A CLINICAL PROGNOSTIC MODEL FOR THE IDENTIFICATION OF LOW-RISK PATIENTS WITH ACUTE SYMPTOMATIC PULMONARY EMBOLISM AND ACTIVE CANCER.
Chest. 2012 Jul 17;
Authors: Exter1 PL, Gómez2 V, Jiménez3 D, Trujillo-Santos4 J, Muriel5 A, Huisman1 MV, Monreal6 M, for the RIETE investigators
ABSTRACT BACKGROUND: Clinicians 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). OBJECTIVE: To develop a simple risk score for predicting 30-day mortality in PE patients with 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 RIETE registry 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 that contained 6 variables: age > 80 years, heart rate > 110/min, systolic blood pressure < 100 mm Hg, body weight < 60 Kg, recent immobility, and presence of metastases. In the internal validation cohort (n = 508), the 22.2% (113/508) of patients classified as low-risk by the prognostic model had a 30-day mortality of 4.4% (95% CI, 0.6 to 8.2%) compared to 29.9% (95 % CI, 25.4 to 34.4%) in high-risk group. In the external validation cohort, the 18% (47/261) of patients classified as low-risk by the prognostic model had a 30-day mortality of 0%, compared to 19.6% (95% CI, 14.3 to 25.0%) in the high-risk group. CONCLUSIONS: The developed clinical prediction rule accurately identifies low-risk cancer patients with acute PE.
PMID: 22814859 [PubMed - as supplied by publisher]Link to Article at PubMed