sPESI (simplified Pulmonary Embolism Severity Index)
30-day mortality risk in confirmed acute pulmonary embolism
- ESC 2019 PE guideline
- AWMF S2k VTE 2023
- Derived in Spain, validated in RIETE registry
Sources last checked: 2026-10-13
sPESI (simplified Pulmonary Embolism Severity Index)
30-day mortality risk in confirmed acute pulmonary embolism
30-day mortality 1.0 % (95 % CI 0.0–2.1 %) in the derivation cohort. ESC 2019 and AWMF 2023 describe this group as candidates for early discharge / home treatment if RV function, troponin and social circumstances allow.
Only for haemodynamically stable, confirmed PE. sPESI 0 does not capture right-ventricular dysfunction: ESC 2019 places patients with RV dysfunction or raised troponin in the intermediate-risk group even with sPESI 0. Any cancer moves the patient out of the low-risk class.
Interpretation
| 0 — low risk | 30-day mortality 1.0 % (95 % CI 0.0–2.1 %) in the derivation cohort. ESC 2019 and AWMF 2023 describe this group as candidates for early discharge / home treatment if RV function, troponin and social circumstances allow. |
|---|---|
| ≥ 1 — not low risk | 30-day mortality 10.9 % (95 % CI 8.5–13.2 %). Not low risk in ESC 2019, which foresees in-hospital treatment and further stratification with RV imaging and troponin (intermediate-low vs intermediate-high). |
What is the sPESI (simplified Pulmonary Embolism Severity Index)?
The simplified PESI keeps six of the eleven PESI variables and gives each one point. Jiménez and colleagues derived it in Spanish outpatients with acute symptomatic PE and validated it in 7,106 patients from the RIETE registry (Arch Intern Med 2010). A score of 0 identifies about a third of patients with a 30-day mortality around 1 %.
When to use it
- Confirmed acute PE in a haemodynamically stable patient, to separate low-risk from intermediate-risk disease (ESC 2019 algorithm).
- Deciding whether early discharge or home treatment is an option.
- As a quick bedside alternative to the full PESI.
When not to use it
- Suspected (not confirmed) PE — it is a prognostic, not a diagnostic, tool.
- Haemodynamically unstable (high-risk) PE, for which ESC 2019 foresees reperfusion therapy irrespective of the score.
- As the only criterion for discharge — RV function, troponin, comorbidity and social situation also count.
How it is calculated
| Criterion | Points |
|---|---|
| Age > 80 years | +1 |
| Cancer | +1 |
| Chronic cardiopulmonary disease (heart failure or chronic lung disease) | +1 |
| Heart rate ≥ 110 /min | +1 |
| Systolic blood pressure < 100 mmHg | +1 |
| Arterial oxyhaemoglobin saturation < 90 % | +1 |
Clinical pearls and limitations
- Only for haemodynamically stable, confirmed PE. sPESI 0 does not capture right-ventricular dysfunction: ESC 2019 places patients with RV dysfunction or raised troponin in the intermediate-risk group even with sPESI 0. Any cancer moves the patient out of the low-risk class.
- Heart failure and chronic lung disease together count as one item (chronic cardiopulmonary disease).
- Any cancer gives 1 point, so cancer patients can never be sPESI-low-risk.
- ESC 2019: sPESI ≥ 1, or sPESI 0 with RV dysfunction or raised troponin, defines intermediate risk; both positive = intermediate-high.
- Heart rate threshold is ≥ 110/min, not 100/min.
Frequently asked questions
What does an sPESI of 0 mean?
Low risk: 30-day mortality about 1 % in the derivation and RIETE cohorts. ESC 2019 and AWMF 2023 describe such patients as possible candidates for early discharge if RV function, troponin and home circumstances allow.
sPESI or PESI — which is better?
Prognostic accuracy is the same (AUC 0.75 in Jiménez 2010). sPESI is easier to calculate; PESI gives five classes. ESC 2019 accepts either.
Is sPESI part of the ESC risk classification?
Yes. ESC 2019 uses PESI class III–V or sPESI ≥ 1, together with RV imaging and troponin, to classify intermediate-risk PE.
Evidence and guidelines
- Primary source: Jiménez D et al. Simplification of the Pulmonary Embolism Severity Index for prognostication in patients with acute symptomatic pulmonary embolism. Arch Intern Med 2010;170(15):1383-1389.
- ESC 2019 acute PE guideline, Table 7 (original and simplified PESI) and risk-stratification algorithm.
- AWMF S2k 065-002 (2023), Tab. 3.6 and Empfehlung 3.19 (ambulante Therapie bei negativem sPESI).
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Ask Medelix about the sPESI (simplified Pulmonary Embolism Severity Index)Related calculators
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