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Thromb Haemost 2021; 121(06): 834-844
DOI: 10.1055/a-1355-3549
Stroke, Systemic or Venous Thromboembolism

Comparison of Different Clinical Prognostic Scores in Patients with Pulmonary Embolism and Active Cancer

Xiaoqian Li
1   Department of Respiratory and Critical Care Medicine, West China Hospital of Sichuan University, Chengdu, China
,
Yuehong Hu
1   Department of Respiratory and Critical Care Medicine, West China Hospital of Sichuan University, Chengdu, China
,
Ping Lin
1   Department of Respiratory and Critical Care Medicine, West China Hospital of Sichuan University, Chengdu, China
,
Jiarui Zhang
1   Department of Respiratory and Critical Care Medicine, West China Hospital of Sichuan University, Chengdu, China
,
Yongjiang Tang
1   Department of Respiratory and Critical Care Medicine, West China Hospital of Sichuan University, Chengdu, China
,
Qun Yi
1   Department of Respiratory and Critical Care Medicine, West China Hospital of Sichuan University, Chengdu, China
,
Zong'an Liang
1   Department of Respiratory and Critical Care Medicine, West China Hospital of Sichuan University, Chengdu, China
,
Haixia Zhou
1   Department of Respiratory and Critical Care Medicine, West China Hospital of Sichuan University, Chengdu, China
,
Maoyun Wang
1   Department of Respiratory and Critical Care Medicine, West China Hospital of Sichuan University, Chengdu, China
› Author Affiliations Funding This study was supported by the National Key Research Program of China (grant 2016YFC1304202) and the Sichuan Science and Technology Program (grants 2015JY0176 and 2019YJ0152).
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Comment on:

Risk Scores for Death in Patients with Cancer-related Venous Thromboembolism: Still a Long Road AheadThromb Haemost 2021; 121(06): 700-702
DOI: 10.1055/s-0041-1727244

Abstract

Objective This article aimed to validate and compare the prognostic performance of generic scores (Pulmonary Embolism Severity Index [PESI] and Hestia) and cancer-specific pulmonary embolism (PE)/venous thromboembolism (VTE) scales (Registro Informatizado de la Enfermedad TromboEmbólica [RIETE], POMPE-C, and modified Ottawa) in PE patients with active cancer.

Methods A retrospective study was conducted among 460 patients with PE and active cancer. The primary outcome was 30-day overall mortality. Secondary outcomes were 30-day PE-related death and overall adverse outcomes. The prognostic accuracy of clinical scores was determined using receiver operating characteristic (ROC) curve analysis.

Results Within 30 days, 18.0% of patients died, 2.0% suffered major bleeding, and 0.2% presented recurrence of VTE. All scales showed a high area under the ROC curve (AUC) for predicting 30-day overall mortality except modified Ottawa (0.74 [0.70–0.78] for PESI, Hestia, and RIETE; 0.78 (0.74–0.81) for POMPE-C; 0.64 (0.59–0.68) for modified Ottawa]. PESI divided the least patients (9.1%) into low risk, followed by modified Ottawa (17.0%). Hestia stratified the most patients (65.4%) as low risk. But overall mortality of low-risk patients based on these three scales is high (>5%). RIETE and POMPE-C both classified 30.9% of patients as low risk, and low-risk patients stratified by these two scales presented a low overall mortality (1.4 and 3.5%). Similar predictive performance was found for 30-day PE-related death and overall adverse outcomes in these scores.

Conclusion Cancer-specific PE prognostic scores (RIETE and POMPE-C) performed better than generic scales (PESI and Hestia) and a cancer-specific VTE prognostic scale (modified Ottawa) in identifying low-risk PE patients with active cancer who may be suitable for outpatient treatment.

Keywords

pulmonary embolism - active cancer - clinical prognostic scores

Supplementary Material



Publication History

Received: 12 August 2020

Accepted: 13 January 2021

Accepted Manuscript online:
15 January 2021

Article published online:
09 March 2021

© 2021. Thieme. All rights reserved.

