Prospective comparison of clinical prognostic scores in elder patients with a pulmonary embolism
type: Article
item type: journalArticle
is part of: J Thromb Haemost
authors: Person
  surname: Zwierzina
  given name: D.
authors: Person
  surname: Limacher
  given name: A.
authors: Person
  surname: Mean
  given name: M.
authors: Person
  surname: Righini
  given name: M.
authors: Person
  surname: Jaeger
  given name: K.
authors: Person
  surname: Beer
  given name: H. J.
authors: Person
  surname: Frauchiger
  given name: B.
authors: Person
  surname: Osterwalder
  given name: J.
authors: Person
  surname: Kucher
  given name: N.
authors: Person
  surname: Matter
  given name: C. M.
authors: Person
  surname: Banyai
  given name: M.
authors: Person
  surname: Angelillo-Scherrer
  given name: A.
authors: Person
  surname: Lammle
  given name: B.
authors: Person
  surname: Egloff
  given name: M.
authors: Person
  surname: Aschwanden
  given name: M.
authors: Person
  surname: Mazzolai
  given name: L.
authors: Person
  surname: Hugli
  given name: O.
authors: Person
  surname: Husmann
  given name: M.
authors: Person
  surname: Bounameaux
  given name: H.
authors: Person
  surname: Cornuz
  given name: J.
authors: Person
  surname: Rodondi
  given name: N.
authors: Person
  surname: Aujesky
  given name: D.
subject: Aged
subject: Aged, 80 and over
subject: Algorithms
subject: Cohort Studies
subject: Female
subject: Hemodynamics
subject: Humans
subject: Male
subject: Predictive Value of Tests
subject: Prognosis
subject: Prospective Studies
subject: Pulmonary Embolism/*diagnosis/*mortality/pathology
subject: ROC Curve
subject: Risk
subject: Severity of Illness Index
subject: Switzerland
subject: Treatment Outcome
subject: elderly patients
subject: prognostic scores
subject: pulmonary embolism
abstract: 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.
date: 2012-09-19
pages: 2270-6
coverage: 22985129

J Thromb Haemost
type: Journal
volume: 10
number: 11
identifier: DOI 10.1111/j.1538-7836.2012.04929.x
identifier: ISSN 1538-7836 (Electronic) 1538-7836 (Linking)