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Original Research: Lung Cancer |

A Clinical Prognostic Model for the Identification of Low-Risk Patients With Acute Symptomatic Pulmonary Embolism and Active CancerA Risk Score for Cancer and Pulmonary Embolism

Paul L. den Exter, MD; Vicente Gómez, MD, PhD; David Jiménez, MD, PhD; Javier Trujillo-Santos, MD, PhD; Alfonso Muriel, MSc; Menno V. Huisman, MD, PhD; Manuel Monreal, MD, PhD; for the Registro Informatizado de la Enfermedad TromboEmbólica (RIETE) Investigators*
Author and Funding Information

From Leiden University Medical Center (Drs den Exter and Huisman), Leiden, The Netherlands; the Medicine Department (Dr Gómez), the Respiratory Department (Dr Jiménez), and the Biostatistics Department (Mr Muriel), Ramón y Cajal Hospital, Instituto Ramón y Cajal de Investigación Sanitaria, Madrid, Spain; the Medicine Department (Dr Trujillo-Santos), Santa Lucía Hospital, Cartagena, Murcia, Spain; and the Medicine Department (Dr Monreal), Germans Trias I Pujol Hospital, Badalona, Barcelona, Spain.

Correspondence to: David Jiménez, MD, PhD, Respiratory Department and Medicine Department, Ramón y Cajal Hospital, Instituto Ramón y Cajal de Investigación Sanitaria and Alcalá de Henares University, 28034 Madrid, Spain; e-mail: djc_69_98@yahoo.com


Drs den Exter and Gómez contributed equally to the manuscript.

*

A complete list of study participants is located in e-Appendix 1.

Funding/Support: The authors have reported to CHEST that no funding was received for this study.

Reproduction of this article is prohibited without written permission from the American College of Chest Physicians. See online for more details.


Chest. 2013;143(1):138-145. doi:10.1378/chest.12-0964
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Background:  Physicians need a specific risk-stratification tool to facilitate safe and cost-effective approaches to the management of patients with cancer and acute pulmonary embolism (PE). The objective of this study was to develop a simple risk score for predicting 30-day mortality in patients with PE and cancer by using measures readily obtained at the time of PE diagnosis.

Methods:  Investigators randomly allocated 1,556 consecutive patients with cancer and acute PE from the international multicenter Registro Informatizado de la Enfermedad TromboEmbólica to derivation (67%) and internal validation (33%) samples. The external validation cohort for this study consisted of 261 patients with cancer and acute PE. Investigators compared 30-day all-cause mortality and nonfatal adverse medical outcomes across the derivation and two validation samples.

Results:  In the derivation sample, multivariable analyses produced the risk score, which contained six variables: age > 80 years, heart rate ≥ 110/min, systolic BP < 100 mm Hg, body weight < 60 kg, recent immobility, and presence of metastases. In the internal validation cohort (n = 508), the 22.2% of patients (113 of 508) classified as low risk by the prognostic model had a 30-day mortality of 4.4% (95% CI, 0.6%-8.2%) compared with 29.9% (95% CI, 25.4%-34.4%) in the high-risk group. In the external validation cohort, the 18% of patients (47 of 261) classified as low risk by the prognostic model had a 30-day mortality of 0%, compared with 19.6% (95% CI, 14.3%-25.0%) in the high-risk group.

Conclusions:  The developed clinical prediction rule accurately identifies low-risk patients with cancer and acute PE.

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