CC-BY 4.0 · TH Open 2018; 02(02): e158-e166
DOI: 10.1055/s-0038-1642022
Original Article
Georg Thieme Verlag KG Stuttgart · New York

Predictors of Early Mortality in Cancer-Associated Thrombosis: Analysis of the RIETE Database

Alfonso J. Tafur
NorthShore University HealthSystem, Evanston, Illinois, United States
,
Harry Fuentes
John Stroger Cook County Hospital, Chicago, Illinois, United States
,
Joseph A. Caprini
NorthShore University HealthSystem, Evanston, Illinois, United States
,
Agustina Rivas
Hospital Universitario Araba, Álava, Spain
,
F. Uresandi
Hospital de Cruces, Barakaldo, Vizcaya, Spain
,
Rita Duce
Ospedale Galliera, Genova, Italy
,
Raquel Lopez-Reyes
Hospital Universitari i Politècnic La Fe, Valencia, Spain
,
Adriana Visona
Ospedale Castelfranco Veneto, Castelfranco Veneto, Italy
,
Adel Merah
Université Jean-Monnet, Service de Medecine Vasculaire et Therapeutique, CHU de Saint Etienne, Saint-Etienne, France
,
Manuel Monreal
Hospital Universitario Germans Trias i Pujol de Badalona, Universidad Católica de Murcia, Barcelona, Spain
› Author Affiliations
Further Information

Publication History

19 December 2017

13 March 2018

Publication Date:
19 April 2018 (online)

Abstract

Cancer-associated thrombosis (CT) carries a high, heterogeneous, and poorly predicted likelihood of mortality. Thus, we aimed to define predictors of 30-day mortality in 10,025 patients with CT. In a randomly selected derivation cohort, we used recursive partitioning analysis to detect variables that select for a risk of mortality within 30 days. In a validation cohort, we evaluated our results using Cochran–Armitage test. The most common types of cancer were lung (16%), breast (14%), and colorectal (14%); median age was 69 years (range, 14–101); most had metastatic disease (63%); 13% of patients died within 30 days. In the derivation cohort (n = 6,660), a white blood cell (WBC) count in the highest quartile predicted early mortality (odds ratio, 7.8; 95% confidence interval [CI], 4.6–13.1); and the presence of metastatic disease, pulmonary embolism (PE), and immobility defined the risk of those with normal WBC count. We defined death risk according four sequential questions: (1) Does the patient have an elevated WBC count? (Yes, group D). (2) If no, does the patient have metastasis? (No, group A). (3) If yes, is the patient immobile? (Yes, group D). (4) If no, does the patient have a PE? (Yes, group C; no, group B). In the validation cohort (n = 3,365), the 30-day risk of death was 2.9% in group A (95% CI, 1.9–4.3), compared with 25% in group D (95% CI, 22.5–27.5), and there was a rate escalation between groups (p for trend < 0.01). In conclusion, with four sequential questions, the risk of death in CT can be easily stratified. An elevated WBC count at baseline predicted 30-day mortality better than metastases, PE, or immobility.