Prediction of short-term prognosis in elderly patients with acute pulmonary embolism: validation of the RIETE score.

INTRODUCTION

The RIETE score was derived to identify patients with pulmonary embolism (PE) at low risk of overall complications.

OBJECTIVE

To externally validated the RIETE score and compared its prognostic performance to the Pulmonary Embolism Severity Index (PESI), its simplified version (sPESI), and the Geneva Prognostic Score (GPS).

METHODS

In a prospective multicenter cohort, we studied 687 elderly patients with acute PE. The primary outcome was 10-day overall complications (death, recurrent PE, or major bleeding), the secondary outcome was 30-day overall mortality. We compared complications and mortality in low- vs. higher-risk patients and the area under the receiver operating characteristic (ROC) curve across scores.

RESULTS

Overall, 27 patients (3.9%) had complications within 10 days and 22 (3.2%) died within 30 days. The RIETE score classified a smaller proportion of patients as low-risk (31%) than the PESI (35%), sPESI (36%), and the GPS (90%). The proportion of low-risk patients based on the RIETE score, PESI, sPESI, and GPS who had complications was 1.9%, 1.7%, 1.6%, and 2.9%, respectively. The RIETE score had a lower area under the ROC curve (0.60) for predicting complications than the PESI (0.67), sPESI (0.65), and GPS (0.72). The area under the ROC curve for predicting mortality was similar (0.76-0.78) for all scores.

CONCLUSION

The RIETE score classified fewer patients as low-risk than the other scores. It accurately identified patients at low mortality risk but was not superior to other scores in predicting 10-day overall complications. This article is protected by copyright. All rights reserved.