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

Abstract

Objective: To validate and compare the prognostic performance of generic scores (PESI and Hestia) and cancer-specific pulmonary embolism (PE)/venous thromboembolism (VTE) scales (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: 18.0% of patients died within 30 days, 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 are high (>5%). RIETE and POMPE-C both classified 30.9% 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 were found for 30-day PE-related death and overall adverse outcomes in these scores. Conclusions: 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.

2022 ESC Guidelines on cardio-oncology developed in collaboration with the European Hematology Association (EHA), the European Society for Therapeutic Radiology and Oncology (ESTRO) and the International Cardio-Oncology Society (IC-OS)

“…563 The risk factors for VTE in cancer are summarized in Figure 35. 564,565 Patients with symptoms or signs suggestive of VTE, such as unilateral lower limb oedema or unexplained dyspnoea, should be screened with lower-extremity venous ultrasonography or contrast-enhanced CT for DVT and CT pulmonary angiography for PE, according to the 2019 ESC Guidelines for the diagnosis and management of acute pulmonary embolism recommendations 566 Figure 35 Risk factors for venous thromboembolism in patients with cancer. ATE, arterial thromboembolism; BMI, body mass index; CrCl, creatinine clearance; IMiD, immunomodulatory drugs; PI, proteasome inhibitors; VTE, venous thromboembolism.…”

Prognostic Performance of Hestia Criteria in Acute Pulmonary Embolism: A Systematic Review and Meta-Analysis

“…The summary characteristics of the 8 included articles were presented in Table 1. Among these studies, five 3,8,9,13,15 conducted in Europe, two 14,17 conducted in USA, and China 16 carried out one record. Published between 2013 and 2021, the enrolled eight studies consisted of four prospective studies and other four studies were retrospective.…”

“…After carefully reviewing full texts of remaining literatures, 4 articles were removed due to overlapping data. Finally, 8 eligible articles 3,8,9,[13][14][15][16][17] with 4110 participants were enrolled in this metaanalysis. The detailed flow chart of literature selection is shown in Figure 1.…”

¿Tienen los pacientes con tromboembolismo pulmonar agudo y un puntaje PESI (Índice de Severidad del Embolismo Pulmonar) intermedio o alto, asociado a cáncer activo, un mayor riesgo de presentar una evolución desfavorable respecto de aquellos sin cáncer?

“…que buscan identificar los pacientes con TEP-CA que tengan riesgo bajo de complicaciones y en quienes se podría ofrecer una alternativa terapéutica que pueda evitar o reducir el tiempo de internación. (18) Al igual que lo observado en otros registros, (19,20) la MIH de los pacientes con TEP con valores de PESI ≥86 puntos fue elevada, aunque no observamos diferencias entre la población sin cáncer vs. con TEP-CA (8 % vs. 12,7 %, p=NS). A diferencia de lo observado en otros estudios, (21,22) donde los pacientes con TEP-CA son de mayor edad que aquellos sin cáncer, en nuestro estudio la población con TEP-CA resultó ser más joven.…”