Elevated white blood cell count and outcome in cancer patients with venous thromboembolism

Javier Trujillo-Santos; Pierpaolo Di Micco; Mariateresa Iannuzzo; Ramón Lecumberri; Ricardo Guijarro; Olga Madridano; Manuel Monreal; for the RIETE Investigators

doi:10.1160/TH08-05-0339

Thrombosis and Haemostasis, Table of Contents

Thromb Haemost 2008; 100(05): 905-911
DOI: 10.1160/TH08-05-0339

Cellular Proteolysis and Oncology

Schattauer GmbH

Elevated white blood cell count and outcome in cancer patients with venous thromboembolism

Findings from the RIETE Registry^[*]

Javier Trujillo-Santos

¹Department of Internal Medicine, Hospital Universitario Santa María de Rosell, Cartagena, Murcia, Spain

,

Pierpaolo Di Micco

²Internal Medicine and Emergency Room, Ospedale Buon Consiglio Fatebenefratelli, Naples, Italy

,

Mariateresa Iannuzzo

³Department of Epidemiology, Fatebenefratelli Hospital, Naples, Italy

,

Ramón Lecumberri

⁴Department of Haematology, Clinica Universitaria de Navarra, Pamplona, Spain

,

Ricardo Guijarro

⁵Departament of Internal Medicine, Hospital Universitario Carlos Haya, Málaga, Spain

,

Olga Madridano

⁶Departament of Internal Medicine, Hospital La Paz, Madrid, Spain

,

Manuel Monreal

⁷Department of Internal Medicine, Hospital Universitari Germans Trias i Pujol, Badalona, Spain

,

for the RIETE Investigators

› Author Affiliations

Abstract

Summary

A significant association between elevated white blood cell (WBC) count and mortality in patients with cancer has been reported,but the predictive value of elevatedWBC on mortality in cancer patients with acute venous thromboembolism (VTE) has not been explored. RIETE is an ongoing registry of consecutive patients with acute VTE. We compared the three-month outcome of cancer patients with acuteVTE according to theirWBC count at baseline. As of May 2007, 3805 patients with active cancer and acuteVTE had been enrolled in RIETE. Of them, 215 (5.7%) had low- (<4,000 cells/µl), 2,403 (63%) normal- (4,000–11,000 cells/µl), 1,187 (31%) elevated (>11,000 cells/µl) WBC count. During the study period 190 patients (5.0%) had recurrent VTE, 156 (4.1%) major bleeding, 889 (23%) died (399 of disseminated cancer, 113 of PE, 46 of bleeding. Patients with elevated WBC count at baseline had an increased incidence of recurrent VTE (odds ratio [OR]: 1.6; 95% confidence interval [CI]:1.2–2.2),major bleeding (OR:1.5;95% CI:1.1–2.1) or death (OR:2.7;95% CI:2.3–3.2).Most of the reported causes of death were significantly more frequent in patients with elevated BC count.Multivariate analysis confirmed that elevated WBC count was independently associated with an increased incidence of all three complications. In conclusion, cancer patients with acute VTE and elevated WBC count had an increased incidence of VTE recurrences,major bleeding or death. This worse outcome was consistent among all subgroups and persisted after multivariate adjustment.

Keywords

Cancer - leukocytosis - venous thromboembolism - outcome

Full Text

References

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