The prognostic value of respiratory symptoms and performance status in ambulatory cancer patients and unsuspected pulmonary embolism; analysis of an international, prospective, observational cohort study
Background Optimal risk stratification of unsuspected pulmonary embolism (UPE) in ambulatory cancer patients (ACPs) remains unclear. Existing clinical predictive rules (CPRs) are derived from retrospective databases and have limitations. The UPE registry is a prospective international registry with...
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| Veröffentlicht in: | Journal of thrombosis and haemostasis 2021-11, Vol.19 (11), p.2791-2800 |
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| creator | Maraveyas, Anthony Kraaijpoel, Noémie Bozas, George Huang, Chao Mahé, Isabelle Bertoletti, Laurent Bartels‐Rutten, Annemarieke Beyer‐Westendorf, Jan Constans, Joel Iosub, Diana Couturaud, Francis Muñoz, Andres J. Biosca, Mercedes Lerede, Teresa van Es, Nick Di Nisio, Marcello |
| description | Background
Optimal risk stratification of unsuspected pulmonary embolism (UPE) in ambulatory cancer patients (ACPs) remains unclear. Existing clinical predictive rules (CPRs) are derived from retrospective databases and have limitations. The UPE registry is a prospective international registry with pre‐specified characteristics of ACPs with a recent UPE. The aim of this study was to assess the utility of risk factors captured in the UPE registry in predicting proximate (30‐, 90‐ and 180‐day) mortality and how they performed when applied to an existing CPR.
Objectives
To evaluate risk factors for proximate mortality, overall survival, recurrent venous thromboembolism and major bleeding, in the patients enrolled in the UPE registry cohort.
Methods
Data from the 695 ACPs in this registry were subjected to multivariate logistic regression analyses to identify predictors independently associated with proximate mortality and overall survival. The most consistent predictors were applied to the Hull CPR, an existing 5‐point prediction rule.
Results
The most consistent predictors of mortality were patient‐reported respiratory symptoms within 14 days before, and ECOG performance status at the time of UPE. These predictors applied to the Hull‐CPR produced a consistent correlation with proximate mortality and overall survival (area under the curve [AUC] = 0.70 [95% CI 0.63, 077], AUC = 0.65 [95% CI 0.60, 070], AUC = 0.64 [95% CI 0.59, 068], and AUC = 0.61, 95% CI 0.57, 0.65, respectively).
Conclusion
In ACPs with UPE, ECOG performance status logged contemporaneously to the UPE diagnosis and respiratory symptoms prior to UPE diagnosis can stratify mortality risk. When applied to the HULL‐CPR these risk predictors confirmed the risk stratification clusters of low‐intermediate and high‐risk for proximate mortality as seen in the original derivation cohort. |
| doi_str_mv | 10.1111/jth.15489 |
| format | Article |
| fullrecord | <record><control><sourceid>proquest_hal_p</sourceid><recordid>TN_cdi_hal_primary_oai_HAL_hal_04508597v1</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><sourcerecordid>2583303177</sourcerecordid><originalsourceid>FETCH-LOGICAL-c3999-f6dc176d0622cc18709366948c81395e10846889477fd9210202ab36b978aed03</originalsourceid><addsrcrecordid>eNp1ks-KFDEQxhtRcF09-AYBLwo7u0mnu5PgaVnUUQa8jOeQSVc7GdJJmz-z9DP6Uqa3VwXBXBJSv_rqq6Kq6jXB16Scm1M6XpO24eJJdUFayjeM0-7p77eg9Hn1IsYTxkS0Nb6ofu6PgKbgvzsfk9HorGwG5AcUIE4mqOTDjOI8TsmPESnXownC4MOonAYUk0o5IuOQGg_ZrrReQgFNKhlwaU3KLuY4gU5QBLIdvVOFhPHgrYnj-8IoO0cTl8rKFcEEwRWBwtmrxd9DsjnDFfKHCOH8GEPaH31IxUju55fVs0HZCK8e78vq28cP-7vtZvf10-e7291GUyHEZuh6TVjX466utSacYUG7TjRcc0JFCwTzpuNcNIwNvagJrnGtDrQ7CMYV9JheVu9W3aOycgpmLL1Ir4zc3u7k8oebFvNWsDMp7NuVLT38yBCTHE3UYK1y4HOUdcuaBnPGFvTNP-jJ5zIFu1CcUkwJY3-L6zKUGGD444BguayALCsgH1agsDcre28szP8H5Zf9ds34BZCat0k</addsrcrecordid><sourcetype>Open Access Repository</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>2583303177</pqid></control><display><type>article</type><title>The prognostic value of respiratory symptoms and performance status in ambulatory cancer patients and unsuspected