Scientific publications
Clinical features and short-term outcomes of cancer patients with suspected and unsuspected pulmonary embolism: the EPIPHANY study
Carme Font 1 , Alberto Carmona-Bayonas 2 , Carmen Beato 3 , Òscar Reig 4 , Antonia Sáez 5 , Paula Jiménez-Fonseca 6 , Juana M Plasencia 7 , David Calvo-Temprano 8 , Marcelo Sanchez 9 , Mariana Benegas 9 , Mercedes Biosca 10 , Diego Varona 11 , Maria Angeles Vicente 2 , Laura Faez 6 , Maria Del Pilar Solís 6 , Irma de la Haba 12 , Maite Antonio 12 , Olga Madridano 13 , Eduardo Castañon 14 , María Jose Martinez 15 , Pablo Marchena 16 , Avinash Ramchandani 17 , Angel Dominguez 18 , Alejandro Puerta 19 , David Martinez de la Haza 20 , Jesus Pueyo 21 , Susana Hernandez 22 , Angela Fernandez-Plaza 23 , Lourdes Martinez-Encarnacion 23 , Mar Martin 13 , Gema Marin 24 , Francisco Ayala 2 , Vicente Vicente 2 , Remedios Otero 25 , Asociación para la Investigación de la Enfermedad Tromboembólica de la región de Murcia
Abstract
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 30-day 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.
CITATION Eur Respir J. 2017 Jan 4;49(1):1600282. doi: 10.1183/13993003.00282-2016. Print 2017 Jan.
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