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

Background 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. Methods The SIMpLe risk score contained vital S igns, IM aging testing, and L aboratory tests. For the primary outcome of 30-day all-cause mortality and the secondary outcome composed of clinical deterioration or PE-related mortality, we used three independent cohorts from sites in Europe to assess the overall performance of the score; discrimination; calibration; and prediction. Results The participants had a median ( IQR ) 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; 51%–58% women per cohort. The SIMpLe score had areas under the curve ( AUC ) 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. Conclusions The SIMpLe score can be applied to identify the sickest normotensive patients with acute PE and to support shared decision-making.