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

According to the 2019 European Society of Cardiology (ESC) guidelines on pulmonary embolism (PE), prognosis is calculated using the Pulmonary Embolism Severity Index (PESI), a complex score with debated validity, or simplified PESI (sPESI). We have developed and validated a new risk score for in-hos...

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Published in:Clinical and experimental emergency medicine 2023-03, Vol.10 (1), p.26-36
Main Authors: 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, Giorgio, Roberto De, Franceschi, Francesco
Format: Article
Language:English
Subjects:
clinical prediction rules
emergency medical services
Original
prognosis
pulmonary embolism
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Summary:According to the 2019 European Society of Cardiology (ESC) guidelines on pulmonary embolism (PE), prognosis is calculated using the Pulmonary Embolism Severity Index (PESI), a complex score with debated validity, or simplified PESI (sPESI). We have developed and validated a new risk score for in-hospital mortality (IHM) of patients with PE in the emergency department. 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. 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. The PATHOS scores were developed using independent variables to predict mortality: platelet count, age, troponin, heart rate, oxygenation, and systolic blood pressure. 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
ISSN:2383-4625
2383-4625
DOI:10.15441/ceem.22.369