TELOS-plus identifies normotensive patients with pulmonary embolism at high risk of 30-day mortality

Background: Risk stratification of normotensive patients with acute pulmonary embolism (PE) remains suboptimal, with current models failing to consistently identify a subset at sufficiently high risk to warrant advanced therapies. We aimed to enhance the TELOS score by integrating respiratory parameters and a refined definition of right ventricular dysfunction (RVD). Methods: This retrospective cohort study included 1091 normotensive PE patients from a prospective registry (2008–2019). We enhanced the TELOS score into TELOS-plus score by combining novel parameters: Multivariable logistic regression identified independent predictors of 30-day PE-related mortality. The model's performance was compared to TELOS and other established scores using ROC analysis. Results: The 30-day PE-related mortality rate was 3.8 %. Severe respiratory failure (12.8 % of patients) was associated with 15.7 % mortality (OR 8.7; 95 % CI 4.6–16.4), while revised RVD (17.8 % of patients) had a mortality of 10.3 % (OR 2.2; 95 % CI 1.1–5.1). TELOS-plus showed the highest AUC (0.85) among other bedside models except SHIeLD and identified a large intermediate-high risk group (17.1 %) with high mortality (16.1 %). Conclusions: The TELOS-plus score reliably identifies normotensive PE patients at intermediate-high risk for 30-day mortality, with improved prognostic accuracy compared to previous models. Its simplicity and clinical applicability support its potential use in guiding decisions on escalated therapies.