External Validation of Generic and Cancer-Specific Risk Stratification Tools in Patients With Pulmonary Embolism and Active Cancer

Weeda, Erin R.; Caranfa, Jonathan T.; Zeichner, Simon B.; Coleman, Craig I.; Nguyen, Elaine; Kohn, Christine G.

doi:10.6004/jnccn.2017.7004

Cited by 9 publications

(12 citation statements)

References 18 publications

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“…The reported mortality rate, demographics, and cancer type distribution in our study are consistent with that observed in recent cancer thrombosis trials. 6 10 11 13 In the EPIPHANY trial, it was already noted that among patients with cancer-associated PE, there were some predictors of death that overlap with our findings. 23 The authors evaluated 1,033 patients with PE and found that performance status and metastatic disease were predictors of death.…”

Section: Discussionsupporting

confidence: 81%

“…7 8 In contrast, POMPE-C was derived from a population with PE and cancer; it has a better performance in external validation (AUC, 0.8), but is only specific to patients with cancer who present with PE. 9 10 11 These scores have a segmented and limited approach to mortality prediction in CT; the scores assume that only patients with PE will have a high mortality. Fatal PE alone does not appear to explain the high death rate after CT. 12 The likelihood of fatal PE among patients with a history of VTE and cancer was described in the Registro Informatizado de Enfermedad TromboEmbólica (RIETE) database and was 1.4% at 3 months.…”

Section: Introductionmentioning

confidence: 99%

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Predictors of Early Mortality in Cancer-Associated Thrombosis: Analysis of the RIETE Database

Tafur

Fuentes

Caprini

et al. 2018

TH Open

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Cancer-associated thrombosis (CT) carries a high, heterogeneous, and poorly predicted likelihood of mortality. Thus, we aimed to define predictors of 30-day mortality in 10,025 patients with CT. In a randomly selected derivation cohort, we used recursive partitioning analysis to detect variables that select for a risk of mortality within 30 days. In a validation cohort, we evaluated our results using Cochran-Armitage test. The most common types of cancer were lung (16%), breast (14%), and colorectal (14%); median age was 69 years (range, 14-101); most had metastatic disease (63%); 13% of patients died within 30 days. In the derivation cohort (n ¼ 6,660), a white blood cell (WBC) count in the highest quartile predicted early mortality (odds ratio, 7.8; 95% confidence interval [CI], 4.6-13.1); and the presence of metastatic disease, pulmonary embolism (PE), and immobility defined the risk of those with normal WBC count. We defined death risk according four sequential questions: (1) (Yes, group C; no, group B). In the validation cohort (n ¼ 3,365), the 30-day risk of death was 2.9% in group A (95% CI, 1.9-4.3), compared with 25% in group D (95% CI, 22.5-27.5), and there was a rate escalation between groups (p for trend < 0.01). In conclusion, with four sequential questions, the risk of death in CT can be easily stratified. An elevated WBC count at baseline predicted 30-day mortality better than metastases, PE, or immobility.

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Section: Discussionsupporting

confidence: 81%

Section: Introductionmentioning

confidence: 99%

Predictors of Early Mortality in Cancer-Associated Thrombosis: Analysis of the RIETE Database

Tafur

Fuentes

Caprini

et al. 2018

TH Open

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“…). Eight studies evaluating 10 CPRs in 3974 (range 124 to 1075) unique patients reported mortality data in low‐ and higher‐risk PE patients with cancer and were included in our meta‐analysis (Table ) [; E.R. Weeda, unpublished data].…”

Section: Resultsmentioning

confidence: 99%

“…The Geneva Prognostic Score (GPS) was used in three patient groups; a clinical decision rule developed by Carmona‐Bayonas et al ., criteria by Font and colleagues, and both modified PESI and simplified PESI (sPESI) rules were evaluated in two patient groups each; the Registro de Embolia Pulmonar en Pacientes con Neoplasias (EPIPHANY) index and Hestia score were used in one patient group each. In both the modified PESI and modified sPESI rules, investigators replaced the ‘cancer’ variable with a more specific requirement for ‘metastatic’ disease .…”

