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

Zwierzina, Daniela; Limacher, Andreas; Méan, Marie; Righini, M.; Jaeger, K.; Beer, H.-J.; Frauchiger, B.; Osterwalder, J.; Kucher, Nils; Matter, C. M.; Banyai, M.; Angelillo, Anne; Lämmle, Bernhard; Egloff, M.; Aschwanden, M.; Mazzolai, L.; Hugli, O.; Husmann, M.; Bounameaux, H.; Cornuz, J.; ... (2012). Prospective comparison of clinical prognostic scores in elderly patients with pulmonary embolism. Journal of thrombosis and haemostasis, 10(11), pp. 2270-2276. Oxford: Wiley-Blackwell 10.1111/j.1538-7836.2012.04929.x

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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.

Item Type:

Journal Article (Original Article)

Division/Institute:

04 Faculty of Medicine > Pre-clinic Human Medicine > CTU Bern
04 Faculty of Medicine > Department of General Internal Medicine (DAIM) > Clinic of General Internal Medicine
04 Faculty of Medicine > Department of Haematology, Oncology, Infectious Diseases, Laboratory Medicine and Hospital Pharmacy (DOLS) > Clinic of Haematology and Central Haematological Laboratory
04 Faculty of Medicine > Department of General Internal Medicine (DAIM) > Clinic of General Internal Medicine > Centre of Competence for General Internal Medicine
04 Faculty of Medicine > Department of Cardiovascular Disorders (DHGE) > Clinic of Angiology

UniBE Contributor:

Zwierzina, Daniela; Limacher, Andreas; Méan, Marie; Kucher, Nils; Angelillo, Anne; Lämmle, Bernhard; Rodondi, Nicolas and Aujesky, Drahomir

Subjects:

600 Technology > 610 Medicine & health

ISSN:

1538-7836

Publisher:

Wiley-Blackwell

Language:

English

Submitter:

Factscience Import

Date Deposited:

04 Oct 2013 14:28

Last Modified:

16 Jul 2018 14:17

Publisher DOI:

10.1111/j.1538-7836.2012.04929.x

PubMed ID:

22985129

Web of Science ID:

000310548400007

Uncontrolled Keywords:

elderly patients, prognostic scores, pulmonary embolism

BORIS DOI:

10.7892/boris.10378

URI:

https://boris.unibe.ch/id/eprint/10378 (FactScience: 216250)

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