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

Posch, Florian; Ay, Cihan

doi:10.1183/13993003.02225-2016

Cited by 5 publications

(2 citation statements)

References 24 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…This suggests that purely radiological inclusion criteria have enrolled an unselected cohort that includes very ill non-ambulatory patients. Even the 4S derivative rule from the EPIPHANY dataset does little more than categorize the truly asymptomatic UPE (TAUPE)-only subgroup of the ambulatory population 26,27 leaving the rest of the cohort un-stratified.…”

Section: Discussionmentioning

confidence: 99%

The prognostic value of respiratory symptoms and performance status in ambulatory cancer patients and unsuspected pulmonary embolism; analysis of an international, prospective, observational cohort study

Maraveyas

Kraaijpoel

Bozas

et al. 2021

Journal of Thrombosis and Haemostasis

View full text Add to dashboard Cite

show abstract

Section: Discussionmentioning

confidence: 99%

The prognostic value of respiratory symptoms and performance status in ambulatory cancer patients and unsuspected pulmonary embolism; analysis of an international, prospective, observational cohort study

Maraveyas

Kraaijpoel

Bozas

et al. 2021

Journal of Thrombosis and Haemostasis

View full text Add to dashboard Cite

show abstract

“…However, the score is only valid for patients with PE; the performance in patients with cancer is modest (area under the curve [AUC], 0.7), and cancer as a single variable is very heavily weighted in the score, potentially limiting dispersion of the model. 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.…”

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

View full text Add to dashboard Cite

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.

show abstract

External validation of three risk stratification rules in patients presenting with pulmonary embolism and cancer

Weeda

Caranfa

Lyman

et al. 2018

Support Care Cancer

View full text Add to dashboard Cite

Numerous risk stratification rules exist to predict post-pulmonary embolism (PE) mortality; however, few were designed for use in cancer patients. In the EPIPHANY registry, adapted versions of common rules (the Hestia criteria, Pulmonary Embolism Severity Index [PESI], and simplified PESI [sPESI]) displayed high sensitivity for prognosticating mortality in PE patients with cancer. These adapted rules have yet to be externally validated. Therefore, we sought to evaluate the performance of an adapted Hestia criteria, PESI, and sPESI for predicting 30-day post-PE mortality in patients with cancer. We identified consecutive, adults presenting with objectively confirmed PE and cancer to our institution (November 2010 to January 2014). The proportion of patients categorized as low or high risk by these three risk stratification rules was calculated, and each rule's accuracy for predicting 30-day all-cause mortality was determined. Of the 124 patients with PE and active cancer identified, 25 (20%) experienced mortality at 30 days. The adapted Hestia criteria categorized 23 (19%) patients as low risk, while exhibiting a sensitivity of 88% (95% confidence interval [CI] = 68-97%), a negative predictive value NPV of 87% (95% CI = 65-97%), and a specificity of 20% (95% CI = 13-30%). A total of 38 (31%) and 30 (24%) patients were low risk by the adapted PESI and sPESI, with both displaying sensitivities of 92% and NPVs> 93%. Specificities were 36% (95% CI = 27-47%) and 28% (95% CI = 20-38%) for PESI and sPESI. In our external validation, the adapted Hestia, PESI, and sPESI demonstrated high sensitivity but low specificity for 30-day PE mortality in patients with cancer. Larger, prospective trials are needed to optimize strategies for risk stratification in this population.

show abstract

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

Cited by 5 publications

References 24 publications

The prognostic value of respiratory symptoms and performance status in ambulatory cancer patients and unsuspected pulmonary embolism; analysis of an international, prospective, observational cohort study

The prognostic value of respiratory symptoms and performance status in ambulatory cancer patients and unsuspected pulmonary embolism; analysis of an international, prospective, observational cohort study

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

External validation of three risk stratification rules in patients presenting with pulmonary embolism and cancer

Contact Info

Product

Resources

About