Section: Resultsmentioning

confidence: 99%

Clinical prediction rules for mortality in patients with pulmonary embolism and cancer to guide outpatient management: a meta‐analysis

Nguyen

Caranfa

Lyman

et al. 2018

Journal of Thrombosis and Haemostasis

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Background Cancer treatment is commonly complicated by pulmonary embolism (PE), which remains a leading cause of morbidity and mortality in these patients. Some guidelines recommend the use of clinical prediction rules (CPRs) to help clinicians identify patients at low risk of mortality and therefore guide care. Objective To determine and compare the accuracy of available CPRs for identifying cancer patients with PE at low risk of mortality. Methods A literature search of Medline and Scopus (January 2000 to August 2017) was performed. Studies deriving/validating ≥ 1 CPR for early post-PE all-cause mortality were included. A bivariate, random-effects model was used to pool sensitivity and specificity estimates for each CPR. Traditional random-effects meta-analysis was performed to estimate the weighted proportion of patients deemed at low risk of early mortality, mortality in low risk patients and odds ratios for death compared with higher-risk patients. Results Eight studies evaluating 10 CPRs were included. The highest sensitivities were observed with Hestia (98.1%, 95% confidence interval [CI] = 75.6-99.9%) and the EPIPHANY index (97.4%, 95% CI = 93.2-99.0%); sensitivities of remaining rules ranged from 59.9 to 96.6%. Of the six CPRs with sensitivities ≥ 95%, none had specificities > 33%. Random-effects meta-analysis suggested that 6.6-51.6% of cancer patients with PE were at low risk of mortality, 0-14.3% of low-risk patients died and low-risk patients had a 43-94% lower odds of death compared with those at higher risk. Conclusions Because of the limited total body of evidence regarding CPRs, their results, in conjunction with other pertinent patient-specific clinical factors, should continue to be used in identifying appropriate management for PE in patients with cancer.

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“…Only thrombophilia, history of DVT or PE and OC achieved statistically significant results [13]. [20].…”

Section: Risk Factors Paediatric Patientsmentioning

confidence: 95%

Pulmonary embolism - assessment of risk factors and emboli locations

Komisarczuk

Kaczor

Kopyto

et al. 2020

J Educ Health Sport

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INTRODUCTION: Pulmonary embolism (PE) is a widespread disorder, which appears as a result of closure or restriction of main pulmonary artery or its branches and is often associated with deep vein thrombosis (DVT).The severity and clinical picture is frequently erratic and what is worrying it is a major cause of hospitalization and mortality in Europe. OBJECTIVE:The main purpose of our study was to demonstrate meaning of emboli location in prognosis, favour risk factors which could be overlooked by clinicians and help to avoid further misdiagnosis. ABBREVIATED DESRCIPTION OF THE STATE OF KNOWLEDGE:We highlighted the importance of defining a genetic profile, personal and family history of VTE, especially in patients with atypical pulmonary symptoms. Moreover, the awareness of possible occurring PE among children, during serious infections or in patients with malignancy is still insufficient. Furthermore, according our analysis clinical symptoms in patients with pulmonary embolism are undoubtedly influenced by the location. The more massive the thrombus appears, the more serious consequences can be expected for the patient. Along with the size of the thrombus, the risk of its complications increases because of haemodynamic changes.SUMMARY:Diagnosing of pulmonary embolism in hemodynamically stable patients is still challenging for clinicians. There were many attempts to find significant and unmistakeable relationship between emboli location in pulmonary vasculature and prognosis.That knowledge could be helpful for clinicians in setting accurate diagnosis, implementing appropriate treatment and avoid possible life-threatening consequences.Risk stratification is crucial to the management and prognosis of patients with acute PE.

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External Validation of Generic and Cancer-Specific Risk Stratification Tools in Patients With Pulmonary Embolism and Active Cancer

Cited by 9 publications

References 18 publications

Predictors of Early Mortality in Cancer-Associated Thrombosis: Analysis of the RIETE Database

Predictors of Early Mortality in Cancer-Associated Thrombosis: Analysis of the RIETE Database

Clinical prediction rules for mortality in patients with pulmonary embolism and cancer to guide outpatient management: a meta‐analysis

Pulmonary embolism - assessment of risk factors and emboli locations

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