Anthony Maraveyas
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
Noémie Kraaijpoel
George Bozas
Dr Chao Huang C.Huang@hull.ac.uk
Reader in Statistics
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 |
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