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Thromb Haemost 2021; 121(06): 834-844
DOI: 10.1055/a-1355-3549
Stroke, Systemic or Venous Thromboembolism

Comparison of Different Clinical Prognostic Scores in Patients with Pulmonary Embolism and Active Cancer

Xiaoqian Li
1   Department of Respiratory and Critical Care Medicine, West China Hospital of Sichuan University, Chengdu, China
,
Yuehong Hu
1   Department of Respiratory and Critical Care Medicine, West China Hospital of Sichuan University, Chengdu, China
,
Ping Lin
1   Department of Respiratory and Critical Care Medicine, West China Hospital of Sichuan University, Chengdu, China
,
Jiarui Zhang
1   Department of Respiratory and Critical Care Medicine, West China Hospital of Sichuan University, Chengdu, China
,
Yongjiang Tang
1   Department of Respiratory and Critical Care Medicine, West China Hospital of Sichuan University, Chengdu, China
,
Qun Yi
1   Department of Respiratory and Critical Care Medicine, West China Hospital of Sichuan University, Chengdu, China
,
Zong'an Liang
1   Department of Respiratory and Critical Care Medicine, West China Hospital of Sichuan University, Chengdu, China
,
Haixia Zhou
1   Department of Respiratory and Critical Care Medicine, West China Hospital of Sichuan University, Chengdu, China
,
Maoyun Wang
1   Department of Respiratory and Critical Care Medicine, West China Hospital of Sichuan University, Chengdu, China
› Author Affiliations Funding This study was supported by the National Key Research Program of China (grant 2016YFC1304202) and the Sichuan Science and Technology Program (grants 2015JY0176 and 2019YJ0152).
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Comment on:

Risk Scores for Death in Patients with Cancer-related Venous Thromboembolism: Still a Long Road AheadThromb Haemost 2021; 121(06): 700-702
DOI: 10.1055/s-0041-1727244

Abstract

Objective This article aimed to validate and compare the prognostic performance of generic scores (Pulmonary Embolism Severity Index [PESI] and Hestia) and cancer-specific pulmonary embolism (PE)/venous thromboembolism (VTE) scales (Registro Informatizado de la Enfermedad TromboEmbólica [RIETE], POMPE-C, and modified Ottawa) in PE patients with active cancer.

Methods A retrospective study was conducted among 460 patients with PE and active cancer. The primary outcome was 30-day overall mortality. Secondary outcomes were 30-day PE-related death and overall adverse outcomes. The prognostic accuracy of clinical scores was determined using receiver operating characteristic (ROC) curve analysis.

Results Within 30 days, 18.0% of patients died, 2.0% suffered major bleeding, and 0.2% presented recurrence of VTE. All scales showed a high area under the ROC curve (AUC) for predicting 30-day overall mortality except modified Ottawa (0.74 [0.70–0.78] for PESI, Hestia, and RIETE; 0.78 (0.74–0.81) for POMPE-C; 0.64 (0.59–0.68) for modified Ottawa]. PESI divided the least patients (9.1%) into low risk, followed by modified Ottawa (17.0%). Hestia stratified the most patients (65.4%) as low risk. But overall mortality of low-risk patients based on these three scales is high (>5%). RIETE and POMPE-C both classified 30.9% of patients as low risk, and low-risk patients stratified by these two scales presented a low overall mortality (1.4 and 3.5%). Similar predictive performance was found for 30-day PE-related death and overall adverse outcomes in these scores.

Conclusion Cancer-specific PE prognostic scores (RIETE and POMPE-C) performed better than generic scales (PESI and Hestia) and a cancer-specific VTE prognostic scale (modified Ottawa) in identifying low-risk PE patients with active cancer who may be suitable for outpatient treatment.

Keywords

pulmonary embolism - active cancer - clinical prognostic scores

Supplementary Material



Publication History

Received: 12 August 2020

Accepted: 13 January 2021

Accepted Manuscript online:
15 January 2021

Article published online:
09 March 2021

© 2021. Thieme. All rights reserved.

Georg Thieme Verlag KG
Rüdigerstraße 14, 70469 Stuttgart, Germany

 

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