Predicting in-hospital mortality in pulmonary embolism patients: development and external validation of the PATHOS score
Objective 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...
| Main Authors: | , , , , , , , , , , , , , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
The Korean Society of Emergency Medicine
2022-11-01
|
| Series: | Clinical and Experimental Emergency Medicine |
| Subjects: | |
| Online Access: | http://www.ceemjournal.org/upload/pdf/ceem-22-369.pdf |
| _version_ | 1797845634105999360 |
|---|---|
| author | Michele Domenico Spampinato Marcello Covino Angelina Passaro Marcello Benedetto Luca D’Angelo Giorgio Galizia Irma Sofia Fabbri Teresa Pagano Andrea Portoraro Matteo Guarino Rita Previati Gianluca Tullo Antonio Gasbarrini Roberto De Giorgio Francesco Franceschi |
| author_facet | Michele Domenico Spampinato Marcello Covino Angelina Passaro Marcello Benedetto Luca D’Angelo Giorgio Galizia Irma Sofia Fabbri Teresa Pagano Andrea Portoraro Matteo Guarino Rita Previati Gianluca Tullo Antonio Gasbarrini Roberto De Giorgio Francesco Franceschi |
| author_sort | Michele Domenico Spampinato |
| collection | DOAJ |
| description | Objective 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. 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. 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<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. |
| first_indexed | 2024-04-09T17:42:08Z |
| format | Article |
| id | doaj.art-d05bc050edc54d7dbf6ecc173a13a584 |
| institution | Directory Open Access Journal |
| issn | 2383-4625 |
| language | English |
| last_indexed | 2024-04-09T17:42:08Z |
| publishDate | 2022-11-01 |
| publisher | The Korean Society of Emergency Medicine |
| record_format | Article |
| series | Clinical and Experimental Emergency Medicine |
| spelling | doaj.art-d05bc050edc54d7dbf6ecc173a13a5842023-04-17T04:26:52ZengThe Korean Society of Emergency MedicineClinical and Experimental Emergency Medicine2383-46252022-11-01101263610.15441/ceem.22.369426Predicting in-hospital mortality in pulmonary embolism patients: development and external validation of the PATHOS scoreMichele Domenico Spampinato0Marcello Covino1Angelina Passaro2Marcello Benedetto3Luca D’Angelo4Giorgio Galizia5Irma Sofia Fabbri6Teresa Pagano7Andrea Portoraro8Matteo Guarino9Rita Previati10Gianluca Tullo11Antonio Gasbarrini12Roberto De Giorgio13Francesco Franceschi14 Department of Translational Medicine, University of Ferrara, Ferrara, Italy Department of Emergency Medicine, Gemelli University Hospital, Catholic University of the Sacred Heart of Rome, Rome, Italy Department of Translational Medicine, University of Ferrara, Ferrara, Italy Department of Translational Medicine, University of Ferrara, Ferrara, Italy Department of Translational Medicine, University of Ferrara, Ferrara, Italy Department of Translational Medicine, University of Ferrara, Ferrara, Italy Department of Translational Medicine, University of Ferrara, Ferrara, Italy Department of Translational Medicine, University of Ferrara, Ferrara, Italy Department of Translational Medicine, University of Ferrara, Ferrara, Italy Department of Translational Medicine, University of Ferrara, Ferrara, Italy Department of Emergency Medicine, St. Anna Hospital, Ferrara, Italy Department of Emergency Medicine, Gemelli University Hospital, Catholic University of the Sacred Heart of Rome, Rome, Italy Department of Internal Medicine, Gemelli University Hospital, Catholic University of the Sacred Heart of Rome, Rome, Italy Department of Translational Medicine, University of Ferrara, Ferrara, Italy Department of Emergency Medicine, Gemelli University Hospital, Catholic University of the Sacred Heart of Rome, Rome, ItalyObjective 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. 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. 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<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.http://www.ceemjournal.org/upload/pdf/ceem-22-369.pdfpulmonary embolismprognosisclinical prediction rulesemergency medical services |
| spellingShingle | Michele Domenico Spampinato Marcello Covino Angelina Passaro Marcello Benedetto Luca D’Angelo Giorgio Galizia Irma Sofia Fabbri Teresa Pagano Andrea Portoraro Matteo Guarino Rita Previati Gianluca Tullo Antonio Gasbarrini Roberto De Giorgio Francesco Franceschi Predicting in-hospital mortality in pulmonary embolism patients: development and external validation of the PATHOS score Clinical and Experimental Emergency Medicine pulmonary embolism prognosis clinical prediction rules emergency medical services |
| title | Predicting in-hospital mortality in pulmonary embolism patients: development and external validation of the PATHOS score |
| title_full | Predicting in-hospital mortality in pulmonary embolism patients: development and external validation of the PATHOS score |
| title_fullStr | Predicting in-hospital mortality in pulmonary embolism patients: development and external validation of the PATHOS score |
| title_full_unstemmed | Predicting in-hospital mortality in pulmonary embolism patients: development and external validation of the PATHOS score |
| title_short | Predicting in-hospital mortality in pulmonary embolism patients: development and external validation of the PATHOS score |
| title_sort | predicting in hospital mortality in pulmonary embolism patients development and external validation of the pathos score |
| topic | pulmonary embolism prognosis clinical prediction rules emergency medical services |
| url | http://www.ceemjournal.org/upload/pdf/ceem-22-369.pdf |
| work_keys_str_mv | AT micheledomenicospampinato predictinginhospitalmortalityinpulmonaryembolismpatientsdevelopmentandexternalvalidationofthepathosscore AT marcellocovino predictinginhospitalmortalityinpulmonaryembolismpatientsdevelopmentandexternalvalidationofthepathosscore AT angelinapassaro predictinginhospitalmortalityinpulmonaryembolismpatientsdevelopmentandexternalvalidationofthepathosscore AT marcellobenedetto predictinginhospitalmortalityinpulmonaryembolismpatientsdevelopmentandexternalvalidationofthepathosscore AT lucadangelo predictinginhospitalmortalityinpulmonaryembolismpatientsdevelopmentandexternalvalidationofthepathosscore AT giorgiogalizia predictinginhospitalmortalityinpulmonaryembolismpatientsdevelopmentandexternalvalidationofthepathosscore AT irmasofiafabbri predictinginhospitalmortalityinpulmonaryembolismpatientsdevelopmentandexternalvalidationofthepathosscore AT teresapagano predictinginhospitalmortalityinpulmonaryembolismpatientsdevelopmentandexternalvalidationofthepathosscore AT andreaportoraro predictinginhospitalmortalityinpulmonaryembolismpatientsdevelopmentandexternalvalidationofthepathosscore AT matteoguarino predictinginhospitalmortalityinpulmonaryembolismpatientsdevelopmentandexternalvalidationofthepathosscore AT ritapreviati predictinginhospitalmortalityinpulmonaryembolismpatientsdevelopmentandexternalvalidationofthepathosscore AT gianlucatullo predictinginhospitalmortalityinpulmonaryembolismpatientsdevelopmentandexternalvalidationofthepathosscore AT antoniogasbarrini predictinginhospitalmortalityinpulmonaryembolismpatientsdevelopmentandexternalvalidationofthepathosscore AT robertodegiorgio predictinginhospitalmortalityinpulmonaryembolismpatientsdevelopmentandexternalvalidationofthepathosscore AT francescofranceschi predictinginhospitalmortalityinpulmonaryembolismpatientsdevelopmentandexternalvalidationofthepathosscore |