• elderly patients;
  • prognostic scores;
  • pulmonary embolism

Summary.  Background:  The Geneva Prognostic Score (GPS), the Pulmonary Embolism Severity Index (PESI) and its simplified version (sPESI) are well-known clinical prognostic scores for a pulmonary embolism (PE).

Objectives:  To compare the prognostic performance of these scores in elderly patients with a PE.

Patients and methods:  In a multicenter Swiss cohort of elderly patients with venous thromboembolism, we prospectively studied 449 patients aged ≥ 65 years with a symptomatic PE. The outcome was 30-day overall mortality. We dichotomized patients as low vs. higher risk in all three scores using the following thresholds: GPS scores ≤ 2 vs. > 2, PESI risk classes I–II vs. III–V and sPESI scores 0 vs. ≥ 1. We compared 30-day mortality in low- vs. higher-risk patients and the areas under the receiver-operating characteristic curve (ROC).

Results:  Overall, 3.8% of patients (17/449) died within 30 days. The GPS classified a greater proportion of patients as low risk (92% [413/449]) than the PESI (36.3% [163/449]) and the sPESI (39.6% [178/449]) (< 0.001 for each comparison). Low-risk patients based on the sPESI had a mortality of 0% (95% confidence interval [CI] 0–2.1%) compared with 0.6% (95% CI 0–3.4%) for low-risk patients based on the PESI and 3.4% (95% CI 1.9–5.6%) for low-risk patients based on the GPS. The areas under the ROC curves were 0.77 (95% CI 0.72–0.81), 0.76 (95% CI 0.72–0.80) and 0.71 (95% CI 0.66–0.75), respectively (= 0.47).

Conclusions:  In this cohort of elderly patients with PE, the GPS identified a higher proportion of patients as low risk but the PESI and sPESI were more accurate in predicting mortality.