Key result
PATHOS score predicts in-hospital PE mortality with 0.74 AUROC, outperforming PESI, sPESI, and shock index.
Why the study?
Existing PE risk stratification relies on PESI, which is complex and has debated validity, or sPESI, prompting the need for a new score to predict in-hospital mortality in the emergency department.
Does the PATHOS score improve prediction of in-hospital mortality compared to PESI, sPESI, and shock index in patients with pulmonary embolism?
Cohort (n=1,358)
Yes
Does the PATHOS score improve prediction of in-hospital mortality compared to PESI, sPESI, and shock index in patients with pulmonary embolism?
Effect estimate: AUROC 0.74 (95% CI 0.68-0.80)
Absolute Event Rate: 0.74% vs 0.68%
p-value: p=<0.01
The PATHOS score is a simple and effective tool that outperforms PESI, sPESI, and shock index for predicting in-hospital mortality in emergency department patients with pulmonary embolism.
May aid ED mortality risk stratification in pulmonary embolism; leaves open need for prospective validation before practice change.
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.
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Spampinato et al. (2022) conducted a cohort in Pulmonary embolism (n=1,358). PATHOS score vs. PESI, sPESI, and shock index was evaluated on In-hospital mortality (validation cohort AUROC) (AUROC 0.74, 95% CI 0.68-0.80, p=<0.01). The PATHOS score accurately predicted in-hospital mortality in pulmonary embolism patients with an AUROC of 0.74 in the validation cohort, significantly outperforming the PESI, sPESI, and shock index.
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