pulmonary embolism; analysis of an international, prospective, observational cohort study</title><source>EZB-FREE-00999 freely available EZB journals</source><source>Alma/SFX Local Collection</source><creator>Maraveyas, Anthony ; Kraaijpoel, Noémie ; Bozas, George ; Huang, Chao ; Mahé, Isabelle ; Bertoletti, Laurent ; Bartels‐Rutten, Annemarieke ; Beyer‐Westendorf, Jan ; Constans, Joel ; Iosub, Diana ; Couturaud, Francis ; Muñoz, Andres J. ; Biosca, Mercedes ; Lerede, Teresa ; van Es, Nick ; Di Nisio, Marcello</creator><creatorcontrib>Maraveyas, Anthony ; Kraaijpoel, Noémie ; Bozas, George ; Huang, Chao ; Mahé, Isabelle ; Bertoletti, Laurent ; Bartels‐Rutten, Annemarieke ; Beyer‐Westendorf, Jan ; Constans, Joel ; Iosub, Diana ; Couturaud, Francis ; Muñoz, Andres J. ; Biosca, Mercedes ; Lerede, Teresa ; van Es, Nick ; Di Nisio, Marcello</creatorcontrib><description>Background
Optimal risk stratification of unsuspected pulmonary embolism (UPE) in ambulatory cancer patients (ACPs) remains unclear. Existing clinical predictive rules (CPRs) are derived from retrospective databases and have limitations. The UPE registry is a prospective international registry with pre‐specified characteristics of ACPs with a recent UPE. The aim of this study was to assess the utility of risk factors captured in the UPE registry in predicting proximate (30‐, 90‐ and 180‐day) mortality and how they performed when applied to an existing CPR.
Objectives
To evaluate risk factors for proximate mortality, overall survival, recurrent venous thromboembolism and major bleeding, in the patients enrolled in the UPE registry cohort.
Methods
Data from the 695 ACPs in this registry were subjected to multivariate logistic regression analyses to identify predictors independently associated with proximate mortality and overall survival. The most consistent predictors were applied to the Hull CPR, an existing 5‐point prediction rule.
Results
The most consistent predictors of mortality were patient‐reported respiratory symptoms within 14 days before, and ECOG performance status at the time of UPE. These predictors applied to the Hull‐CPR produced a consistent correlation with proximate mortality and overall survival (area under the curve [AUC] = 0.70 [95% CI 0.63, 077], AUC = 0.65 [95% CI 0.60, 070], AUC = 0.64 [95% CI 0.59, 068], and AUC = 0.61, 95% CI 0.57, 0.65, respectively).
Conclusion
In ACPs with UPE, ECOG performance status logged contemporaneously to the UPE diagnosis and respiratory symptoms prior to UPE diagnosis can stratify mortality risk. When applied to the HULL‐CPR these risk predictors confirmed the risk stratification clusters of low‐intermediate and high‐risk for proximate mortality as seen in the original derivation cohort.</description><identifier>ISSN: 1538-7933</identifier><identifier>ISSN: 1538-7836</identifier><identifier>EISSN: 1538-7836</identifier><identifier>DOI: 10.1111/jth.15489</identifier><language>eng</language><publisher>Oxford: Elsevier Limited</publisher><subject>cancer associated thrombosis ; clinical prediction rule ; Cohort analysis ; Diagnosis ; Embolism ; incidental pulmonary embolism ; Life Sciences ; Lung cancer ; Mortality ; Observational studies ; Patients ; Pulmonary embolisms ; risk assessment model ; Risk factors ; Survival ; Thromboembolism ; unsuspected pulmonary embolism</subject><ispartof>Journal of thrombosis and haemostasis, 2021-11, Vol.19 (11), p.2791-2800</ispartof><rights>2021 International Society on Thrombosis and Haemostasis</rights><rights>Distributed under a Creative Commons Attribution 4.0 International License</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c3999-f6dc176d0622cc18709366948c81395e10846889477fd9210202ab36b978aed03</citedby><cites>FETCH-LOGICAL-c3999-f6dc176d0622cc18709366948c81395e10846889477fd9210202ab36b978aed03</cites><orcidid>0000-0001-5256-6346 ; 0000-0003-1760-7880 ; 0000-0002-6983-9993 ; 0000-0001-5930-7304 ; 0000-0002-1124-695X ; 0000-0003-1749-4855 ; 0000-0001-8214-3010 ; 0000-0003-4176-5176 ; 0000-0002-1855-8032</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>230,314,780,784,885,27924,27925</link.rule.ids><backlink>$$Uhttps://hal.science/hal-04508597$$DView