On the necessity of new decision-making methods for cancer-associated, symptomatic, pulmonary embolism

Carmona-Bayonas, Alberto; Font, Carme; Jiménez‐Fonseca, Paula; Fenoy, Francisco J.; Otero, Remedios; Beato, Carmen; Plasencia, J.; Biosca, Mercedes; Sánchez, Marcelo; Benegas, Mariana; Calvo-Temprano, David; Varona, Diego; Faez, L.; Vicente, M. A.; Haba, I. de la; Antonio, Maite; Madridano, Olga; Ramchandani, Avinash; Castañón, Eduardo; Marchena, Pablo Javier; Martínez, M.J.; Martín, Mar; Marín, Gema; Peña, Francisco Ayala de la; Vicente, V.

doi:10.1016/j.thromres.2016.05.010

Cited by 19 publications

(35 citation statements)

References 26 publications

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“…Insofar as the previously developed scales are concerned (RIETE, POMPE-C, PESI, etc.) (Aujesky et al , 2006; Jiménez et al , 2010; Kline et al , 2012; Den Exter et al , 2013), we do not know for sure if they can complement these criteria, although a preliminary analysis performed by our group suggests that their use is not likely to be necessary after applying a clinical classification rule (Carmona-Bayonas et al , 2016). …”

Section: Discussionmentioning

confidence: 99%

“…This registry's design, methods, and characteristics have been previously reported in depth (Carmona-Bayonas et al , 2016; Font et al , 2016; Plasencia-Martínez et al , 2016). Briefly put, the basic eligibility criteria required that patients be adults (⩾18 years) with a PE diagnosis confirmed by means of objective imaging (CT angiography scans, high probability scintigraphy, or CT scheduled to assess tumour response or for other reasons).…”

Section: Methodsmentioning

confidence: 99%

“…On the other hand, prognostic multivariate models have been created, such as the RIETE registry scale and POMPE-C score, that predict 30-day mortality probability following PE (Kline et al , 2012; Den Exter et al , 2013); although, at best, they are marginally superior to other classifications developed for PE in the general population (e.g., PESI or sPESI; Carmona-Bayonas et al , 2016). Nevertheless, using any of them to assist in decision-making involves problems, not least of which is that their suitability for incidental PE has yet to be proven (Kline et al , 2012; Den Exter et al , 2013).…”

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confidence: 99%

“…Nevertheless, using any of them to assist in decision-making involves problems, not least of which is that their suitability for incidental PE has yet to be proven (Kline et al , 2012; Den Exter et al , 2013). Furthermore, they are not sensitive to competitive risks, such as increased bleeding, responsible for some 10% of early mortality, or cancer progression, which accounts for 50% of 30-day mortality after a PE event (Den Exter et al , 2013; Carmona-Bayonas et al , 2016). …”

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confidence: 99%

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Predicting serious complications in patients with cancer and pulmonary embolism using decision tree modelling: the EPIPHANY Index

et al. 2017

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Background:Our objective was to develop a prognostic stratification tool that enables patients with cancer and pulmonary embolism (PE), whether incidental or symptomatic, to be classified according to the risk of serious complications within 15 days.Methods:The sample comprised cases from a national registry of pulmonary thromboembolism in patients with cancer (1075 patients from 14 Spanish centres). Diagnosis was incidental in 53.5% of the events in this registry. The Exhaustive CHAID analysis was applied with 10-fold cross-validation to predict development of serious complications following PE diagnosis.Results:About 208 patients (19.3%, 95% confidence interval (CI), 17.1–21.8%) developed a serious complication after PE diagnosis. The 15-day mortality rate was 10.1%, (95% CI, 8.4–12.1%). The decision tree detected six explanatory covariates: Hestia-like clinical decision rule (any risk criterion present vs none), Eastern Cooperative Group performance scale (ECOG-PS; <2 vs ⩾2), O2 saturation (<90 vs ⩾90%), presence of PE-specific symptoms, tumour response (progression, unknown, or not evaluated vs others), and primary tumour resection. Three risk classes were created (low, intermediate, and high risk). The risk of serious complications within 15 days increases according to the group: 1.6, 9.4, 30.6% P<0.0001. Fifteen-day mortality rates also rise progressively in low-, intermediate-, and high-risk patients: 0.3, 6.1, and 17.1% P<0.0001. The cross-validated risk estimate is 0.191 (s.e.=0.012). The optimism-corrected area under the receiver operating characteristic curve is 0.779 (95% CI, 0.717–0.840).Conclusions:We have developed and internally validated a prognostic index to predict serious complications with the potential to impact decision-making in patients with cancer and PE.

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Section: Discussionmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

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confidence: 99%

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Predicting serious complications in patients with cancer and pulmonary embolism using decision tree modelling: the EPIPHANY Index

et al. 2017

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“…Therefore, cancer-specific PE risk tools have been developed [7,8], but they do not account for UPE. Thus, contemporary clinical data that could fill this evidence gap are much needed to identify patients with cancer-associated PE who can safely be treated as outpatients [17,18].…”

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Symptoms, signs, suspicion and setting: a PESI score for cancer-associated pulmonary embolism?

Posch

2017

Eur Respir J

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Validation of the EPIPHANY index for predicting risk of serious complications in cancer patients with incidental pulmonary embolism

Kim

Cooksley²,

Banala

et al. 2018

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On the necessity of new decision-making methods for cancer-associated, symptomatic, pulmonary embolism

Cited by 19 publications

References 26 publications

Predicting serious complications in patients with cancer and pulmonary embolism using decision tree modelling: the EPIPHANY Index

Predicting serious complications in patients with cancer and pulmonary embolism using decision tree modelling: the EPIPHANY Index

Symptoms, signs, suspicion and setting: a PESI score for cancer-associated pulmonary embolism?

Validation of the EPIPHANY index for predicting risk of serious complications in cancer patients with incidental pulmonary embolism

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