Beyond screening for pulmonary arterial hypertension: The DETECT score is a potential promising prediction tool for all-cause mortality in systemic sclerosis: Analysis from the EUSTAR database.

BACKGROUND

Systemic sclerosis (SSc) is characterized by an increased mortality. Various mortality risk factors are included in the DETECT algorithm, a screening tool for SSc-associated pulmonary arterial hypertension. We tested the DETECT score as a predictor of all-cause mortality in SSc.

METHODS

SSc patients from the European Scleroderma Trial And Research (EUSTAR) cohort, with available data for calculating the DETECT and the SCOpE (currently proposed risk algorithm) scores and follow-up were included. Patients from the University Hospital Zurich served as derivation cohort, the remaining EUSTAR patients formed the validation cohort. Uni- and multivariable Cox regression tested the DETECT score as a predictor of mortality. A time-dependent ROC curve analysis was used to assess predictive accuracy (at 1, 3, and 5 years), and to derive and validate optimal cutoffs.

RESULTS

The derivation cohort (n = 605) showed less cardio-pulmonary and diffuse cutaneous involvements, but longer follow-up and higher mortality than the validation cohort (n = 1017). The DETECT score independently predicted mortality in both cohorts, even after excluding pulmonary hypertension patients. Time-dependent ROC analysis showed excellent predictive accuracy for mortality (AUC>0.85) in the derivation cohort, non-inferior to the SCOpE score. In the validation cohort, a moderate-to-good performance for 1-year mortality was retained. A DETECT score>40 demonstrated strong performance (sensitivity≥0.68; specificity≥0.83) in the derivation, and performed moderately in the validation cohort (sensitivity = 0.54; specificity = 0.71).

CONCLUSION

The DETECT score robustly predicts all-cause mortality in SSc across phenotypically different cohorts. A DETECT score>40 may refine risk stratification, guiding tighter monitoring and management. Further validation over 1-year outcomes is warranted.