Objective: : According to the 2019 European Society of Cardiology (ESC) guidelines on PE, prognosis is calculated using the Pulmonary Embolism Severity Index (PESI), a complex score with debated validity, or simplified PESI (sPESI), and ESC class risk. We have developed and validated a new risk score for in-hospital mortality (IHM) of patients with PE in the emergency department. Methods: : This retrospective, dual-center cohort study was conducted in the emergency departments of two third-level university hospitals. Patients aged >18 years with a contrast-enhanced computed tomography-confirmed PE were included. Clinical variables and laboratory tests were evaluated blindly to IHM. Multivariable logistic regression was performed to identify the new score's predictors, and the new score was compared with the PESI, sPESI, and shock index. Results: : A total of 1,358 patients were included in this study: 586 in the derivation cohort and 772 in the validation cohort, with a global 10.6% of IHM. Platelet count, age, troponin, heart rate, oxygenation, and systolic blood pressure were identified as independent predictors and are included in the PATHOS score. The PATHOS score showed good calibration and high discrimination, with an area under the receiver operating characteristics curve of 0.83 (95% confidence interval [CI], 0.77-0.89) in the derivation population and 0.74 (95% CI, 0.68-0.80) in the validation cohort, which is significantly higher than the PESI, sPESI, and shock index in both cohorts (P<0.01 for all comparisons). Conclusion: : PATHOS is a simple and effective prognostic score for predicting IHM in patients with PE in an emergency setting.

Predicting in-hospital mortality in pulmonary embolism patients: development and external validation of PATHOS score

Michele Domenico Spampinato
Co-primo
;
Angelina Passaro
Secondo
;
Marcello Benedetto;Luca D’Angelo;Giorgio Galizia;Irma Sofia Fabbri;Teresa Pagano;Andrea Portoraro;Matteo Guarino;Rita Previati;Roberto De Giorgio
Penultimo
;
2023

Abstract

Objective: : According to the 2019 European Society of Cardiology (ESC) guidelines on PE, prognosis is calculated using the Pulmonary Embolism Severity Index (PESI), a complex score with debated validity, or simplified PESI (sPESI), and ESC class risk. We have developed and validated a new risk score for in-hospital mortality (IHM) of patients with PE in the emergency department. Methods: : This retrospective, dual-center cohort study was conducted in the emergency departments of two third-level university hospitals. Patients aged >18 years with a contrast-enhanced computed tomography-confirmed PE were included. Clinical variables and laboratory tests were evaluated blindly to IHM. Multivariable logistic regression was performed to identify the new score's predictors, and the new score was compared with the PESI, sPESI, and shock index. Results: : A total of 1,358 patients were included in this study: 586 in the derivation cohort and 772 in the validation cohort, with a global 10.6% of IHM. Platelet count, age, troponin, heart rate, oxygenation, and systolic blood pressure were identified as independent predictors and are included in the PATHOS score. The PATHOS score showed good calibration and high discrimination, with an area under the receiver operating characteristics curve of 0.83 (95% confidence interval [CI], 0.77-0.89) in the derivation population and 0.74 (95% CI, 0.68-0.80) in the validation cohort, which is significantly higher than the PESI, sPESI, and shock index in both cohorts (P<0.01 for all comparisons). Conclusion: : PATHOS is a simple and effective prognostic score for predicting IHM in patients with PE in an emergency setting.
2023
Spampinato, MICHELE DOMENICO; Covino, Marcello; Passaro, Angelina; Benedetto, Marcello; D’Angelo, Luca; Galizia, Giorgio; Fabbri, Irma Sofia; Pagano, Teresa; Portoraro, Andrea; Guarino, Matteo; Previati, Rita; Tullo, Gianluca; Gasbarrini, Antonio; DE GIORGIO, Roberto; Franceschi, Francesco
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Utilizza questo identificativo per citare o creare un link a questo documento: https://hdl.handle.net/11392/2510830
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