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

Kim, Won Young; Cooksley, Tim; Banala, Srinivas R.; Buffardi, Luke; Rice, Terry W.

doi:10.1007/s00520-018-4235-9

Cited by 11 publications

(11 citation statements)

References 20 publications

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“…Third, the capacity to discriminate prognosis in incidental episodes is one of the most noteworthy contributions, since the rest of the scores were designed for acute, symptomatic PE [37] and do not contain the variables that make it possible to discriminate levels of risk within unsuspected PE. Our results are consistent with the retrospective validation by Ahn et al, focused on incidental PE, that reported a 15-day complication rate of 3.4, 8.9, and 23.8% for low-, intermediate-, and high-risk EPIPHANY episodes [28]. In return, the EPIPHANY Index/Hestia criteria perform worse in acute, symptomatic PE, as patients in this scenario are rarely classified as low risk.…”

Section: Discussionsupporting

confidence: 91%

“…for low-, intermediate-, and high-risk EPIPHANY episodes [28]. In return, the EPIPHANY Index/Hestia criteria perform worse in acute, symptomatic PE, as patients in this scenario are rarely classified as low risk.…”

Section: Discussionmentioning

confidence: 99%

“…In contrast with other proposals, the EPIPHANY Index is applicable across the entire gamut of PE severity (suspected or unsuspected). A meta-analysis comparing the accuracy of clinical decision rules found that higher sensitivity is obtained with the Hestia criteria and the EPIPHANY Index [27]; however, validations of both sets of criteria in patients with cancer are meager [28].…”

Section: Introductionmentioning

confidence: 99%

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Prediction of serious complications in patients with cancer and pulmonary thromboembolism: validation of the EPIPHANY Index in a prospective cohort of patients from the PERSEO Study

Sánchez-Cánovas

Jiménez-Fonseca

Garay

et al. 2022

Preprint

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Introduction: There is currently no validated score capable of classifying cancer-associated pulmonary embolism (PE) in its full spectrum of severity. This study has validated the EPIHANY Index, a new tool to predict serious complications in cancer patients with suspected or unsuspected PE. Method: The PERSEO Study prospectively recruited individuals with PE and cancer from 22 Spanish hospitals. The estimation of the relative frequency θ of complications based on the EPIPHANY Index categories was made using the Bayesian alternative for the binomial test. Results: Nine hundred patients diagnosed with PE between 2017/2020 were recruited. The rate of serious complications at 15 days was 11.8%, 95% highest density interval [HDI], 9.8-14.1%. Of the EPIPHANY low-risk patients, 2.4% (95% HDI, 0.8-4.6%) had serious complications, as did 5.5% (95% HDI, 2.9-8.7%) of the moderate-risk participants and 21.0% (95% HDI, 17.0-24.0%) of those with high-risk episodes. The EPIPHANY Index correlated with overall survival. Both the EPIPHANY Index and the Hestia criteria exhibited greater negative predictive value and a lower negative likelihood ratio than the remaining models. The incidence of bleeding at 6 months was 6.2% (95% HDI, 2.9-9.5%) in low/moderate-risk vs 12.7% (95% HDI, 10.1-15.4%) in high-risk (p-value=0.037) episodes. Of the outpatients, complications at 15 days were recorded in 2.1% (95% HDI, 0.7-4.0%) of the cases with EPIPHANY low/intermediate-risk vs 5.3% (95% HDI, 1.7-11.8%) in high-risk cases. Conclusion: We have validated the EPIPHANY Index in patients with incidental or symptomatic cancer-related PE. This model can contribute to standardize decision-making in a scenario lacking quality evidence.

