Abstract Number: OC 23.3
Meeting: ISTH 2021 Congress
Background: The optimal risk stratification of unsuspected pulmonary embolism (UPE) in ambulatory cancer patients remains unclear. Existing prognostic models have been developed from retrospective datasets, mostly of suspected PE cases and have limitations. The UPE registry collected data prospectively from an ambulatory population with active cancer and a diagnosis of recent UPE.
Aims: To assess risk factors for recurrent venous thromboembolism (rVTE), major bleeding (MB), and death in cancer patients with UPE.
Methods: 695 patients with UPE were included in multivariate logistic regression and competing risk survival analyses to identify factors independently associated with proximate (30-day, 90-day and 180-day) mortality, overall survival, rVTE, and MB. The most consistent predictors found were subjected to an exploratory analysis using the Hull CPR, an existing 5-point prediction rule (1). Receiver operating characteristic analysis was used to assess discriminatory performance.
Results: During 12-month follow-up, 283 patients had died (cumulative incidence, 41%; 95% CI, 39 to 46) with 30-day, 90-day and 180-day mortality of 5.6% (n=39), 15.0% (n=104), and 25.2% (n=175), respectively. Most consistent predictors of mortality were patient-reported respiratory symptoms within 2 weeks before, and ECOG performance status score at the time of UPE diagnosis (Table).
Exploratory application of these predictors to the Hull CPR produced a consistent correlation with 30-day, 90-day and 180-day 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)(Figure). No factors were associated with MB or rVTE.
Conclusions: In ambulatory cancer patients with UPE computation of ECOG performance status logged contemporaneously to the UPE diagnosis and self-reported respiratory symptoms prior to UPE diagnosis can stratify mortality risk. When applied to the HULL-CPR these risk predictors reproduced the risk stratification of the derivation cohort(1).
To cite this abstract in AMA style:Maraveyas A, Kraaijpoel N, Georgios B, Huang C, Mahe I, Bertoletti L, Bartels-Rutten A, Beyer-Westendorf J, Constans J, Iosub D, Couturaud F, Munoz A, Biosca M, Lerede T, Van Es N, Di Nisio M. The Prognostic Value of Symptoms and Performance Status in Ambulatory Cancer Patients and Unsuspected Pulmonary Embolism: Analysis of an International, Prospective, Observational Cohort Study [abstract]. Res Pract Thromb Haemost. 2021; 5 (Suppl 2). https://abstracts.isth.org/abstract/the-prognostic-value-of-symptoms-and-performance-status-in-ambulatory-cancer-patients-and-unsuspected-pulmonary-embolism-analysis-of-an-international-prospective-observational-cohort-study/. Accessed December 11, 2023.
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