record in HAL$$Hfree_for_read</backlink></links><search><creatorcontrib>Maraveyas, Anthony</creatorcontrib><creatorcontrib>Kraaijpoel, Noémie</creatorcontrib><creatorcontrib>Bozas, George</creatorcontrib><creatorcontrib>Huang, Chao</creatorcontrib><creatorcontrib>Mahé, Isabelle</creatorcontrib><creatorcontrib>Bertoletti, Laurent</creatorcontrib><creatorcontrib>Bartels‐Rutten, Annemarieke</creatorcontrib><creatorcontrib>Beyer‐Westendorf, Jan</creatorcontrib><creatorcontrib>Constans, Joel</creatorcontrib><creatorcontrib>Iosub, Diana</creatorcontrib><creatorcontrib>Couturaud, Francis</creatorcontrib><creatorcontrib>Muñoz, Andres J.</creatorcontrib><creatorcontrib>Biosca, Mercedes</creatorcontrib><creatorcontrib>Lerede, Teresa</creatorcontrib><creatorcontrib>van Es, Nick</creatorcontrib><creatorcontrib>Di Nisio, Marcello</creatorcontrib><title>The prognostic value of respiratory symptoms and performance status in ambulatory cancer patients and unsuspected pulmonary embolism; analysis of an international, prospective, observational cohort study</title><title>Journal of thrombosis and haemostasis</title><description>Background
Optimal risk stratification of unsuspected pulmonary embolism (UPE) in ambulatory cancer patients (ACPs) remains unclear. Existing clinical predictive rules (CPRs) are derived from retrospective databases and have limitations. The UPE registry is a prospective international registry with pre‐specified characteristics of ACPs with a recent UPE. The aim of this study was to assess the utility of risk factors captured in the UPE registry in predicting proximate (30‐, 90‐ and 180‐day) mortality and how they performed when applied to an existing CPR.
Objectives
To evaluate risk factors for proximate mortality, overall survival, recurrent venous thromboembolism and major bleeding, in the patients enrolled in the UPE registry cohort.
Methods
Data from the 695 ACPs in this registry were subjected to multivariate logistic regression analyses to identify predictors independently associated with proximate mortality and overall survival. The most consistent predictors were applied to the Hull CPR, an existing 5‐point prediction rule.
Results
The most consistent predictors of mortality were patient‐reported respiratory symptoms within 14 days before, and ECOG performance status at the time of UPE. These predictors applied to the Hull‐CPR produced a consistent correlation with proximate mortality and overall survival (area under the curve [AUC] = 0.70 [95% CI 0.63, 077], AUC = 0.65 [95% CI 0.60, 070], AUC = 0.64 [95% CI 0.59, 068], and AUC = 0.61, 95% CI 0.57, 0.65, respectively).
Conclusion
In ACPs with UPE, ECOG performance status logged contemporaneously to the UPE diagnosis and respiratory symptoms prior to UPE diagnosis can stratify mortality risk. When applied to the HULL‐CPR these risk predictors confirmed the risk stratification clusters of low‐intermediate and high‐risk for proximate mortality as seen in the original derivation cohort.</description><subject>cancer associated thrombosis</subject><subject>clinical prediction rule</subject><subject>Cohort analysis</subject><subject>Diagnosis</subject><subject>Embolism</subject><subject>incidental pulmonary embolism</subject><subject>Life Sciences</subject><subject>Lung cancer</subject><subject>Mortality</subject><subject>Observational studies</subject><subject>Patients</subject><subject>Pulmonary embolisms</subject><subject>risk assessment model</subject><subject>Risk factors</subject><subject>Survival</subject><subject>Thromboembolism</subject><subject>unsuspected pulmonary