Prospective comparison of clinical prognostic scores in elder patients with a pulmonary embolism
Article first published online: 30 OCT 2012
© 2012 International Society on Thrombosis and Haemostasis
Journal of Thrombosis and Haemostasis
Volume 10, Issue 11, pages 2270–2276, November 2012
How to Cite
ZWIERZINA, D., LIMACHER, A., MÉAN, M., RIGHINI, M., JAEGER, K., BEER, H.-J., FRAUCHIGER, B., OSTERWALDER, J., KUCHER, N., MATTER, C. M., BANYAI, M., ANGELILLO-SCHERRER, A., LÄMMLE, B., EGLOFF, M., ASCHWANDEN, M., MAZZOLAI, L., HUGLI, O., HUSMANN, M., BOUNAMEAUX, H., CORNUZ, J., RODONDI, N. and AUJESKY, D. (2012), Prospective comparison of clinical prognostic scores in elder patients with a pulmonary embolism. Journal of Thrombosis and Haemostasis, 10: 2270–2276. doi: 10.1111/j.1538-7836.2012.04929.x
- Issue published online: 30 OCT 2012
- Article first published online: 30 OCT 2012
- Accepted manuscript online: 17 SEP 2012 10:29AM EST
- Received: 27 July 2012, accepted: 10 September 2012
- 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]) (P < 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 (P = 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.