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.

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Journal
Journal of Autoimmunity
Published
2026-04-20
DOI
https://doi.org/10.1016/j.jaut.2026.103555
Primary Topic
Systemic Sclerosis and Related Diseases
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article
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article

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

Luc Mouthon, Edoardo Rosato, Lorenzo Tofani, Rosario Foti et al.
Journal of Autoimmunity
Systemic Sclerosis and Related Diseases
article

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

Luc Mouthon, Edoardo Rosato, Lorenzo Tofani, Rosario Foti, Michele Iudici, Antonella Marcoccia, Rucsandra Dobrota, Elena Rezuş, Ana-Maria Ramazan, Marie‐Elise Truchetet, Branimir Anić, Simona Rednic, Jorge Juan González Martín, Hadi Poormoghim, Cosimo Bruni, Massimiliano Limonta, Ana Maria Gheorghiu, Luca Idolazzi, Valeria Riccieri, Mette Mogensen, Addolorata Corrado, Julia Spierings, Simone Matteo Negrini, Carina Mihai, M. Parvu, Nicoletta Del Papa, Britta Maurer, Muriel Elhaï, Anna Wojteczek, Vasiliki Liakouli, Elisabetta Zanatta, Marco Matucci Cerinic, Nico Hunzelmann, Ulf Müeller-Ladner, Figen Yargucu Zhini, Joerg Henes, Sule Yavuz, Andra Balanescu, Lidia P. Ananieva, Gianluca Moroncini, Florenzo Iannone, Christina Bergmann, Maria De Santis, Paolo Airò, Ulrich Andreas Walker, Oliver Distler, Anna-Maria Hoffmann-Vold, Mickaël Martin, Yair Levy, Alberto Cauli, Arsene Mekinian, Martin Aringer, Gabriela Riemekasten, Masataka Kuwana, Gesa Sauer, Bojana Stamenkovic, Tomas Soukup, Svetlana Agachi, Silvia Bellando-Randone, Radim Bečvář, Carmen-Pilar Simeón-Aznar, Mike O. Becker, Kamal Solanki, Ignasi Rodriguez-Pinto, David Launay, Ina Koetter, Vanessa Smith, Yoshiya Tanaka, Petros Sfikakis, Yannick Allanore, Florian Käs, Francesco Del Galdo, Mislav Radic, Gábor Kumánovics, Patricia E. Carreira
article en

Abstract

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.

Journal of AutoimmunityVol. 160
University of Zurich (CH), Iuliu Hațieganu University of Medicine and Pharmacy (RO), Université de Poitiers (FR), Institute of Rheumatology (CZ), University Hospital of Zurich (CH), Hospital Universitario 12 De Octubre (ES), Istituto Ortopedico Gaetano Pini (IT), NIHR Leeds Musculoskeletal Biomedical Research Unit (GB), Azienda Ospedaliero-Universitaria Careggi (IT), Vall d'Hebron Hospital Universitari (ES), Kerckhoff Klinik (DE), Spitalul Clinic Colentina (RO), Spitalul Clinic Judetean de Urgenta Sibiu (RO), University of Pecs (HU), University of Brescia (IT)
Good health and well-being
Openalex Percentile: Top 21%
Systemic Sclerosis and Related Diseases
DOIOpen Access PDFOpenAlex
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