embolism</subject><issn>1538-7933</issn><issn>1538-7836</issn><issn>1538-7836</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2021</creationdate><recordtype>article</recordtype><recordid>eNp1ks-KFDEQxhtRcF09-AYBLwo7u0mnu5PgaVnUUQa8jOeQSVc7GdJJmz-z9DP6Uqa3VwXBXBJSv_rqq6Kq6jXB16Scm1M6XpO24eJJdUFayjeM0-7p77eg9Hn1IsYTxkS0Nb6ofu6PgKbgvzsfk9HorGwG5AcUIE4mqOTDjOI8TsmPESnXownC4MOonAYUk0o5IuOQGg_ZrrReQgFNKhlwaU3KLuY4gU5QBLIdvVOFhPHgrYnj-8IoO0cTl8rKFcEEwRWBwtmrxd9DsjnDFfKHCOH8GEPaH31IxUju55fVs0HZCK8e78vq28cP-7vtZvf10-e7291GUyHEZuh6TVjX466utSacYUG7TjRcc0JFCwTzpuNcNIwNvagJrnGtDrQ7CMYV9JheVu9W3aOycgpmLL1Ir4zc3u7k8oebFvNWsDMp7NuVLT38yBCTHE3UYK1y4HOUdcuaBnPGFvTNP-jJ5zIFu1CcUkwJY3-L6zKUGGD444BguayALCsgH1agsDcre28szP8H5Zf9ds34BZCat0k</recordid><startdate>202111</startdate><enddate>202111</enddate><creator>Maraveyas, Anthony</creator><creator>Kraaijpoel, Noémie</creator><creator>Bozas, George</creator><creator>Huang, Chao</creator><creator>Mahé, Isabelle</creator><creator>Bertoletti, Laurent</creator><creator>Bartels‐Rutten, Annemarieke</creator><creator>Beyer‐Westendorf, Jan</creator><creator>Constans, Joel</creator><creator>Iosub, Diana</creator><creator>Couturaud, Francis</creator><creator>Muñoz, Andres J.</creator><creator>Biosca, Mercedes</creator><creator>Lerede, Teresa</creator><creator>van Es, Nick</creator><creator>Di Nisio, Marcello</creator><general>Elsevier Limited</general><general>Wiley</general><scope>AAYXX</scope><scope>CITATION</scope><scope>7T5</scope><scope>H94</scope><scope>K9.</scope><scope>7X8</scope><scope>1XC</scope><orcidid>https://orcid.org/0000-0001-5256-6346</orcidid><orcidid>https://orcid.org/0000-0003-1760-7880</orcidid><orcidid>https://orcid.org/0000-0002-6983-9993</orcidid><orcidid>https://orcid.org/0000-0001-5930-7304</orcidid><orcidid>https://orcid.org/0000-0002-1124-695X</orcidid><orcidid>https://orcid.org/0000-0003-1749-4855</orcidid><orcidid>https://orcid.org/0000-0001-8214-3010</orcidid><orcidid>https://orcid.org/0000-0003-4176-5176</orcidid><orcidid>https://orcid.org/0000-0002-1855-8032</orcidid></search><sort><creationdate>202111</creationdate><title>The prognostic value of respiratory symptoms and performance status in ambulatory cancer patients and unsuspected pulmonary embolism; analysis of an international, prospective, observational cohort study</title><author>Maraveyas, Anthony ; Kraaijpoel, Noémie ; Bozas, George ; Huang, Chao ; Mahé, Isabelle ; Bertoletti, Laurent ; Bartels‐Rutten, Annemarieke ; Beyer‐Westendorf, Jan ; Constans, Joel ; Iosub, Diana ; Couturaud, Francis ; Muñoz, Andres J. ; Biosca, Mercedes ; Lerede, Teresa ; van Es, Nick ; Di Nisio, Marcello</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c3999-f6dc176d0622cc18709366948c81395e10846889477fd9210202ab36b978aed03</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2021</creationdate><topic>cancer associated thrombosis</topic><topic>clinical prediction rule</topic><topic>Cohort analysis</topic><topic>Diagnosis</topic><topic>Embolism</topic><topic>incidental pulmonary embolism</topic><topic>Life Sciences</topic><topic>Lung cancer</topic><topic>Mortality</topic><topic>Observational studies</topic><topic>Patients</topic><topic>Pulmonary embolisms</topic><topic>risk assessment model</topic><topic>Risk factors</topic><topic>Survival</topic><topic>Thromboembolism</topic><topic>unsuspected pulmonary embolism</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Maraveyas, Anthony</creatorcontrib><creatorcontrib>Kraaijpoel, Noémie</creatorcontrib><creatorcontrib>Bozas, George</creatorcontrib><creatorcontrib>Huang, Chao</creatorcontrib><creatorcontrib>Mahé, Isabelle</creatorcontrib><creatorcontrib>Bertoletti, Laurent</creatorcontrib><creatorcontrib>Bartels‐Rutten, Annemarieke</creatorcontrib><creatorcontrib>Beyer‐Westendorf, Jan</creatorcontrib><creatorcontrib>Constans, Joel</creatorcontrib><creatorcontrib>Iosub, Diana</creatorcontrib><creatorcontrib>Couturaud, Francis</creatorcontrib><creatorcontrib>Muñoz, Andres J.</creatorcontrib><creatorcontrib>Biosca, Mercedes</creatorcontrib><creatorcontrib>Lerede, Teresa</creatorcontrib><creatorcontrib>van Es, Nick</creatorcontrib><creatorcontrib>Di Nisio, Marcello</creatorcontrib><collection>CrossRef</collection><collection>Immunology Abstracts</collection><collection>AIDS and Cancer Research Abstracts</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>MEDLINE - Academic</collection><collection>Hyper Article en Ligne (HAL)</collection><jtitle>Journal of thrombosis and haemostasis</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Maraveyas, Anthony</au><au>Kraaijpoel, Noémie</au><au>Bozas, George</au><au>Huang, Chao</au><au>Mahé, Isabelle</au><au>Bertoletti, Laurent</au><au>Bartels‐Rutten, Annemarieke</au><au>Beyer‐Westendorf, Jan</au><au>Constans, Joel</au><au>Iosub, Diana</au><au>Couturaud, Francis</au><au>Muñoz, Andres J.