Clinical features and short-term outcomes of cancer patients with suspected and unsuspected pulmonary embolism: the EPIPHANY study

被引：58

作者：

Font, Carme ^{[1
]}

Carmona-Bayonas, Alberto ^{[2
]}

Beato, Carmen ^{[3
]}

Reig, Oscar ^{[1
]}

Saez, Antonia ^{[4
]}

Jimenez-Fonseca, Paula ^{[5
]}

Plasencia, Juana M. ^{[6
]}

Calvo-Temprano, David ^{[7
]}

Sanchez, Marcelo ^{[8
]}

Benegas, Mariana ^{[8
]}

Biosca, Mercedes ^{[9
]}

Varona, Diego ^{[10
]}

Angeles Vicente, Maria ^{[2
]}

Faez, Laura ^{[5
]}

del Pilar Solis, Maria ^{[5
]}

de la Haba, Irma ^{[11
]}

Antonio, Maite ^{[11
]}

Madridano, Olga ^{[12
]}

Castanon, Eduardo ^{[13
]}

Jose Martinez, Maria ^{[14
]}

Marchena, Pablo ^{[15
]}

Ramchandani, Avinash ^{[16
]}

Dominguez, Angel ^{[17
]}

Puerta, Alejandro ^{[18
]}

Martinez de la Haza, David ^{[19
]}

Pueyo, Jesus ^{[20
]}

Hernandez, Susana ^{[21
]}

Fernandez-Plaza, Angela ^{[22
]}

Martinez-Encarnacion, Lourdes ^{[22
]}

Martin, Mar ^{[12
]}

Marin, Gema ^{[23
]}

Ayala, Francisco ^{[2
]}

Vicente, Vicente ^{[2
]}

Otero, Remedios ^{[24
]}

机构：

[1] Hosp Clin Barcelona, Dept Med Oncol, IDIBAPS Translat Genom & Targeted Therapeut Solid, Villarroel 170, E-08036 Barcelona, Spain

[2] Hosp Univ Morales Meseguer, Med Oncol & Hematol Dept, Murcia, Spain

[3] Hosp Nisa Aljarafe, Dept Med Oncol, Seville, Spain

[4] Axioma Comunicac, Dept Stat, Seville, Spain

[5] Hosp Univ Cent Asturias, Dept Med Oncol, Oviedo, Spain

[6] Hosp Univ Morales Meseguer, Dept Radiol, Murcia, Spain

[7] Hosp Univ Cent Asturias, Dept Radiol, Oviedo, Spain

[8] Hosp Clin Barcelona, Radiodiagnost Dept, Barcelona, Spain

[9] Hosp Univ Vall Hebron, Dept Med Oncol, Barcelona, Spain

[10] Hosp Univ Vall Hebron, Dept Radiol, Barcelona, Spain

[11] Hosp Llobregat, Hosp Duran & Reynals, Inst Catalad Oncol, Dept Med Oncol, Barcelona, Spain

[12] Hosp Infanta Sof San Sebastian Ios Reves, Dept Internal Med, Madrid, Spain

[13] Univ Navarra Clin, Dept Med Oncol, Pamplona, Spain

[14] Hosp Santa Lucia, Dept Med Oncol, Murcia, Spain

[15] Hosp San Juan Dios, Dept Internal Med, Esplugues Llobregat, Barcelona, Spain

[16] Hosp Insular Gran Canaria, Dept Med Oncol, Las Palmas Gran Canaria, Spain

[17] Hosp Nisa Aljarafe, Dept Radiol, Seville, Spain

[18] Hosp Reina Sofia, Dept Radiol, Murcia, Spain

[19] Hosp Llobregat, Hosp Duran & Reynals, Inst Catalad Oncol, Dept Radiol, Barcelona, Spain

[20] Univ Navarra Clin, Dept Radiol, Pamplona, Spain

[21] Hosp Infanta Sofia San Sebastian los Reves, Dept Radiol, Madrid, Spain

[22] Hosp Santa Lucia, Dept Radiol, Murcia, Spain

[23] Hosp Clin Univ Virgen la Arrixaca, Dept Med Oncol, Murcia, Spain

[24] HUVR IBiS, CIBERES, Dept Pneumol, Seville, Spain

来源：

EUROPEAN RESPIRATORY JOURNAL | 2017年 / 49卷 / 01期

关键词：

ADVERSELY IMPACT SURVIVAL; VENOUS THROMBOEMBOLISM; OUTPATIENT MANAGEMENT; PROGNOSTIC MODEL; SEVERITY INDEX; RISK; GUIDELINES; DIAGNOSIS;

D O I：

10.1183/13993003.00282-2016

中图分类号：

R56 [呼吸系及胸部疾病];

学科分类号：

摘要：

The study aimed to identify predictors of overall 30-day mortality in cancer patients with pulmonary embolism including suspected pulmonary embolism (SPE) and unsuspected pulmonary embolism (UPE) events. Secondary outcomes included 30-and 90-day major bleeding and venous thromboembolism (VTE) recurrence. The study cohort included 1033 consecutive patients with pulmonary embolism from the multicentre observational ambispective EPIPHANY study (March 2006-October 2014). A subgroup of 497 patients prospectively assessed for the study were subclassified into three work-up scenarios (SPE, truly asymptomatic UPE and UPE with symptoms) to assess outcomes. The overall 30-day mortality rate was 14%. The following variables were associated with the overall 30day mortality on multivariate analysis: VTE history, upper gastrointestinal cancers, metastatic disease, cancer progression, performance status, arterial hypotension <100 mmHg, heart rate >110 beats.min(-1), basal oxygen saturation <90% and SPE (versus overall UPE). The overall 30-day mortality was significantly lower in patients with truly asymptomatic UPE events (3%) compared with those with UPE-S (20%) and SPE (21%) (p<0.0001). Thirty-and 90-day VTE recurrence and major bleeding rates were similar in all the groups. In conclusion, variables associated with the severity of cancer and pulmonary embolism were associated with short-term mortality. Our findings may help to develop pulmonary embolism risk-assessment models in this setting.

