A novel prognostic prediction indicatior in patients with acute pulmonary embolism: Naples prognostic score
Ning Zhu1†, Shanhong Lin2† and Chao Cao1*
Abstract
Acute pulmonary embolism (APE) is a potentially fatal disease. Early risk stratification is essential to determining
appropriate treatment. We aimed to investigate the predictive value of the Naples Prognostic Score (NPS) for 30-
day all-cause mortality in patients with APE. In this retrospective analysis, 325 hospitalized patients with APE were
divided into Groups 0 (n = 131), 1 (n = 153), and 2 (n = 41) according to the NPS. The primary outcome event was
all-cause mortality during 30 days of follow-up from the day of admission. The correlation between NPS, clinical
features, and outcomes in each group was evaluated. The patients were divided into two groups, survivor (n = 294)
and nonsurvivor (n = 31), according to their prognosis. The results of the comparison between the three NPS
groups revealed that patients with older age, faster heart rate, lower systolic blood pressure, low albumin and total
cholesterol levels, high neutrophil to lymphocyte ratio (NLR), low lymphocyte-to-monocyte ratio (LMR), right heart
dilatation, heart failure, malignancy, and lower extremity venous thrombosis had significantly higher 30-day allcause
mortality (P < 0.05). Area under the receiver operating characteristic curve (AUC) for NPS to predict all-cause
death within 30 days in patients with APE was 0.780 (95% confidence interval [CI] = 0.678–0.855), with sensitivity
being 80.6% (95% CI = 0.667–0.946) and specificity being 72.1% (95% CI = 0.670–0.772). Kaplan-Meier (KM) curves
showed that Group 2 APE patients had the highest risk of all-cause mortality compared with the other two groups
(log-rank test, P = 0.0004). Forest plot visualization using the Cox proportional hazard model showed a significant
increase in the risk of 30-day all-cause mortality by 239% (hazard ratio [HR] = 3.385 [1.115–10.273], P = 0.031) and
338% (HR = 4.377 [1.228–15.598], P = 0.023), and the trend test showed a statistical difference (P = 0.042). The study
concluded that NPS is a novel, reliable, and multidimensional prognostic scoring system with good prediction of
30-day all-cause mortality in patients with APE.
Keywords Acute Pulmonary Embolism, Naples Prognostic score, Mortality, Prediction
NON-2024-0670