</au><au>Biosca, Mercedes</au><au>Lerede, Teresa</au><au>van Es, Nick</au><au>Di Nisio, Marcello</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>The prognostic value of respiratory symptoms and performance status in ambulatory cancer patients and unsuspected pulmonary embolism; analysis of an international, prospective, observational cohort study</atitle><jtitle>Journal of thrombosis and haemostasis</jtitle><date>2021-11</date><risdate>2021</risdate><volume>19</volume><issue>11</issue><spage>2791</spage><epage>2800</epage><pages>2791-2800</pages><issn>1538-7933</issn><issn>1538-7836</issn><eissn>1538-7836</eissn><abstract>Background
Optimal risk stratification of unsuspected pulmonary embolism (UPE) in ambulatory cancer patients (ACPs) remains unclear. Existing clinical predictive rules (CPRs) are derived from retrospective databases and have limitations. The UPE registry is a prospective international registry with pre‐specified characteristics of ACPs with a recent UPE. The aim of this study was to assess the utility of risk factors captured in the UPE registry in predicting proximate (30‐, 90‐ and 180‐day) mortality and how they performed when applied to an existing CPR.
Objectives
To evaluate risk factors for proximate mortality, overall survival, recurrent venous thromboembolism and major bleeding, in the patients enrolled in the UPE registry cohort.
Methods
Data from the 695 ACPs in this registry were subjected to multivariate logistic regression analyses to identify predictors independently associated with proximate mortality and overall survival. The most consistent predictors were applied to the Hull CPR, an existing 5‐point prediction rule.
Results
The most consistent predictors of mortality were patient‐reported respiratory symptoms within 14 days before, and ECOG performance status at the time of UPE. These predictors applied to the Hull‐CPR produced a consistent correlation with proximate mortality and overall survival (area under the curve [AUC] = 0.70 [95% CI 0.63, 077], AUC = 0.65 [95% CI 0.60, 070], AUC = 0.64 [95% CI 0.59, 068], and AUC = 0.61, 95% CI 0.57, 0.65, respectively).
Conclusion
In ACPs with UPE, ECOG performance status logged contemporaneously to the UPE diagnosis and respiratory symptoms prior to UPE diagnosis can stratify mortality risk. When applied to the HULL‐CPR these risk predictors confirmed the risk stratification clusters of low‐intermediate and high‐risk for proximate mortality as seen in the original derivation cohort.</abstract><cop>Oxford</cop><pub>Elsevier Limited</pub><doi>10.1111/jth.15489</doi><tpages>10</tpages><orcidid>https://orcid.org/0000-0001-5256-6346</orcidid><orcidid>https://orcid.org/0000-0003-1760-7880</orcidid><orcidid>https://orcid.org/0000-0002-6983-9993</orcidid><orcidid>https://orcid.org/0000-0001-5930-7304</orcidid><orcidid>https://orcid.org/0000-0002-1124-695X</orcidid><orcidid>https://orcid.org/0000-0003-1749-4855</orcidid><orcidid>https://orcid.org/0000-0001-8214-3010</orcidid><orcidid>https://orcid.org/0000-0003-4176-5176</orcidid><orcidid>https://orcid.org/0000-0002-1855-8032</orcidid><oa>free_for_read</oa></addata></record> |
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| source | EZB-FREE-00999 freely available EZB journals; Alma/SFX Local Collection |
| subjects | cancer associated thrombosis clinical prediction rule Cohort analysis Diagnosis Embolism incidental pulmonary embolism Life Sciences Lung cancer Mortality Observational studies Patients Pulmonary embolisms risk assessment model Risk factors Survival Thromboembolism unsuspected pulmonary embolism |
| title | The prognostic value of respiratory symptoms and performance status in ambulatory cancer patients and unsuspected pulmonary embolism; analysis of an international, prospective, observational cohort study |
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