovasc Interv. 2024;17:e014088. DOI: 10.1161/CIRCINTERVENTIONS.124.014088. PMID: 38994599: in acute intermediate-risk embolism, a high score of 3 or more (low score below 3) had in-hospital death, resuscitated cardiac arrest or hemodynamic decompensation in 22% versus 2.4% with a low score (adjusted hazard ratio 6.48). (2023)

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Clinical inputs

  • Elevated troponin
  • Elevated B-type natriuretic peptide
  • Moderately or severely reduced right ventricular function
  • Saddle pulmonary embolism
  • Concomitant deep vein thrombosis
  • Heart rate 100 beats/min or more

Primary source

Bangalore S, Horowitz JM, Beam D, Jaber WA, Khandhar S, Toma C, Weinberg MD, Mina B. Prevalence and predictors of cardiogenic shock in intermediate-risk pulmonary embolism: insights from the FLASH registry. JACC Cardiovasc Interv. 2023;16:958-972. DOI: 10.1016/j.jcin.2023.02.004. PMID: 37100559. Statistical analysis and Table 1 footnote d: the composite shock score is elevated troponin, elevated B-type natriuretic peptide, moderately or severely reduced right ventricular function, saddle pulmonary embolism, concomitant deep vein thrombosis, and tachycardia of 100 beats/min or more, with 1 point for each positive component, all weighted equally, maximum 6. Normotensive shock (cardiac index 2.2 L/min/m2 or less) was 0% at a score of 0 and 58.3% at a score of 6; a score of 6 was a significant predictor of normotensive shock (odds ratio 5.84, 95% CI 2.00-17.04). Outcome cutoff from Zhang RS, Yuriditsky E, et al. Composite Pulmonary Embolism Shock Score and Risk of Adverse Outcomes in Patients With Pulmonary Embolism. Circ Cardiovasc Interv. 2024;17:e014088. DOI: 10.1161/CIRCINTERVENTIONS.124.014088. PMID: 38994599: in acute intermediate-risk embolism, a high score of 3 or more (low score below 3) had in-hospital death, resuscitated cardiac arrest or hemodynamic decompensation in 22% versus 2.4% with a low score (adjusted hazard ratio 6.48). (2023)

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