Publication

Prospective comparison of clinical prognostic scores in elderly patients with pulmonary embolism

Journal Paper/Review - Sep 17, 2012

Units
PubMed
Doi

Citation
Zwierzina D, Lämmle B, Egloff M, Aschwanden M, Mazzolai L, Hugli O, Husmann M, Bounameaux H, Cornuz J, Rodondi N, Angelillo-Scherrer A, Banyai M, Limacher A, Méan M, Righini M, Jaeger K, Beer H, Frauchiger B, Osterwalder J, Kucher N, Matter C, Aujesky D. Prospective comparison of clinical prognostic scores in elderly patients with pulmonary embolism. J Thromb Haemost 2012
Type
Journal Paper/Review (English)
Journal
J Thromb Haemost 2012
Publication Date
Sep 17, 2012
Issn Electronic
1538-7836
Brief description/objective

Background: The Geneva Prognostic Score (GPS), the Pulmonary Embolism Severity Index (PESI), and its simplified version (sPESI) are well known clinical prognostic scores for pulmonary embolism (PE).Objectives: To compare the prognostic performance of these scores in elderly patients with PE. Patients/Methods: In a multicenter Swiss cohort of elderly patients with venous thromboembolism, we prospectively studied 449 patients aged ≥65 years with 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 to 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. © 2012 International Society on Thrombosis and Haemostasis.