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Prospective comparison of clinical prognostic scores in elder patients with a pulmonary embolism
Author(s) -
ZWIERZINA D.,
LIMACHER A.,
MÉAN M.,
RIGHINI M.,
JAEGER K.,
BEER H.J.,
FRAUCHIGER B.,
OSTERWALDER J.,
KUCHER N.,
MATTER C. M.,
BANYAI M.,
ANGELILLOSCHERRER A.,
LÄMMLE B.,
EGLOFF M.,
ASCHWANDEN M.,
MAZZOLAI L.,
HUGLI O.,
HUSMANN M.,
BOUNAMEAUX H.,
CORNUZ J.,
RODONDI N.,
AUJESKY D.
Publication year - 2012
Publication title -
journal of thrombosis and haemostasis
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.947
H-Index - 178
eISSN - 1538-7836
pISSN - 1538-7933
DOI - 10.1111/j.1538-7836.2012.04929.x
Subject(s) - medicine , pulmonary embolism , confidence interval , receiver operating characteristic , prospective cohort study , cohort study , area under the curve
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.