Current guidelines on the management of pericardial diseases suggest to
identify high-risk features associated with an increased risk of
non-idiopathic aetiology and complications. The aim of this study is to
evaluate a “pericarditis score” to assess potential complicated
pericarditis in order to facilitate initial clinical triage. Consecutive
patients with pericarditis were included in a prospective cohort study
from January 2017 to December 2018. Complicated pericarditis was defined
as pericarditis with a non-idiopathic aetiology, and/or complications,
and/or requiring hospitalization. A clinical and echocardiographic
follow-up were performed at 1, 3, 6 months and then every 6 months. The
study population was randomized in derivation and validation cohorts. In
the derivation cohort, female gender (HR 2.57, p = 0.016), fever > 38
degrees C (HR 2.86, p = 0.005), previous lack of colchicine use (HR
3.16, p = 0.006), previous use of corticosteroids (HR 3.01, p = 0.009),
and echocardiographic signs of constriction (HR 2.26, p = 0.018) were
selected by a stepwise procedure in a Cox regression model and
constituted the score showing a C-statistics of 0.81. In the validation
group, the score was significantly associated with the risk of
complicated pericarditis (HR 1.438 per 10-points increase, 95% CI
1.208-1.711, p < 0.001) and showed an increase in event rate with
increasing score (low risk <= 20 points: complicated pericarditis in
4/19 patients, incidence 21%, p = 0.003, high risk > 40 points:
complicated pericarditis in 18/24 patients, incidence 75%, p = 0.006).
In this study, we developed and tested a simple score to efficiently
identify at presentation patients at high risk of developing complicated
pericarditis