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
Department of Translational Medicine, University of Ferrara, Ferrara, Italy.
University of Ferrara School of Emergency Medicine, Ferrara, Italy.
Clin Exp Emerg Med. 2023 Mar;10(1):26-36. doi: 10.15441/ceem.22.369. Epub 2022 Nov 17.
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<0.01 for all comparisons).
PATHOS is a simple and effective prognostic score for predicting IHM in patients with PE in an emergency setting.
根据2019年欧洲心脏病学会（ESC）关于肺栓塞（PE）的指南，使用肺栓塞严重程度指数（PESI）来计算预后，PESI是一个有效性存在争议的复杂评分，或者使用简化的PESI（sPESI）。我们已经开发并验证了一种用于急诊科PE患者院内死亡率（IHM）的新风险评分。
这项回顾性、双中心队列研究在两家三级大学医院的急诊科进行。纳入年龄>18岁且经对比增强计算机断层扫描确诊为PE的患者。对IHM进行盲法评估临床变量和实验室检查。进行多变量逻辑回归以确定新评分的预测因素，并将新评分与PESI、sPESI和休克指数进行比较。
本研究共纳入1358例患者：推导队列中有586例，验证队列中有772例，总体IHM为10.6%。使用独立变量血小板计数、年龄、肌钙蛋白、心率、氧合和收缩压来制定PATHOS评分以预测死亡率。PATHOS评分显示出良好的校准和高辨别力，推导人群中受试者工作特征曲线下面积为0.83（95%置信区间[CI]，0.77 - 0.89），验证队列中为0.74（95%CI，0.68 - 0.80），在两个队列中均显著高于PESI、sPESI和休克指数（所有比较P<0.01）。
PATHOS是一种简单有效的预后评分，用于预测急诊科PE患者中的IHM。
