TY - JOUR
T1 - 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
AU - Maraveyas, Anthony
AU - Kraaijpoel, Noémie
AU - Bozas, George
AU - Huang, Chao
AU - Mahé, Isabelle
AU - Bertoletti, Laurent
AU - Bartels-Rutten, Annemarieke
AU - Beyer-Westendorf, Jan
AU - Constans, Joel
AU - Iosub, Diana
AU - Couturaud, Francis
AU - Muñoz, Andres J.
AU - Biosca, Mercedes
AU - Lerede, Teresa
AU - van Es, Nick
AU - di Nisio, Marcello
AU - the UPE investigators
AU - Accassat, S.
AU - Aquilanti, S.
AU - Assaf, J. D.
AU - Baars, J.
AU - Beenen, L. F. M.
AU - Bergmann, J. F.
AU - Caliandro, R.
AU - Carrier, M.
AU - Confrere, E.
AU - Désormais, I.
AU - Dublanchet, N.
AU - Endig, S.
AU - Falanga, A.
AU - Falvo, N.
AU - Ferrer Pérez, A. I.
AU - García Escobar, I.
AU - Gonzàlez Santiago, S.
AU - Grange, C.
AU - Helfer, H.
AU - Kleinjan, A.
AU - Lalezari, F.
AU - de Magalhaes, E.
AU - Marten, S.
AU - Martinez del Prado, P.
AU - Otten, H. M.
AU - Paleiron, N.
AU - Pérez Ramírez, S.
AU - Pinson, M.
AU - Piovella, F.
AU - Planquette, B.
AU - Rickles, F.
AU - Russi, I.
AU - Rutjes, A. W.
AU - Thaler, J.
N1 - Publisher Copyright: © 2021 International Society on Thrombosis and Haemostasis.
PY - 2021/11
Y1 - 2021/11
N2 - Background: Optimal risk stratification of unsuspected pulmonary embolism (UPE) in ambulatory cancer patients (ACPs) remains unclear. Existing clinical predictive rules (CPRs) are derived from retrospective databases and have limitations. The UPE registry is a prospective international registry with pre-specified characteristics of ACPs with a recent UPE. The aim of this study was to assess the utility of risk factors captured in the UPE registry in predicting proximate (30-, 90- and 180-day) mortality and how they performed when applied to an existing CPR. Objectives: To evaluate risk factors for proximate mortality, overall survival, recurrent venous thromboembolism and major bleeding, in the patients enrolled in the UPE registry cohort. Methods: Data from the 695 ACPs in this registry were subjected to multivariate logistic regression analyses to identify predictors independently associated with proximate mortality and overall survival. The most consistent predictors were applied to the Hull CPR, an existing 5-point prediction rule. Results: The most consistent predictors of mortality were patient-reported respiratory symptoms within 14 days before, and ECOG performance status at the time of UPE. These predictors applied to the Hull-CPR produced a consistent correlation with proximate mortality and overall survival (area under the curve [AUC] = 0.70 [95% CI 0.63, 077], AUC = 0.65 [95% CI 0.60, 070], AUC = 0.64 [95% CI 0.59, 068], and AUC = 0.61, 95% CI 0.57, 0.65, respectively). Conclusion: In ACPs with UPE, ECOG performance status logged contemporaneously to the UPE diagnosis and respiratory symptoms prior to UPE diagnosis can stratify mortality risk. When applied to the HULL-CPR these risk predictors confirmed the risk stratification clusters of low-intermediate and high-risk for proximate mortality as seen in the original derivation cohort.
AB - Background: Optimal risk stratification of unsuspected pulmonary embolism (UPE) in ambulatory cancer patients (ACPs) remains unclear. Existing clinical predictive rules (CPRs) are derived from retrospective databases and have limitations. The UPE registry is a prospective international registry with pre-specified characteristics of ACPs with a recent UPE. The aim of this study was to assess the utility of risk factors captured in the UPE registry in predicting proximate (30-, 90- and 180-day) mortality and how they performed when applied to an existing CPR. Objectives: To evaluate risk factors for proximate mortality, overall survival, recurrent venous thromboembolism and major bleeding, in the patients enrolled in the UPE registry cohort. Methods: Data from the 695 ACPs in this registry were subjected to multivariate logistic regression analyses to identify predictors independently associated with proximate mortality and overall survival. The most consistent predictors were applied to the Hull CPR, an existing 5-point prediction rule. Results: The most consistent predictors of mortality were patient-reported respiratory symptoms within 14 days before, and ECOG performance status at the time of UPE. These predictors applied to the Hull-CPR produced a consistent correlation with proximate mortality and overall survival (area under the curve [AUC] = 0.70 [95% CI 0.63, 077], AUC = 0.65 [95% CI 0.60, 070], AUC = 0.64 [95% CI 0.59, 068], and AUC = 0.61, 95% CI 0.57, 0.65, respectively). Conclusion: In ACPs with UPE, ECOG performance status logged contemporaneously to the UPE diagnosis and respiratory symptoms prior to UPE diagnosis can stratify mortality risk. When applied to the HULL-CPR these risk predictors confirmed the risk stratification clusters of low-intermediate and high-risk for proximate mortality as seen in the original derivation cohort.
KW - cancer associated thrombosis
KW - clinical prediction rule
KW - incidental pulmonary embolism
KW - risk assessment model
KW - unsuspected pulmonary embolism
UR - http://www.scopus.com/inward/record.url?scp=85115337296&partnerID=8YFLogxK
U2 - https://doi.org/10.1111/jth.15489
DO - https://doi.org/10.1111/jth.15489
M3 - Article
C2 - 34532927
SN - 1538-7933
VL - 19
SP - 2791
EP - 2800
JO - Journal of thrombosis and haemostasis
JF - Journal of thrombosis and haemostasis
IS - 11
ER -