Background: Risk stratification clinical prognostic rules (CPRs) commonly used to predict adverse outcomes of suspected pulmonary embolism (PE) have limitations in discriminating outcomes for ambulatory cancer patients with incidental PE (IPE). The HULL score, derived from the prospective cohort of 234 ambulatory cancer patients from 2010-2014, uses a 5-point scoring system incorporating performance status and self-reported new or recently evolving symptoms at IPE diagnosis (1). It stratifies patients into low, intermediate and high risk for adverse outcomes at 30, 90 and 180 days.

Aims: To validate the HULL CPR in a prospective cohort of ambulatory cancer patients with IPE derived from the same clinical setting.

Methods: 284 consecutive patients managed under the IPE-acute oncology service in HUTH NHS trust from January 2015 to March 2020 were included. Primary outcome measures were 30-day, 90-day, 180-day mortality and overall survival (OS) for the three risk categories. Other parameters studied were hospitalization within 30-days post IPE diagnosis, recurrent venous thromboembolism (VTE) and major bleeding.

Results: Survival curves for the Hull score groups for the first 12 months of follow-up for validation cohort. Line separators for the 30-day, 90-day, 180-day cut-offs and the median for survival are included.Mortality by HULL CPR score in derivation (2010-2014) and validation (2015-2020) cohorts

30-day, 90-day and 180-day mortality for the whole cohort was 3.4% (n=7), 21.1% (n=43) and 39.2% (n= 80) respectively. Recurrence occurred in 10.6% (30), major bleeding in 3.9% (11); 12.8% (36) hospitalized within 30 days post IPE. The HULL score stratified them into low 35.5% (100), intermediate 33.7% (95) and high 28.7% (81) risk groups (Figure 1). Correlation of the risk categories with 30-day, 90-day,180-day mortality and OS was consistent with the derivation cohort (area under curve [AUC] 0.72 [95% CI 0.52, 0.91], AUC 0.77 [95% CI 0.70, 0.84], AUC 0.75 [95% CI 0.69, 0.81] respectively, p <0.001 for OS). (Figure 2).

Conclusions: This study validates the capacity of the HULL score to stratify mortality risk in ambulatory cancer patients with IPE. It is composed of practical oncological parameters and can guide the outpatient management of IPE in an acute oncology setting.

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ISTH Congress Abstracts - https://abstracts.isth.org/abstract/validation-of-the-hull-clinical-prognostic-rule-cpr-for-incidental-pulmonary-embolism-in-ambulatory-cancer-patients/