An integrated model using syncope, right ventricular dysfunction, systolic blood pressure and troponin predicted in-hospital mortality with an optimism-corrected AUC of 0.70 (95% CI 0.63-0.77) in acute pulmonary embolism patients.
Observational (n=322)
No
Does an integrated clinical and biomarker model using penalized regression improve the prediction of in-hospital mortality in patients with acute pulmonary embolism compared to established tools?
A simple predictive model integrating syncope, RV dysfunction, systolic blood pressure, and troponin demonstrates favorable clinical utility for early mortality risk estimation in acute pulmonary embolism, outperforming the sPESI score.
Effect estimate: AUC 0.70 (95% CI 0.630.77)
Background: Early mortality risk stratification is essential in acute pulmonary embolism (PE). Integrating clinical variables with biomarkers may enhance prognostic accuracy beyond established tools. Methods: In a retrospective cohort of 322 patients with confirmed acute PE, we evaluated syncope, right-ventricular (RV) dysfunction, systolic blood pressure (SBP) and biochemical markers as candidate predictors of in-hospital mortality. A penalized logistic regression model using LASSO (least absolute shrinkage and selection operator) was developed and internally validated with five-fold cross-validation and 200 bootstrap repetitions. Discrimination, calibration and clinical utility were assessed using the area under the receiver operating characteristic curve (AUC), Brier score and decision-curve analysis (DCA). Results: In-hospital mortality was 5.6% (n = 18). LASSO retained four predictors: syncope, RV dysfunction, lower SBP and higher troponin levels. The optimism-corrected AUC was 0.70 (95% CI 0.63–0.77), with strong calibration (Brier score 0.066). DCA showed that the model provided greater net benefit than treat-all, treat-none, and sPESI strategies across threshold probabilities of approximately 7–25%, supporting its potential value for early triage. NT-proBNP, D-dimer and lactate did not add incremental predictive information after penalization. Conclusions: A simple, interpretable model integrating clinical parameters and troponin demonstrates good predictive performance and favorable clinical utility for early mortality risk estimation in acute PE. External validation is required before broader implementation.
Cinezan et al. (Fri,) conducted a observational in Adults with acute pulmonary embolism admitted to a single center hospital with confirmed diagnosis by computed tomography pulmonary angiography (n=322). A prognostic model integrating syncope, right ventricular dysfunction, systolic blood pressure, and troponin vs. sPESI score and treat-all, treat-none strategies was evaluated on In-hospital mortality (AUC 0.70, 95% CI 0.630.77). An integrated model using syncope, right ventricular dysfunction, systolic blood pressure and troponin predicted in-hospital mortality with an optimism-corrected AUC of 0.70 (95% CI 0.63-0.77) in acute pulmonary embolism patients.