Georg Thieme Verlag KG
Rüdigerstraße 14, 70469 Stuttgart, Germany

 

  • References

  • 1 Chew HK, Wun T, Harvey D, Zhou H, White RH. Incidence of venous thromboembolism and its effect on survival among patients with common cancers. Arch Intern Med 2006; 166 (04) 458-464
    CrossrefPubMedGoogle Scholar
  • 2 Khorana AA, Francis CW, Culakova E, Kuderer NM, Lyman GH. Thromboembolism is a leading cause of death in cancer patients receiving outpatient chemotherapy. J Thromb Haemost 2007; 5 (03) 632-634
    CrossrefPubMedGoogle Scholar
  • 3 Heit JA. Epidemiology of venous thromboembolism. Nat Rev Cardiol 2015; 12 (08) 464-474
    CrossrefPubMedGoogle Scholar
  • 4 Stein PD, Beemath A, Matta F. et al. Clinical characteristics of patients with acute pulmonary embolism: data from PIOPED II. Am J Med 2007; 120 (10) 871-879
    CrossrefPubMedGoogle Scholar
  • 5 Auer RA, Scheer AS, McSparron JI. et al. Postoperative venous thromboembolism predicts survival in cancer patients. Ann Surg 2012; 255 (05) 963-970
    CrossrefPubMedGoogle Scholar
  • 6 Sørensen HT, Mellemkjaer L, Olsen JH, Baron JA. Prognosis of cancers associated with venous thromboembolism. N Engl J Med 2000; 343 (25) 1846-1850
    CrossrefPubMedGoogle Scholar
  • 7 Epstein AS, O'Reilly EM. Exocrine pancreas cancer and thromboembolic events: a systematic literature review. J Natl Compr Canc Netw 2012; 10 (07) 835-846
    CrossrefPubMedGoogle Scholar
  • 8 Mandalà M, Reni M, Cascinu S. et al. Venous thromboembolism predicts poor prognosis in irresectable pancreatic cancer patients. Ann Oncol 2007; 18 (10) 1660-1665
    CrossrefPubMedGoogle Scholar
  • 9 Spencer FA, Goldberg RJ, Lessard D. et al. Factors associated with adverse outcomes in outpatients presenting with pulmonary embolism: the Worcester Venous Thromboembolism Study. Circ Cardiovasc Qual Outcomes 2010; 3 (04) 390-394
    CrossrefPubMedGoogle Scholar
  • 10 Laporte S, Mismetti P, Décousus H. et al; RIETE Investigators. Clinical predictors for fatal pulmonary embolism in 15,520 patients with venous thromboembolism: findings from the Registro Informatizado de la Enfermedad TromboEmbolica venosa (RIETE) Registry. Circulation 2008; 117 (13) 1711-1716
    CrossrefPubMedGoogle Scholar
  • 11 Streiff MB, Bockenstedt PL, Cataland SR. et al; National Comprehensive Cancer Network. Venous thromboembolic disease. J Natl Compr Canc Netw 2013; 11 (11) 1402-1429
    CrossrefPubMedGoogle Scholar
  • 12 Konstantinides SV, Meyer G, Becattini C. et al; The Task Force for the Diagnosis and Management of Acute Pulmonary Embolism of the European Society of Cardiology (ESC). 2019 ESC Guidelines for the diagnosis and management of acute pulmonary embolism developed in collaboration with the European Respiratory Society (ERS): the Task Force for the diagnosis and management of acute pulmonary embolism of the European Society of Cardiology (ESC). Eur Respir J 2019; 54 (03) 1901647
    CrossrefPubMedGoogle Scholar
  • 13 Kearon C, Akl EA, Ornelas J. et al. Antithrombotic therapy for VTE disease: CHEST guideline and expert panel report. Chest 2016; 149 (02) 315-352
    CrossrefPubMedGoogle Scholar
  • 14 Aujesky D, Obrosky DS, Stone RA. et al. Derivation and validation of a prognostic model for pulmonary embolism. Am J Respir Crit Care Med 2005; 172 (08) 1041-1046
    CrossrefPubMedGoogle Scholar
  • 15 Zondag W, Mos IC, Creemers-Schild D. et al; Hestia Study Investigators. Outpatient treatment in patients with acute pulmonary embolism: the Hestia Study. J Thromb Haemost 2011; 9 (08) 1500-1507
    CrossrefPubMedGoogle Scholar
  • 16 den Exter PL, Gómez V, Jiménez D. et al; Registro Informatizado de la Enfermedad TromboEmbólica (RIETE) Investigators. A clinical prognostic model for the identification of low-risk patients with acute symptomatic pulmonary embolism and active cancer. Chest 2013; 143 (01) 138-145
    CrossrefPubMedGoogle Scholar
  • 17 Kline JA, Roy PM, Than MP. et al. Derivation and validation of a multivariate model to predict mortality from pulmonary embolism with cancer: the POMPE-C tool. Thromb Res 2012; 129 (05) e194-e199
    CrossrefPubMedGoogle Scholar
