Abstract:Objective Simplified pulmonary embolism severity index (sPESI) is a practical validated tool aiming to stratify 30-day mortality risk in acute pulmonary thromboembolism (PTE). However, guidelines for PTE risk stratification are not concerning on age. The aim of our study was to determine the prognostic value of sPESI in the elderly patients with PTE. Methods A retrospective case-control study was carried out on 233 consecutive patients with identified PTE admitted in our hospital from April 2002 to May 2015. They were divided into the elderly group (≥65 years old, n=132) and the non-elderly group (<65 years old, n=101). Their complications, clinical features, sPESI score, and 30-day mortality were compared and analyzed. Results The patients of the elderly group were at age of (76.32±6.77) years, and those of the non-elderly group were (51.93±10.39) years. The former group had a 30-day mortality of 22.73%, and the latter of 11.88%, with significant difference between the two groups (P=0.033). The incidences of cardiac insufficiency, arrhythmia, cerebrovascular diseases, renal insufficiency, hypertension, diabetes and pneumonia were significantly higher in the elderly patients than in the non-elderly ones (all P<0.05). There was no significant difference in the incidence of malignant tumors between the elderly and non-elderly groups (14.39% vs 13.86%, P=0.908). But, the most common tumor was lung cancer in the elderly group, and bone tumor in the non-elderly group. The arterial partial pressure of oxygen was significantly lower in the elderly group than in the non-elderly group [(59.39±11.00) vs (66.44±13.77)mmHg, P=0.002], but the pulmonary arterial pressure, serum levels of brain natriuretic peptide and cardiac troponin-I were obviously higher in the former than in the latter (P=0.000, P=0.003 and P=0.041). Significant difference was observed in the percentage of patients with sPESI score ≥1 between the two groups (73.48% vs 48.51%, P=0.000). In the elderly group, sPESI score ≥1 was found among 90.00% of the dead patients and 68.63% of the survival ones (P=0.020). The mean sPESI score was 2.23±1.52 in the dead patients of the elderly group, significantly higher than those survived (1.18±1.11, P=0.001). The area under the receiver-operating characteristic (ROC) curves was 0.704 [95% confidence interval (CI): 0.596?0.812] for the elderly patients and 0.723 (95%CI: 0.551?0.896) for the non-elderly ones. Conclusion sPESI is helpful for risk stratification in the elderly patients with acute PTE.