Padua prediction score and IMPROVE score do predict in-hospital mortality in Internal Medicine patients
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Padua prediction score and IMPROVE score do predict in‑hospital mortality in Internal Medicine patients Guido Giuseppe Arpaia1 · Alessandro Caleffi2 · Giuseppe Marano3 · Micaela Laregina4 · Giulia Erba1 · Francesco Orlandini5 · Claudio Cimminiello6 · Patrizia Boracchi3 Received: 9 October 2019 / Accepted: 17 December 2019 © Società Italiana di Medicina Interna (SIMI) 2020
Abstract Padua prediction score (PPS) and IMPROVE bleeding score are validated tools for venous thromboembolism (VTE) risk assessment recommended by guidelines, albeit not frequently used. Some data suggest that a positive PPS and IMPROVE score may be were associated with early mortality in Internal Medicine patients. Aim of the study was to characterize the predictive ability on mortality of the two scores using two different populations, respectively, as derivation and validation cohort. The derivation cohort consisted of 1956 Internal Medicine patients admitted to La Spezia Hospital in 2013. 399 Internal Medicine patients admitted to Carate Brianza Hospital in 2016 constituted the validation cohort. PPS and IMPROVE scores were applied to each patient using their validated cutoffs. Frequency of positive PPS and mortality were significantly higher in La Spezia patients. In the derivation cohort, the positivity of at least one of the two scores was associated with a significantly higher mortality compared to both negative scores. Similar results were observed in the validation cohort. In the derivation cohort, the sensitivity of a positive PPS score in predicting mortality was 0.97 (0.94, 0.98) but the specificity was 0.21 (0.19, 0.23), the negative likelihood ratio being 0.15. Sensitivity and specificity of a positive IMPROVE gave specular findings but the positive likelihood ratio was 2.19. The accuracy data in the validation cohort were in the same direction. Both PPS and IMPROVE are associated with in-hospital mortality but their additional predictive accuracy is modest. It is unlikely that both scores could be useful in clinical practice to predict death in hospitalized Internal Medicine patients. Keywords Mortality · Prognosis · Venous thromboembolism · Risk assessment models · Padua prediction score · IMPROVE score
Introduction * Claudio Cimminiello [email protected] 1
Internal Medicine, Medical Department, Carate Brianza Hospital, ASST Di Vimercate, Vimercate, Italy
2
Internal Medicine, Medical Department, Vimercate Hospital, ASST Di Vimercate, Vimercate, Italy
3
Department of Clinical Sciences and Community Health, Laboratory of Medical Statistics, Epidemiology and Biometry G. A. Maccacaro, University of Milan, Milan, Italy
4
Risk Management Unit, ASL5 Liguria, La Spezia, Italy
5
Medical Direction, ASL4 Liguria, Chiavari, Italy
6
Research and Study Center of the Italian Society of Angiology and Vascular Pathology (Società Italiana Di Angiologia E Patologia VascolareSIAPAV), viale Gorizia 22, 20144 Milan, Italy
Venous thromboembolism (VTE) is a leading cause of preventable death in hosp
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