引用

页数：12

共 39 条

[1] Current Concepts: Acute Pulmonary Embolism. [J].

Agnelli, Giancarlo ;

Becattini, Cecilia .

NEW ENGLAND JOURNAL OF MEDICINE, 2010, 363 (03) :266-274

[2] Risk Stratification of Patients With Acute Symptomatic Pulmonary Embolism Based on Presence or Absence of Lower Extremity DVT Systematic Review and Meta-analysis [J].

Becattini, Cecilia ;

Cohen, Alexander T. ;

Agnelli, Giancarlo ;

Howard, Luke ;

Castejon, Borja ;

Trujillo-Santos, Javier ;

Monreal, Manuel ;

Perrier, Arnaud ;

Yusen, Roger D. ;

Jimenez, David .

CHEST, 2016, 149 (01) :192-200

[3] On the necessity of new decision-making methods for cancer-associated, symptomatic, pulmonary embolism [J].

Carmona-Bayonas, A. ;

Font, C. ;

Jimenez-Fonseca, P. ;

Fenoy, Francisco ;

Otero, R. ;

Beato, C. ;

Plasencia, J. ;

Biosca, M. ;

Sanchez, M. ;

Benegas, M. ;

Calvo-Temprano, D. ;

Varona, D. ;

Faez, L. ;

Vicente, M. A. ;

de la Haba, I. ;

Antonio, M. ;

Madridano, O. ;

Ramchandani, A. ;

Castanon, E. ;

Marchena, P. J. ;

Martinez, M. J. ;

Martin, M. ;

Marin, G. ;

Ayala de la Pena, F. ;

Vicente, V. .

THROMBOSIS RESEARCH, 2016, 143 :76-85

[4] THE CLINICAL COURSE OF PULMONARY-EMBOLISM [J].

CARSON, JL ;

KELLEY, MA ;

DUFF, A ;

WEG, JG ;

FULKERSON, WJ ;

PALEVSKY, HI ;

SCHWARTZ, JS ;

THOMPSON, BT ;

POPOVICH, J ;

HOBBINS, TE ;

SPERA, MA ;

ALAVI, A ;

TERRIN, ML .

NEW ENGLAND JOURNAL OF MEDICINE, 1992, 326 (19) :1240-1245

[5] Embolic burden of incidental pulmonary embolism diagnosed on routinely performed contrast-enhanced computed tomography imaging in cancer patients [J].

den Exter, P. L. ;

Kroft, L. J. M. ;

van der Hulle, T. ;

Klok, F. A. ;

Jimenez, D. ;

Huisman, M. V. .

JOURNAL OF THROMBOSIS AND HAEMOSTASIS, 2013, 11 (08) :1620-1622

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

den Exter, Paul L. ;

Gomez, Vicente ;

Jimenez, David ;

Trujillo-Santos, Javier ;

Muriel, Alfonso ;

Huisman, Menno V. ;

Monreal, Manuel .

CHEST, 2013, 143 (01) :138-145

[7] Risk of Recurrent Venous Thromboembolism and Mortality in Patients With Cancer Incidentally Diagnosed With Pulmonary Embolism: A Comparison With Symptomatic Patients [J].

den Exter, Paul L. ;

Hooijer, Jose ;

Dekkers, Olaf M. ;

Huisman, Menno V. .

JOURNAL OF CLINICAL ONCOLOGY, 2011, 29 (17) :2405-2409

[8] Prevalence and Clinical History of Incidental, Asymptomatic Pulmonary Embolism: A Meta-Analysis [J].

Dentali, F. ;

Ageno, W. ;

Becattini, C. ;

Galli, L. ;

Gianni, M. ;

Riva, N. ;

Imberti, D. ;

Squizzato, A. ;

Venco, A. ;

Agnelli, G. .

THROMBOSIS RESEARCH, 2010, 125 (06) :518-522

[9] Diagnosis and treatment of incidental venous thromboembolism in cancer patients: guidance from the SSC of the ISTH [J].

Di Nisio, M. ;

Lee, A. Y. Y. ;

Carrier, M. ;

Liebman, H. A. ;

Khorana, A. A. .

JOURNAL OF THROMBOSIS AND HAEMOSTASIS, 2015, 13 (05) :880-883

[10] Prospective validation of the Pulmonary Embolism Severity Index A clinical prognostic model for pulmonary embolism [J].

Donze, Jacques ;

Le Gal, Gregoire ;

Fine, Michael J. ;

Roy, Pierre-Marie ;

Sanchez, Olivier ;

Verschuren, Franck ;

Cornuz, Jacques ;

Meyer, Guy ;

Perrier, Arnaud ;

Righini, Marc ;

Aujesky, Drahomir .

THROMBOSIS AND HAEMOSTASIS, 2008, 100 (05) :943-948

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