SPC365

THORS score, a better predictor of in-hospital and long-term mortality after acute pulmonary embolism?

Session: Comunicações Orais (Sessão 28) - Cardiopatias Congénitas, Doença Vascular Pulmonar e Embolia Pulmonar 3 - Vários Tópicos
Speaker: João Miguel Santos

Congress: CPC 2022
Topic: F. Valvular, Myocardial, Pericardial, Pulmonary, Congenital Heart Disease
Theme: 21. Pulmonary Circulation, Pulmonary Embolism, Right Heart Failure
Subtheme: 21.2 Pulmonary Circulation, Pulmonary Embolism, Right Heart Failure – Epidemiology, Prognosis, Outcome
Session Type: Comunicações Orais
FP Number: ---
Authors: João Miguel Santos; Vanda Neto; Inês Pires; Joana Correia; Gonçalo Ferreira; Emanuel Correia

<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><strong>Introduction</strong></span></span></p>

<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif">Pulmonary embolism (PE) is a frequent and life-threatening disorder associated with significant in-hospital mortality (IHM). Several scores for mortality prediction have been validated in these patients. Our purpose was to evaluate if a simple and objective score - THORS score -&nbsp;can predict prognosis in&nbsp;acute PE, comparing it to other previously validated scores.</span></span></p>

<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><strong>Methods </strong></span></span></p>

<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif">A retrospective analysis of 134 patients admitted for acute PE was performed. Patients with shock or hemodynamic instability at admission were excluded. FAST, PESI and BOVA scores were calculated for each patient. The newly designed THORS score (variables: <strong>S</strong>ystolic blood pressure, <strong>H</strong>eart rate, <strong>R</strong>ight ventricular pressure overload signs on CT scan, <strong>T</strong>roponin I serum levels and p<strong>O</strong>2/FiO2 ratio) was calculated for each patient (range 0-12&nbsp;points), after identification of the variables significantly associated with IHM (points attributed for each variable according to <em>odds ratio</em>). ROC curve analysis was performed to evaluate the predictive value of the different scores for IHM. Kaplan-Meyer survival plots were used to assess 8-year follow-up mortality (8YM) and the composite endpoint of 8-year re-hospitalization for cardiovascular causes or death (8YHD).</span></span></p>

<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><strong>Results</strong></span></span></p>

<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif">Mean age was 62&plusmn;17y; 62.7% were female; 15.7% had previous history of venous thromboembolism; 16.4% and 53.7% of patients, respectively, had an identifiable major or minor precipitating factor for PE. 32.8% had low-risk PE, 58.2% intermediate-low risk PE&nbsp;and 9% intermediate-high risk PE, as defined by current guidelines. Mean PESI&nbsp;was 94&plusmn;38, mean BOVA 3.7&plusmn;1.9, mean FAST 2.6&plusmn;1.6 and mean THORS score was 4.4&plusmn;2.8. IHM was 5.9%. 8YM and 8YHD rates were 27.1% and 55.6%, respectively. </span></span></p>

<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif">ROC curve analysis revealed that THORS score had the best predictive performance for IHM (AUC: 0.922, <em><span style="background-color:white"><span style="color:black">p</span></span></em><span style="background-color:white"><span style="color:black">=0.001), followed by FAST score (AUC: 0.750, <em>p</em>=0.04). Other scores had poor predictive performance for this outcome. The optimal cut-off point for IHM&nbsp;using THORS, assessed by the Youden index (YI), was 6 (YI: 0.857, sensitivity: 85.7%, specificity: 100%). </span></span>When stratified by risk categories (high risk if THORS score &gt;6 and low risk if THORS &le;6), we observed no in-hospital mortality in low-risk patients, while high-risk patients had 30.4% IHM risk.<span style="background-color:white"><span style="color:black"> Kaplan Meyer analysis by risk subgroup revealed significantly lower median time to 8-year mortality in patients with high-risk THORS score </span></span><span style="background-color:white"><span style="color:black">(1964&plusmn;276 days vs 2505&plusmn;99.4 days, mortality 43.5% vs 21.3%, </span></span><span style="background-color:white"><span style="color:black">&chi;</span></span><sup><span style="background-color:white"><span style="color:black">2</span></span></sup><span style="background-color:white"><span style="color:black">= 4.966, <em>p</em>= 0.026) in comparison with low-risk patients. Analysis of 8YHD rate did not reveal significant differences between groups (</span></span><span style="background-color:white"><span style="color:black">p= 0.541).</span></span></span></span></p>

<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><strong>Conclusion</strong></span></span></p>

<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif">THORS is a simple and objective score that allows excellent IHM risk prediction in patients hospitalized due to acute PE. This new score might be a better tool for IHM prediction in patients hospitalized due to PE and particularly useful for defining a low-risk subgroup, with very low IHM risk.</span></span></p>