On the necessity of new decision-making methods for cancer-associated, symptomatic, pulmonary embolism

被引：18

作者：

Carmona-Bayonas, A. ^{[1
]}

Font, C. ^{[2
]}

Jimenez-Fonseca, P. ^{[3
]}

Fenoy, Francisco ^{[4
]}

Otero, R. ^{[5
]}

Beato, C. ^{[6
]}

Plasencia, J. ^{[1
]}

Biosca, M. ^{[7
]}

Sanchez, M. ^{[2
]}

Benegas, M. ^{[2
]}

Calvo-Temprano, D. ^{[3
]}

Varona, D. ^{[7
]}

Faez, L. ^{[3
]}

Vicente, M. A. ^{[1
]}

de la Haba, I. ^{[8
]}

Antonio, M. ^{[8
]}

Madridano, O. ^{[9
]}

Ramchandani, A. ^{[10
]}

Castanon, E. ^{[11
]}

Marchena, P. J. ^{[12
]}

Martinez, M. J. ^{[13
]}

Martin, M. ^{[9
]}

Marin, G. ^{[14
]}

Ayala de la Pena, F. ^{[1
]}

Vicente, V. ^{[1
]}

机构：

[1] Hosp Univ Morales Meseguer, Murcia, Spain

[2] Hosp Univ Clin, Barcelona, Spain

[3] Hosp Univ Cent Asturias, Oviedo, Spain

[4] Univ Murcia, Dept Physiol, Fac Med, E-30001 Murcia, Spain

[5] Hosp Univ Virgen del Rocio, CIBER Enfermedades Resp, Seville, Spain

[6] Hosp Nisa Aljarafe, Seville, Spain

[7] Hosp Univ Vall DHebron, Barcelona, Spain

[8] ICO Duran & Reynals, Barcelona, Spain

[9] Hosp Univ Infanta Sofia, Madrid, Spain

[10] Hosp Univ Insular Gran Canaria, Gran Canaria, Spain

[11] Univ Navarra Clin, Pamplona, Spain

[12] Parc Sanitari St Joan de Deu, Barcelona, Spain

[13] Hosp Santa Lucia, Cartagena, Spain

[14] Hosp Clin Univ Virgen de la Arrixaca, Murcia, Spain

来源：

THROMBOSIS RESEARCH | 2016年 / 143卷

关键词：

Pulmonary embolism; Risk; Mortality; Cancer; Prognostic scales; Accuracy; Clinical decision rule; CLINICAL PROGNOSTIC MODEL; OUTPATIENT TREATMENT; EXTERNAL VALIDATION; SEVERITY INDEX; MANAGEMENT;

D O I：

10.1016/j.thromres.2016.05.010

中图分类号：

R5 [内科学];

学科分类号：

1002 ; 100201 ;

摘要：

Background: Acute symptomatic pulmonary embolism (PE) varies in its clinical manifestations in patients with cancer and entails specific issues. The objective is to assess the performance of five scores (PESI, sPESI, GPS, POMPE, and RIETE) and a clinical decision rule to predict 30-day mortality. Methods: This is an ambispective, observational, multicenter study that collected episodes of PE in patients with cancer from 13 Spanish centers. The main criterion for comparing scales was the c-indices and 95% confidence intervals (CIs) of the models for predicting 30-day mortality. Results: 585 patients with acute symptomatic PE were recruited. The 30-day mortality rate was 21.3 (95% CI; 18.2-24.8%). The specific scales (POMPE-C and RIETE) were equally effective in discriminating prognosis (c-index of 0.775 and 0.757, respectively). None of these best performing scales was superior to the ECOG-PS with a c-index of 0.724. The remaining scores (PESI, sPESI, and GPS) performed worse, with c-indexes of 0.719, 0.705, and 0.722, respectively. The dichotomic "clinical decision rule" for ambulatory therapy was at least equally reliable in defining a low risk group: in the absence of all exclusion criteria, 30-day mortality was 2%, compared to 5% and 4% in the POMPE-C and RIETE low-risk categories, respectively. Conclusion: The accuracy of the five scales examined was not high enough to rely on to predict 30-day mortality and none of them contribute significantly to qualitative clinical judgment. (C) 2016 Elsevier Ltd. All rights reserved.

引用

页码：76 / 85

页数：10

共 28 条

[1]

[Anonymous], 2011, CATEGORICAL DATA ANA

[2] Outpatient versus inpatient treatment for patients with acute pulmonary embolism: an international, open-label, randomised, non-inferiority trial [J].

Aujesky, Drahomir ;

Roy, Pierre-Marie ;

Verschuren, Franck ;

Righini, Marc ;

Osterwalder, Joseph ;

Egloff, Michael ;

Renaud, Bertrand ;

Verhamme, Peter ;

Stone, Roslyn A. ;

Legal, Catherine ;

Sanchez, Olivier ;

Pugh, Nathan A. ;

N'gako, Alfred ;

Cornuz, Jacques ;

Hugii, Olivier ;

Beer, Hans-Juerg ;

Perrier, Arnaud ;

Fine, Michael J. ;

Yealy, Donald M. .

LANCET, 2011, 378 (9785) :41-48

[3]

Collins GS, 2015, J CLIN EPIDEMIOL, V68, P112, DOI [10.7326/M14-0697, 10.1038/bjc.2014.639, 10.1186/s12916-014-0241-z, 10.1136/bmj.g7594, 10.7326/M14-0698, 10.1016/j.jclinepi.2014.11.010, 10.1016/j.eururo.2014.11.025, 10.1002/bjs.9736]

[4] A Clinical Prognostic Model for the Identification of Low-Risk Patients With Acute Symptomatic Pulmonary Embolism and Active Cancer [J].