A simple score to identify the sickest normotensive patients with acute pulmonary embolism

Emerging evidence suggests that various prognostic factors should be combined to identify normotensive patients with pulmonary embolism (PE) at intermediate-high risk for a short-term complicated course. We proposed and externally validated a pragmatic score to identify those patients.

The SIMpLe risk score contained vital Signs, IMaging testing and Laboratory tests. For the primary outcome of 30-day all-cause mortality and the secondary outcome composed of clinical deterioration or PE-related mortality, three independent cohorts from sites in Europe were used to assess overall score performance, discrimination, calibration and prediction.

The participants had a median (interquartile range) age of 72 (59-80) years in the PROTECT derivation cohort, 73 (66-82) years in TELOS and 69 (59-81) years in the Ramón y Cajal external validation cohorts. Women comprised 51-58% of each cohort. The SIMpLe score had areas under the curve of 0.69, 0.78 and 0.71 in the PROTECT, TELOS and Ramón y Cajal cohorts for the primary outcome, respectively. The score had good calibration. Using a threshold of a 15% probability of 30-day all-cause mortality, the risk score created a binary test with a positive predictive value of 23.5% in PROTECT, 26.7% in TELOS and 27.0% in Ramón y Cajal. For the composite secondary outcome, the risk score created a binary test with a positive predictive value of 23.5% in PROTECT, 26.7% in TELOS and 28.6% in Ramón y Cajal.

The SIMpLe score can be applied to identify the sickest normotensive patients with acute PE and to support shared decision-making.