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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

Maraveyas, Anthony; Kraaijpoel, Noémie; Bozas, George; Huang, Chao; Mahé, Isabelle; Bertoletti, Laurent; Bartels-Rutten, Annemarieke; Beyer-Westendorf, Jan; Constans, Joel; Iosub, Diana; Couturaud, Francis; Muñoz, Andres J.; Biosca, Mercedes; Lerede, Teresa; van Es, Nick; Di Nisio, Marcello; The UPE investigators; Accassat, S.; Aquilanti, S.; Assaf, J. D.; Baars, J.; Beenen, L. F.M.; Bergmann, J. F.; Caliandro, R.; Carrier, M.; Confrere, E.; Désormais, I.; Dublanchet, N.; Endig, S.; Falanga, A.; Falvo, N.; Ferrer Pérez, A. I.; García Escobar, I.; Gonzàlez Santiago, S.; Grange, C.; Helfer, H.; Kleinjan, A.; Lalezari, F.; de Magalhaes, E.; Marten, S.; Martinez del Prado, P.; Otten, H. M.; Paleiron, N.; Pérez Ramírez, S.; Pinson, M.; Piovella, F.; Planquette, B.; Rickles, F.; Russi, I.; Rutjes, A. W.; Salgado Fernàndez, M.; Sanchez, O.; Sevestre, M. A.; Schmidt, J.; Thaler, J.; Torres Pérez-Solero, G.; Tromeur, C.; Zumàrraga Cuesta, A.

Authors

Anthony Maraveyas

Noémie Kraaijpoel

George Bozas

Isabelle Mahé

Laurent Bertoletti

Annemarieke Bartels-Rutten

Jan Beyer-Westendorf

Joel Constans

Diana Iosub

Francis Couturaud

Andres J. Muñoz

Mercedes Biosca

Teresa Lerede

Nick van Es

Marcello Di Nisio

The UPE investigators

S. Accassat

S. Aquilanti

J. D. Assaf

J. Baars

L. F.M. Beenen

J. F. Bergmann

R. Caliandro

M. Carrier

E. Confrere

I. Désormais

N. Dublanchet

S. Endig

A. Falanga

N. Falvo

A. I. Ferrer Pérez

I. García Escobar

S. Gonzàlez Santiago

C. Grange

H. Helfer

A. Kleinjan

F. Lalezari

E. de Magalhaes

S. Marten

P. Martinez del Prado

H. M. Otten

N. Paleiron

S. Pérez Ramírez

M. Pinson

F. Piovella

B. Planquette

F. Rickles

I. Russi

A. W. Rutjes

M. Salgado Fernàndez

O. Sanchez

M. A. Sevestre

J. Schmidt

J. Thaler

G. Torres Pérez-Solero

C. Tromeur

A. Zumàrraga Cuesta



Abstract

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 14days 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.

Citation

Maraveyas, A., Kraaijpoel, N., Bozas, G., Huang, C., Mahé, I., Bertoletti, L., Bartels-Rutten, A., Beyer-Westendorf, J., Constans, J., Iosub, D., Couturaud, F., Muñoz, A. J., Biosca, M., Lerede, T., van Es, N., Di Nisio, M., Accassat, S., The UPE investigators, Aquilanti, S., Assaf, J. D., …Zumàrraga Cuesta, A. (2021). 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. Journal of thrombosis and haemostasis : JTH, 19(11), 2791-2800. https://doi.org/10.1111/jth.15489

Journal Article Type Article
Acceptance Date Aug 9, 2021
Online Publication Date Sep 16, 2021
Publication Date Nov 1, 2021
Deposit Date Apr 4, 2022
Journal Journal of Thrombosis and Haemostasis
Print ISSN 1538-7933
Publisher Wiley
Peer Reviewed Peer Reviewed
Volume 19
Issue 11
Pages 2791-2800
DOI https://doi.org/10.1111/jth.15489
Keywords Cancer associated thrombosis; Clinical prediction rule; Incidental pulmonary embolism; Risk assessment model; Unsuspected pulmonary embolism
Public URL https://hull-repository.worktribe.com/output/3820507