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 all-cause 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.

中文翻译：

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急性肺栓塞患者的新型预后预测指标：那不勒斯预后评分

急性肺栓塞（APE）是一种潜在致命的疾病。早期风险分层对于确定适当的治疗至关重要。我们的目的是调查那不勒斯预后评分 (NPS) 对 APE 患者 30 天全因死亡率的预测价值。在这项回顾性分析中，根据 NPS，325 例 APE 住院患者被分为 0 组（n = 131）、1 组（n = 153）和 2 组（n = 41）。主要结局事件是入院之日起 30 天内随访期间的全因死亡率。评估每组 NPS、临床特征和结果之间的相关性。根据预后，患者被分为两组：幸存者（n = 294）和非幸存者（n = 31）。三个NPS组之间的比较结果显示，患者年龄较大、心率较快、收缩压较低、白蛋白和总胆固醇水平较低、中性粒细胞与淋巴细胞比值（NLR）较高、淋巴细胞与单核细胞比值较低（ LMR）、右心扩张、心力衰竭、恶性肿瘤和下肢静脉血栓形成的30天全因死亡率显着较高（P < 0.05）。NPS 预测 APE 患者 30 天内全因死亡的受试者工作特征曲线 (AUC) 下面积为 0.780（95% 置信区间 [CI] = 0.678–0.855），敏感性为 80.6%（95% CI） = 0.667–0.946)，特异性为 72.1% (95% CI = 0.670–0.772)。Kaplan-Meier (KM) 曲线显示，与其他两组相比，第 2 组 APE 患者的全因死亡风险最高（对数秩检验，P = 0.0004）。使用 Cox 比例风险模型的森林图可视化显示，30 天全因死亡风险显着增加 239%（风险比 [HR] = 3.385 [1.115–10.273]，P = 0.031）和 338%（HR） = 4.377 [1.228–15.598]，P = 0.023），趋势检验显示有统计学差异（P = 0.042）。该研究得出的结论是，NPS 是一种新颖、可靠的多维预后评分系统，可以很好地预测 APE 患者的 30 天全因死亡率。