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

• Published in: The European respiratory journal Vol. 49; no. 1; p. 1600282
• Main Authors: Font, Carme, Carmona-Bayonas, Alberto, Beato, Carmen, Reig, Òscar, Sáez, Antonia, Jiménez-Fonseca, Paula, Plasencia, Juana M., Calvo-Temprano, David, Sanchez, Marcelo, Benegas, Mariana, Biosca, Mercedes, Varona, Diego, Vicente, Maria Angeles, Faez, Laura, Solís, Maria del Pilar, de la Haba, Irma, Antonio, Maite, Madridano, Olga, Castañon, Eduardo, Martinez, María Jose, Marchena, Pablo, Ramchandani, Avinash, Dominguez, Angel, Puerta, Alejandro, Martinez de la Haza, David, Pueyo, Jesus, Hernandez, Susana, Fernandez-Plaza, Angela, Martinez-Encarnacion, Lourdes, Martin, Mar, Marin, Gema, Ayala, Francisco, Vicente, Vicente, Otero, Remedios
• Format: Journal Article
• Language: English
• Published: England European Respiratory Society Journals Ltd 01.01.2017
• Subjects: Adolescent; Adult; Aged; Aged, 80 and over; Bleeding; Cancer; Cohort Studies; Embolism; Embolisms; Female; Health risk assessment; Heart rate; Hemorrhage - epidemiology; Humans; Hypotension; Logistic Models; Lung cancer; Male; Metastases; Middle Aged; Mortality; Multivariate Analysis; Neoplasms - complications; Neoplasms - mortality; Pulmonary arteries; Pulmonary Embolism - diagnostic imaging; Pulmonary Embolism - epidemiology; Pulmonary embolisms; Risk Assessment; Risk Factors; Spain - epidemiology; Thromboembolism; Time Factors; Tomography, X-Ray Computed; Venous Thromboembolism - diagnostic imaging; Venous Thromboembolism - epidemiology; Young Adult
• ISSN: 0903-1936; 1399-3003
• DOI: 10.1183/13993003.00282-2016

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.