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Section: Discussionsupporting

confidence: 91%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Prediction of serious complications in patients with cancer and pulmonary thromboembolism: validation of the EPIPHANY Index in a prospective cohort of patients from the PERSEO Study

Sánchez-Cánovas

Jiménez-Fonseca

Garay

et al. 2022

Preprint

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“…Individualized management of acute cancer presentations is essential in emergency oncology services so it can mirror routine cancer care [57]. The spectrum of emergency cancer presentations is increasing and includes not only FN but also incidental pulmonary embolism, indwelling line infections, and chemotherapy-related acute kidney injury, which can be risk assessed for care in these settings [57][58][59].…”

Section: Expanded Use Of Granulocyte Colony-stimulating Factor Duringmentioning

confidence: 99%

Emerging challenges in the evaluation of fever in cancer patients at risk of febrile neutropenia in the era of COVID-19: a MASCC position paper

Cooksley¹,

Font

Scotté

et al. 2020

Support Care Cancer

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Patients with cancer are at higher risk of more severe COVID-19 infection and have more associated complications. The position paper describes the management of cancer patients, especially those receiving anticancer treatment, during the COVID-19 pandemic. Dyspnea is a common emergency presentation in patients with cancer with a wide range of differential diagnoses, including pulmonary embolism, pleural disease, lymphangitis, and infection, of which SARS-CoV-2 is now a pathogen to be considered. Screening interviews to determine whether patients may be infected with COVID-19 are imperative to prevent the spread of infection, especially within healthcare facilities. Cancer patients testing positive with no or minimal symptoms may be monitored from home. Telemedicine is an option to aid in following patients without potential exposure. Management of complications of systemic anticancer treatment, such as febrile neutropenia (FN), is of particular importance during the COVID-19 pandemic where clinicians aim to minimize patients' risk of infection and need for hospital visits. Outpatient management of patients with low-risk FN is a safe and effective strategy. Although the MASCC score has not been validated in patients with suspected or confirmed SARS-CoV-2, it has nevertheless performed well in patients with a range of infective illnesses and, accordingly, it is reasonable to expect efficacy in the clinical setting of COVID-19. Risk stratification of patients presenting with FN is a vital tenet of the evolving sepsis and pandemic strategy, necessitating access to locally formulated services based on MASCC and other national and international guidelines. Innovative oncology services will need to utilize telemedicine, hospital at home, and ambulatory care services approaches not only to limit the number of hospital visits but also to anticipate the complications of the anticancer treatments.

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“…The EPIPHANY index may be a useful adjunct tool in supporting physicians considering outpatient management for cancer patients with IPE. [17] Cancerassociated DVT is another important presentation suitable for ambulatory management.…”

Section: Ambulatory Emergency Oncology Presentationsmentioning

confidence: 99%

Ambulatory emergency oncology: A key tenet of future emergency oncology care

Cooksley¹,

Marshall

Kim

et al. 2019

Int J Clin Pract

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The challenges of emergency oncology alongside its increasing financial burden has led to an interest in developing optimal care models for meeting patients' needs. Ambulatory care is recognized as a key tenet in ensuring the safety and sustainability of acute care services. Increased access to ambulatory care has successfully reduced ED utilization and improved clinical outcomes in high risk non-Oncological populations. Individualised management of acute cancer presentations is a key challenge for emergency oncology services so that it can mirror routine cancer care. There are an increasing number of acute cancer presentations, such as low risk febrile neutropenia and incidental pulmonary embolism, that can be risk assessed for care in an emergency ambulatory setting. Modelling of ambulatory emergency oncology services will be dependent on local service deliveries and pathways, but are key for providing high quality, personalised and sustainable emergency oncology care. These services will also be at the forefront of much needed emergency oncology to define the optimal management of ambulatory-sensitive presentations.

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

Abstract: Our study suggests the EPIPHANY index could be a useful adjunct tool in risk stratification of cancer patients with IPE.

Cited by 11 publications

References 20 publications

Prediction of serious complications in patients with cancer and pulmonary thromboembolism: validation of the EPIPHANY Index in a prospective cohort of patients from the PERSEO Study

Prediction of serious complications in patients with cancer and pulmonary thromboembolism: validation of the EPIPHANY Index in a prospective cohort of patients from the PERSEO Study

Emerging challenges in the evaluation of fever in cancer patients at risk of febrile neutropenia in the era of COVID-19: a MASCC position paper

Ambulatory emergency oncology: A key tenet of future emergency oncology care

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