  • 18 Louzada ML, Carrier M, Lazo-Langner A. et al. Development of a clinical prediction rule for risk stratification of recurrent venous thromboembolism in patients with cancer-associated venous thromboembolism. Circulation 2012; 126 (04) 448-454
    CrossrefPubMedGoogle Scholar
  • 19 Jiménez D, Aujesky D, Moores L. et al; RIETE Investigators. Simplification of the Pulmonary Embolism Severity Index for prognostication in patients with acute symptomatic pulmonary embolism. Arch Intern Med 2010; 170 (15) 1383-1389
    CrossrefPubMedGoogle Scholar
  • 20 Howard LSGE, Barden S, Condliffe R. et al. British Thoracic Society Guideline for the initial outpatient management of pulmonary embolism (PE). Thorax 2018; 73 (Suppl. 02) ii1-ii29
    CrossrefPubMedGoogle Scholar
  • 21 Pfaundler N, Limacher A, Stalder O. et al. Prognosis in patients with cancer-associated venous thromboembolism: comparison of the RIETE-VTE and modified Ottawa score. J Thromb Haemost 2020; 18 (05) 1154-1161
    CrossrefPubMedGoogle Scholar
  • 22 Alatri A, Mazzolai L, Kucher N. et al. The modified Ottawa score and clinical events in hospitalized patients with cancer-associated thrombosis from the Swiss VTE Registry. Semin Thromb Hemost 2017; 43 (08) 871-876
    Article in Thieme ConnectPubMedGoogle Scholar
  • 23 Yamashita Y, Morimoto T, Amano H. et al; COMMAND VTE Registry Investigators. Usefulness of simplified Pulmonary Embolism Severity Index Score for identification of patients with low-risk pulmonary embolism and active cancer: from the COMMAND VTE Registry. Chest 2020; 157 (03) 636-644
    CrossrefPubMedGoogle Scholar
  • 24 Pollack CV, Schreiber D, Goldhaber SZ. et al. Clinical characteristics, management, and outcomes of patients diagnosed with acute pulmonary embolism in the emergency department: initial report of EMPEROR (Multicenter Emergency Medicine Pulmonary Embolism in the Real World Registry). J Am Coll Cardiol 2011; 57 (06) 700-706
    CrossrefPubMedGoogle Scholar
  • 25 Bergstrom N, Braden BJ, Laguzza A, Holman V. The Braden scale for predicting pressure sore risk. Nurs Res 1987; 36 (04) 205-210
    CrossrefPubMedGoogle Scholar
  • 26 Tritschler T, Kraaijpoel N, Langlois N. et al. Development of a standardized definition of pulmonary embolism-related death: a cross-sectional survey of international thrombosis experts. J Thromb Haemost 2020; 18 (06) 1415-1420
    CrossrefPubMedGoogle Scholar
  • 27 Büller HR, Décousus H, Grosso MA. et al; Hokusai-VTE Investigators. Edoxaban versus warfarin for the treatment of symptomatic venous thromboembolism. N Engl J Med 2013; 369 (15) 1406-1415
    CrossrefPubMedGoogle Scholar
  • 28 Schulman S, Kearon C. Subcommittee on Control of Anticoagulation of the Scientific and Standardization Committee of the International Society on Thrombosis and Haemostasis. Definition of major bleeding in clinical investigations of antihemostatic medicinal products in non-surgical patients. J Thromb Haemost 2005; 3 (04) 692-694
    CrossrefPubMedGoogle Scholar
  • 29 Zondag W, den Exter PL, Crobach MJ. et al; Hestia Study Investigators. Comparison of two methods for selection of out of hospital treatment in patients with acute pulmonary embolism. Thromb Haemost 2013; 109 (01) 47-52
    Article in Thieme ConnectPubMedGoogle Scholar
  • 30 Otero R, Uresandi F, Jiménez D. et al. Home treatment in pulmonary embolism. Thromb Res 2010; 126 (01) e1-e5
    CrossrefPubMedGoogle Scholar
  • 31 Vaughn JE, Buckley SA, Walter RB. Outpatient care of patients with acute myeloid leukemia: benefits, barriers, and future considerations. Leuk Res 2016; 45: 53-58
    CrossrefPubMedGoogle Scholar
  • 32 Efficace F, Kemmler G, Vignetti M, Mandelli F, Molica S, Holzner B. Health-related quality of life assessment and reported outcomes in leukaemia randomised controlled trials - a systematic review to evaluate the added value in supporting clinical decision making. Eur J Cancer 2008; 44 (11) 1497-1506
    CrossrefPubMedGoogle Scholar
  • 33 Blom JW, Doggen CJ, Osanto S, Rosendaal FR. Malignancies, prothrombotic mutations, and the risk of venous thrombosis. JAMA 2005; 293 (06) 715-722
    CrossrefPubMedGoogle Scholar