title: Prospective comparison of clinical prognostic scores in elder patients with a 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).
  
  
  OBJECTIVE
  To compare the prognostic performance of these scores in elderly patients with a PE.
  
  
  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.
authors.affiliation: Division of General Internal Medicine, Bern University Hospital, Bern Clinical Trials Unit Bern, Department of Clinical Research, University of Bern, Bern Division of Angiology and Hemostasis, Geneva University Hospital, Geneva Department of Angiology, Basel University Hospital, Basel Cantonal Hospital of Baden, Baden Department of Internal Medicine, Cantonal Hospital of Frauenfeld, Frauenfeld Emergency Department, Cantonal Hospital of St. Gallen, St. Gallen Division of Angiology, Bern University Hospital, Bern Cardiovascular Research, Institute of Physiology, Zurich Center for Integrative Human Physiology, University of Zurich, Zurich Division of Angiology, Cantonal Hospital of Lucerne, Lucerne Service and Central Laboratory of Hematology, Lausanne University Hospital, Lausanne Division of Haematology and Central Haematology Laboratory, Bern University Hospital, Bern Division of Angiology, Lausanne University Hospital, Lausanne Emergency Department, Lausanne University Hospital, Lausanne Division of Angiology, Zurich University Hospital, Zurich Department of Ambulatory Care and Community Medicine, University of Lausanne, Lausanne, Switzerland.
authors.forename: D
authors.initials: D
authors.lastname: Zwierzina
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authors.lastname: Limacher
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authors.initials: M
authors.lastname: Méan
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authors.initials: M
authors.lastname: Righini
authors.forename: K
authors.initials: K
authors.lastname: Jaeger
authors.forename: H-J
authors.initials: HJ
authors.lastname: Beer
authors.forename: B
authors.initials: B
authors.lastname: Frauchiger
authors.forename: J
authors.initials: J
authors.lastname: Osterwalder
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authors.initials: N
authors.lastname: Kucher
authors.forename: C M
authors.initials: CM
authors.lastname: Matter
authors.forename: M
authors.initials: M
authors.lastname: Banyai
authors.forename: A
authors.initials: A
authors.lastname: Angelillo-Scherrer
authors.forename: B
authors.initials: B
authors.lastname: Lämmle
authors.forename: M
authors.initials: M
authors.lastname: Egloff
authors.forename: M
authors.initials: M
authors.lastname: Aschwanden
authors.forename: L
authors.initials: L
authors.lastname: Mazzolai
authors.forename: O
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authors.lastname: Hugli
authors.forename: M
authors.initials: M
authors.lastname: Husmann
authors.forename: H
authors.initials: H
authors.lastname: Bounameaux
authors.forename: J
authors.initials: J
authors.lastname: Cornuz
authors.forename: N
authors.initials: N
authors.lastname: Rodondi
authors.forename: D
authors.initials: D
authors.lastname: Aujesky
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000465:Algorithms; D015331:Cohort Studies; D005260:Female; D006439:Hemodynamics; D006801:Humans; D008297:Male; D011237:Predictive Value of Tests; D011379:Prognosis; D011446:Prospective Studies; D011655:Pulmonary Embolism / Q000175:diagnosis* / Q000401:mortality* / Q000473:pathology; D012372:ROC Curve; D012306:Risk; D012720:Severity of Illness Index; D013557:Switzerland; D016896:Treatment Outcome