SPC365

Different D-dimer algorithms to rule out Pulmonary Embolism in patients with cancer: a comparative study

Session: Posters - F. Valvular, Myocardial, Pericardial, Pulmonary, Congenital Heart Disease
Speaker: Tiago Graça Rodrigues

Congress: CPC 2021
Topic: F. Valvular, Myocardial, Pericardial, Pulmonary, Congenital Heart Disease
Theme: 21. Pulmonary Circulation, Pulmonary Embolism, Right Heart Failure
Subtheme: 21.6 Pulmonary Circulation, Pulmonary Embolism, Right Heart Failure – Clinical
Session Type: Posters
FP Number: ---
Authors: Tiago Graça Rodrigues; Beatriz Valente Silva; Nelson Cunha; Sara Pereira; Pedro Silvério António; Joana Brito; Catarina Oliveira; Beatriz Garcia; Ana Margarida Martins; Cláudia Jorge; Joana Rigueira; Rui Plácido; Miguel Nobre Menezes; Fausto j. Pinto

<p style="margin-right:-4px; text-align:justify"><span style="font-size:10pt"><span style="font-family:&quot;Times New Roman&quot;"><span style="color:#000000"><strong><span style="font-size:12pt"><span style="font-family:Arial"><span style="color:black">Background: </span></span></span></strong><span style="font-size:12pt"><span style="font-family:Arial"><span style="color:black">Pulmonary embolism (PE) is more prevalent in patients with cancer. D-dimers are a less useful test in these patients due to less specificity. Several algorithms have been developed, as an alternative to the fixed d-dimer cutoff, to avoid the excessive use of&nbsp;computed tomography pulmonary angiography (CTPA), but it is not clear which is the most accurate algorithm in PE patients with cancer.</span></span></span></span></span></span></p>

<p style="margin-right:-4px; text-align:justify"><span style="font-size:10pt"><span style="font-family:&quot;Times New Roman&quot;"><span style="color:#000000"><strong><span style="font-size:12pt"><span style="font-family:Arial"><span style="color:black">Objective</span></span></span></strong><span style="font-size:12pt"><span style="font-family:Arial"><span style="color:black">: To compare the efficacy of 4 algorithms to rule out pulmonary embolism (fixed Ddimer cutoff, age-adjusted cutoff, YEARS and PEGed) in patients with active cancer.</span></span></span></span></span></span></p>

<p style="margin-right:-4px; text-align:justify"><span style="font-size:10pt"><span style="font-family:&quot;Times New Roman&quot;"><span style="color:#000000"><strong><span style="font-size:12pt"><span style="font-family:Arial"><span style="color:black">Methods:</span></span></span></strong><strong>&nbsp;</strong><span style="font-size:12pt"><span style="font-family:Arial"><span style="color:black">Retrospective study of consecutive outpatients who presented to the emergency department and underwent CTPA for PE suspicion from April 2019 to February 2020. The clinical-decision algorithms were retrospectively applied. In fixed and age-adjusted cutoffs, high probability patients are directly selected for CTPA and the others perform CTPA if DDimer&nbsp;&ge;500&micro;g/L or age x10 &micro;g/L within patients over 50 years, respectively. YEARS includes 3 items (signs of deep vein thrombosis, haemoptysis and whether PE is the most likely diagnosis): patients without any YEARS items and Ddimer &ge;1000ng/mL or with &ge;1 items and Ddimer 500ng/mL perform CTPA. In the PEGeD, patients with high&nbsp;clinical probability or with&nbsp;intermediate and Ddimer &gt;500&micro;g/L or low probability and Ddimer &gt;1000 &micro;g/L are selected for CTPA.</span></span></span></span></span></span></p>

<p style="margin-right:-4px; text-align:justify"><span style="font-size:10pt"><span style="font-family:&quot;Times New Roman&quot;"><span style="color:#000000"><strong><span style="font-size:12pt"><span style="font-family:Arial"><span style="color:black">Results:</span></span></span></strong>&nbsp;<span style="font-size:12pt"><span style="font-family:Arial"><span style="color:black">Of 409 patients with suspected PE, 87 (21,3%) patients had cancer. The prevalence of PE was 38% in cancer patients and 35% in patients without cancer (p&gt;0.05).&nbsp;</span></span></span></span></span></span></p>

<p style="margin-right:-4px; text-align:justify"><span style="font-size:10pt"><span style="font-family:&quot;Times New Roman&quot;"><span style="color:#000000"><span style="font-size:12pt"><span style="font-family:Arial"><span style="color:black">Considering the 87 patients with cancer, sensitivity and specificity of each algorithm are summarized in table 1 and ROC curves are presented in figure 1. Age-adjusted cut-off, compared to the conventional cutoff, had an AUC significantly higher (0.68 vs 0.61, p=0.005). Despite both having 100% sensitivity, age-adjusted cutoff had a significant higher specificity compared to conventional cut-off (44% vs 35%, p&lt;0.05).&nbsp;</span></span></span></span></span></span></p>

<p style="margin-right:-4px; text-align:justify"><span style="font-size:10pt"><span style="font-family:&quot;Times New Roman&quot;"><span style="color:#000000"><span style="font-size:12pt"><span style="font-family:Arial"><span style="color:black">Both YEARS and PEGED algorithms had significantly lower sensitivity (p=0.003 and p=0.002, respectively) and higher specificity (p&lt;0.001, for both) compared to conventional cutoff in patients with active cancer. The AUC of these two algorithms was not significantly different compared to conventional cutoff (p=0.08 and p=0.78, respectively).</span></span></span></span></span></span></p>

<p style="margin-right:-4px; text-align:justify">&nbsp;</p>

<p style="margin-right:-4px; text-align:justify"><span style="font-size:10pt"><span style="font-family:&quot;Times New Roman&quot;"><span style="color:#000000"><strong><span style="font-size:12pt"><span style="font-family:Arial"><span style="color:black">Conclusion:</span></span></span></strong><span style="font-size:12pt"><span style="font-family:Arial"><span style="color:black">Considering our results, age-adjusted cut-off seems to be the most accurate algorithm to rule out pulmonary embolism in active cancer patients.</span></span></span></span></span></span></p>