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

Käs F, Elhai M, Becker MO, Dobrota R, Mihai C, Sauer G, Tofani L, Bečvář R, Rednic S, Carreira PE, Kumánovics G, Airò P, Mueller-Ladner U, Del Galdo F, Ramazan AM, Martin M, Simeón-Aznar CP, Parvu M, Del Papa N, Hoffmann-Vold AM, Distler O, Bruni C, Bellando-Randone S, Walker UA, Iannone F, Allanore Y, Iudici M, Zanatta E, Moroncini G, Radic M, Hunzelmann N, Idolazzi L, Henes J, Stamenkovic B, De Santis M, Ananieva LP, Negrini S, Launay D, Riccieri V, Balanescu A, Gheorghiu AM, Bergmann C, Mouthon L, Smith V, Corrado A, Mogensen M, Aringer M, Anić B, Yavuz S, Agachi S, Cauli A, Solanki K, Rosato E, Zhini FY, Foti R, Maurer B, Gonzalez Martin JJ, Limonta M, Marcoccia A, Koetter I, Wojteczek A, Riemekasten G, Levy Y, Rezus E, Poormoghim H, Liakouli V, Sfikakis P, Truchetet ME, Cerinic MM, Spierings J, Kuwana M, Mekinian A, Tanaka Y, Soukup T, Rodriguez-Pinto I (2026)

Publication Type: Journal article

Publication year: 2026

Journal

Book Volume: 160

Article Number: 103555

DOI: 10.1016/j.jaut.2026.103555

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.

Authors with CRIS profile

Involved external institutions

Ospedale Policlinico San Martino Italy (IT) Centre Hospitalier Régional Universitaire de Lille (CHRU de Lille) France (FR) Universitätsspital Zürich (USZ) Switzerland (CH) Università degli Studi di Firenze / University of Florence Italy (IT) Univerzita Karlova v Praze / Charles University in Prague Czech Republic (CZ) Iuliu Hațieganu University of Medicine and Pharmacy / Universitatea de Medicină și Farmacie "Iuliu Hațieganu" (UMF Cluj) Romania (RO) Hospital Universitario 12 de Octubre Spain (ES) University of Pécs / Pécsi Tudományegyetem Hungary (HU) Azienda Ospedale Università Padova / University Hospital of Padova Italy (IT) Azienda Ospedaliero Universitaria Ospedali Riuniti Ancona Italy (IT) University of Split / Sveučilište u Splitu Croatia (HR) Universitätsklinikum Köln Germany (DE) University of Verona / Università degli Studi di Verona Italy (IT) Universitätsklinikum Tübingen Germany (DE) University of Nish Serbia (RS) Humanitas Research Hospital / IRCCS Istituto Clinico Humanitas Italy (IT) V.A. Nasonova Research Institute of Rheumatology Russian Federation (RU) Università degli Studi di Brescia Italy (IT) Justus-Liebig-Universität Gießen Germany (DE) University of Leeds United Kingdom (GB) Spitalului Clinic Județean de Urgență "Sf. Apostol Andrei" Constanța / The Clinical Emergency Hospital of Constanta County Romania (RO) Centre hospitalier universitaire de Poitiers (CHU de Poitiers) France (FR) Vall d'Hebron University Hospital / Hospital Universitari Vall d'Hebron Spain (ES) Spitalul Clinic Colentina Romania (RO) ASST Centro Specialistico Ortopedico Traumatologico Gaetano Pini-CTO Italy (IT) Nicolae Testemițanu State University of Medicine and Pharmacy / Universitatea de Stat de Medicină și Farmacie „Nicolae Testemițanu” Moldova, Republic of (MD) Università degli Studi di Cagliari Italy (IT) University of Waikato New Zealand (NZ) Università degli studi "La Sapienza" Italy (IT) Ege University / Ege Üniversitesi Turkey (TR) Policlinico San Marco Italy (IT) Inselspital, Universitätsspital Bern Switzerland (CH) HM Hospitals Spain (ES) Azienda Ospedaliera Papa Giovanni XXIII Italy (IT) Medical University Gdansk / Gdański Uniwersytet Medyczny Poland (PL) Universitätsklinikum Schleswig-Holstein (UKSH) Germany (DE) Meir Medical Center / מרכז רפואי מאיר Israel (IL) Grigore T. Popa University of Medicine and Pharmacy / Universitatea de Medicină și Farmacie "Grigore T. Popa" (UMF Iași) Romania (RO) Firoozgar General Hospital / بیمارستان آموزشی و درمانی فیروزگر Iran, Islamic Republic of (IR) Università degli studi della Campania Luigi Vanvitelli Italy (IT) Centre Hospitalier Universitaire de Bordeaux / CHU Bordeaux France (FR) Università Vita-Salute San Raffaele (UniSR) Italy (IT) University Medical Centre Utrecht (UMC Utrecht) Netherlands (NL) Nippon Medical School Hospital / 日本医科大学付属病院 Japan (JP) Hôpital Saint-Antoine France (FR) University of Occupational and Environmental Health Japan / 産業医科大学 Japan (JP) University Hospital Hradec Králové / Fakultní Nemocnice Hradec Králové Czech Republic (CZ) Hospital Clínic de Barcelona Spain (ES) Universitätsspital Basel Switzerland (CH) University of Bari Aldo Moro / Università degli Studi di Bari Aldo Moro Italy (IT) Université Paris Cité France (FR) Geneva University Hospitals / Hôpitaux universitaires de Genève (HUG) Switzerland (CH) Carol Davila University of Medicine and Pharmacy / Universitatea de Medicină și Farmacie „Carol Davila” (UMF București) Romania (RO) Hôpital Cochin France (FR) Universiteit Gent (UGent) / Ghent University Belgium (BE) University of Foggia / Università degli studi di Foggia Italy (IT) Bispebjerg Hospital Denmark (DK) Universitätsklinikum Carl Gustav Carus Dresden Germany (DE) Zagreb University Hospital Centre / Klinički bolnički centar Zagreb (KBC) Croatia (HR) Istanbul Science University / Demiroğlu Bilim Üniversitesi Turkey (TR)

How to cite

APA:

Käs, F., Elhai, M., Becker, M.O., Dobrota, R., Mihai, C., Sauer, G.,... Rodriguez-Pinto, I. (2026). 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. Journal of Autoimmunity, 160. https://doi.org/10.1016/j.jaut.2026.103555

MLA:

Käs, Florian, et al. "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." Journal of Autoimmunity 160 (2026).

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