External validation of the PoPE score for predicting 30-day mortality in acute pulmonary embolism: a comparison with PESI and sPESI

Background Risk stratification in acute pulmonary embolism (PE) commonly relies on the Pulmonary Embolism Severity Index (PESI) and the simplified PESI (sPESI), whose complexity limits practicality. We externally validated the newly defined PrOgnosis in Pulmonary Embolism (PoPE) score, a simpler alternative, for predicting 30-day mortality in patients with PE and compared it with PESI and sPESI. Methods This retrospective, single-center prognostic validation study included patients aged ≥ 18 years presenting to a tertiary care emergency department with acute PE confirmed by pulmonary computed tomography angiography within 24 h of initial medical contact, with an available arterial lactate concentration and 30-day follow-up. Patients with cardiorespiratory arrest or hemodynamic collapse at admission, subsegmental PE, fibrinolytic therapy despite hemodynamic stability, or incomplete medical records were excluded. Results Of 316 patients screened, 248 were analyzed. The 30-day all-cause mortality rate was 22.2% (55/248), with a median time to death of 8 days; 86.7% were hospitalized, including 17.8% in intensive care. A PoPE score < 2 carried a mortality of 4.2% (5/119), whereas no death occurred among the 49 patients scoring 0. At the pre-specified threshold of ≥ 2, PoPE had a sensitivity of 90.91% and a specificity of 59.07%. The AUC was 0.832 for PoPE, 0.773 for the PESI risk class and 0.749 for sPESI (DeLong p = 0.057 and p = 0.027, respectively). Conclusions The PoPE score showed discrimination comparable to the PESI risk class and higher than that of sPESI for 30-day mortality, using five admission parameters. A threshold of < 2 may carry residual risk, whereas no death was observed at a score of 0 (0/49, 95% CI 0.0–7.3%). Clinical utility and formal calibration require confirmation in prospective, multicenter cohorts that include lower-acuity patients than the tertiary-care population studied here.