title: Validation of two clinical prognostic models in patients with acute symptomatic pulmonary embolism.
abstract: OBJECTIVE
  The aim of this study was to compare the predictive value of two clinical prognostic models, the Spanish score and the simplified Pulmonary Embolism Severity Index (sPESI), in an independent cohort of patients diagnosed of acute symptomatic pulmonary embolism (PE).
  
  
  METHODS
  We performed a retrospective analysis of a cohort composed of 1447patients with acute symptomatic PE. The Spanish score and the sPESI were calculated for each patient according to different clinical variables. We assessed the predictive accuracy of these scores for 30-day mortality, and a composite of non fatal recurrent venous thromboembolism and non fatal major bleeding, using Cstatistic, which was obtained by means of logistic regression and ROC curves.
  
  
  RESULTS
  Overall, 138 patients died (9.5%) during the first month of follow-up. Both scores showed an excellent predictive value for 30-day all-cause mortality (Cstatistic, 0.72 and 0.74), but the performance was poor for the secondary endpoint (Cstatistic, 0.60 and 0.59). The sPESI classified fewer patients as low risk (32% versus 62%; P<.001). Low-risk patients based on the sPESI had a lower 30-day mortality than those based on the Spanish score (1.1% versus 4.2%), while the 30-day rate of non fatal recurrent VTE or major bleeding was similar (2.2% versus 2.3%).
  
  
  CONCLUSIONS
  Both scores provide excellent information to stratify the risk of mortality in patients treated of PE. The usefulness of these models for nonfatal adverse events is questionable. The sPESI identified low-risk patients with PE better than the Spanish score.
authors.affiliation: Servicio de Neumología, Hospital Virgen del Rocío-IBIS, CIBERES, Sevilla, España.
authors.forename: Marta
authors.initials: M
authors.lastname: Ferrer
authors.forename: Raquel
authors.initials: R
authors.lastname: Morillo
authors.forename: Teresa
authors.initials: T
authors.lastname: Elías
authors.forename: Luis
authors.initials: L
authors.lastname: Jara
authors.forename: Leticia
authors.initials: L
authors.lastname: García
authors.forename: Rosa
authors.initials: R
authors.lastname: Nieto
authors.forename: Emmanuel
authors.initials: E
authors.lastname: Sandoval
authors.forename: Fernando
authors.initials: F
authors.lastname: Uresandi
authors.forename: Remedios
authors.initials: R
authors.lastname: Otero
authors.forename: David
authors.initials: D
authors.lastname: Jiménez
mesh_terms: D000208:Acute Disease; D000368:Aged; D000369:Aged, 80 and over; D000925:Anticoagulants / Q000009:adverse effects; D017128:Embolectomy; D005260:Female; D005500:Follow-Up Studies; D006470:Hemorrhage / Q000139:chemically induced / Q000453:epidemiology; D017052:Hospital Mortality; D006801:Humans; D008297:Male; D008875:Middle Aged; D008954:Models, Biological; D011237:Predictive Value of Tests; D011379:Prognosis; D011655:Pulmonary Embolism / Q000188:drug therapy / Q000401:mortality* / Q000517:prevention & control / Q000601:surgery; D012372:ROC Curve; D012008:Recurrence; D012189:Retrospective Studies; D018570:Risk Assessment; D012720:Severity of Illness Index; D013030:Spain / Q000453:epidemiology; D015912:Thrombolytic Therapy; D016306:Vena Cava Filters; D054556:Venous Thromboembolism / Q000453:epidemiology / Q000628:therapy
chemical_list: D000925:Anticoagulants
keywords: Clinical scores; Escalas clínicas; Prognosis; Pronóstico; Pulmonary embolism; Tromboembolia de pulmón