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).

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.

Supplementary Material



Publication History

Received: 12 August 2020

Accepted: 13 January 2021

Publication Date:
15 January 2021 (online)

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