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

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

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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