Comparison of seven prognostic tools to identify low-risk pulmonary embolism in patients aged <50 years
Authors: Jara-Palomares Luis , Alfonso Maria , Maestre Ana , Jimenez David , Garcia-Bragado Fernando , Font Carme , Reyes Raquel Lopez , Blasco Luis Hernandez , Vidal Gemma , Otero Remedios , Monreal Manuel ,   The RIETE investigators, Adarraga Mª Dolores , Aibar Miguel Ángel , Aibar Jesús , Amado Cristina , Arcelus Juan Ignacio , Ballaz Aitor , Barba Raquel , Barrón Manuel , Barrón-Andrés Belén , Bascuñana José , Blanco-Molina Ángeles , Camón Ana María , Cañas Inmaculada , Carrasco Cristina , Castro Joaquín , de Ancos Cristina , Del Toro Jorge , Demelo Pablo , Díaz-Peromingo José Antonio , Díaz-Simón Raquel , Falgá Conxita , Farfán Ana Isabel , Fernández-Capitán Carmen , del Carmen Fernández-Criado María , Fernández-Núñez Sandra , Fidalgo Ángeles , Font Llorenç , García Maria Angelina , García-Morillo Marcial , García-Raso Aranzázu , Gavín-Sebastián Olga , del Carmen Gayol María , Gil-Díaz Aída , Gómez Vicente , Gómez-Cuervo Covadonga , González-Martínez José , Grau Enric , Gutiérrez Javier , Gutiérrez-González Sara , Iglesias Marina , Jaras Mª Jesús , Jou Inés , Joya María Dolores , Lalueza Antonio , Lima Jorge , Llamas Pilar , Lobo Jose Luis , López-Jiménez Luciano , López-Miguel Patricia , López-Núñez Juan José , López-Sáez Juan Bosco , Lorente Manuel Alejandro , Lorenzo Alicia , Loring Mónica , Madridano Olga , Marchena Pablo Javier , Martín Javier Miguel , Mellado Meritxell , Morales Mª del Valle , Nieto María Luisa , Nieto José Antonio , Núñez Manuel Jesús , Olivares María Carmen , Pedrajas José María , Pellejero Galadriel , Pérez-Rus Gloria , Peris Mª Luisa , Porras José Antonio , Rivas Agustina , Rodríguez-Dávila Mª Ángeles , Adela Rodríguez-Hernández A. , Rubio Carmen Mª , Ruiz-Artacho Pedro , Ruiz-Ruiz Justo , Ruiz-Sada Pablo , Sahuquillo Joan Carles , Salazar Vladimir , Sampériz Ángel , Muñoz-Torrero Juan Francisco Sánchez , Sancho Teresa , Soler Silvia , Suriñach José María , Tapia Elena , Tolosa Carles , Torres María Isabel , Trujillo-Santos Javier , Uresandi Fernando , Valle Reina , Villares Paula , Gutiérrez Paula , Vázquez Fernando Javier , Vilaseca Alicia , Vanassche Thomas , Vandenbriele Christophe , Verhamme Peter , Hirmerova Jana , Malý Radovan , Celis Gregory , del Pozo Gustavo , Salgado Estuardo , Benzidia Ilham , Bertoletti Laurent , Bura-Riviere Alessandra , Debourdeau Philippe , Farge-Bancel Dominique , Hij Adrian , Mahé Isabelle , Moustafa Farès , Schellong Sebastian , Braester Andrei , Brenner Benjamin , Tzoran Inna , Sharif-Kashani Babak , Barillari Giovanni , Bilora Franca , Bortoluzzi Cristiano , Brandolin Barbara , Bucherini Eugenio , Ciammaichella Maurizio , Dentali Francesco , Di Micco Pierpaolo , Maida Rosa , Mastroiacovo Daniela , Mumoli Nicola , Pace Federica , Parisi Roberto , Pesavento Raffaelle , Prandoni Paolo , Quintavalla Roberto , Rocci Anna , Romualdi Roberta , Sinicalchi Carmine , Tufano Antonella , Visonà Adriana , Hong Ngoc Vo , Zalunardo Beniamino , Gibietis Valdis , Kigitovica Dana , Skride Andris , Bosevski Marijan , Bounameaux Henri , Mazzolai Lucia , Caprini Joseph A. , Bui Hanh My , Pham Khanh Quoc , Reis Abilio 
Published: December 2019

In young patients with acute pulmonary embolism (PE), the predictive value of currently available prognostic tools has not been evaluated. Our objective was to compare prognostic value of 7 available tools (GPS, PESI, sPESI, Prognostic Algorithm, PREP, shock index and RIETE) in patients aged <50 years. We used the RIETE database, including PE patients from 2001 to 2017. The major outcome was 30-day all-cause mortality. Of 34,651 patients with acute PE, 5,822 (17%) were aged <50 years. Of these, 83 (1.4%) died during the first 30 days. Number of patients deemed low risk with tools was: PREP (95.9%), GPS (89.6%), PESI (87.2%), Shock index (70.9%), sPESI (59.4%), Prognostic algorithm (58%) and RIETE score (48.6%). The tools with a highest sensitivity were: Prognostic Algorithm (91.6%; 95% CI: 85.6–97.5), RIETE score (90.4%; 95%CI: 84.0–96.7) and sPESI (88%; 95% CI: 81–95). The RIETE, Prognostic Algorithm and sPESI scores obtained the highest overall sensitivity estimates for also predicting 7- and 90-day all-cause mortality, 30-day PE-related mortality, 30-day major bleeding and 30-day VTE recurrences. The proportion of low-risk patients who died within the first 30 days was lowest using the Prognostic Algorithm (0.2%), RIETE (0.3%) or sPESI (0.3%) scores. In PE patients less 50 years, 30-day mortality was low. Although sPESI, RIETE and Prognostic Algorithm scores were the most sensitive tools to identify patients at low risk to die, other tools should be evaluated in this population to obtain more efficient results.