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Comparison of different clinical prognostic scores in patients with pulmonary embolism and active cancer
Session:
Comunicações Orais (Sessão 16) - Doença CV em Populações Especiais
Speaker:
Beatriz Valente Silva
Congress:
CPC 2022
Topic:
K. Cardiovascular Disease In Special Populations
Theme:
30. Cardiovascular Disease in Special Populations
Subtheme:
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Session Type:
Comunicações Orais
FP Number:
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Authors:
Beatriz Valente Silva; Pedro Silvério António; Sara Couto Pereira; Pedro Alves da Silva; Joana Brito; Ana Beatriz Garcia; Catarina Simões de Oliveira; Ana Margarida Martins; Miguel Azaredo Raposo; Rui Plácido; Miguel Nobre Menezes; Andreia Magalhães; Manuela Fiúza; Fausto j. Pinto
Abstract
<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><span style="color:#000000"><strong>Introduction/Purpose</strong></span></span></span><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><span style="color:#000000">: Several prognostic models have been validated for risk-stratification in patients with pulmonary embolism (PE), but current literature lacks a consensus tool to quantify short-term prognosis among cancer patients. This study aimed to compare the prognostic performance of generic (original and simplified PESI) and cancer-specific prognostic scores (POMPE-C and modified Ottawa) to estimate 30-day mortality after PE.</span></span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><span style="color:#000000"><strong>Methods</strong></span></span></span><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><span style="color:#000000">: Retrospective study of patients with PE and active cancer. The primary outcome was 30-day overall mortality. The prognostic accuracy of the clinical scores was determined using receiver operating characteristic (ROC) curve analysis. </span></span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><span style="color:#000000"><strong>Results</strong></span></span></span><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><span style="color:#000000">: Seventy-six patients were evaluated (50% female, mean age 71 </span></span></span><span style="font-size:11pt"><span style="font-family:'Times New Roman'"><span style="color:#000000">±</span></span></span><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><span style="color:#000000"> 14 years). Mortality at 30 days occurred in 21 patients (27.6%). Figure 1 shows the ROC curves for 30-day overall mortality. Original and simplified PESI scores did not predict mortality in PE patients with cancer. Indeed, sPESI score categorized all cancer patients as high risk, limiting its discriminatory power. Only the cancer-specific POMPE-C and modified Ottawa scores predicted PE-related mortality in this population (AUC 0.65 and 0.68, respectively). Compared to patients with POMPE-C score <7.7 (1</span></span></span><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><span style="color:#000000"><sup>st</sup></span></span></span><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><span style="color:#000000"> tertile), 30-days mortality was four times higher in the ones presenting higher scores (OR: 4.0; 95%CI: 1.05-15.22; P<0.042). The Kaplan-Meier individual survival analysis for mortality stratified by POMPE-C score is represented in Figure 2 (LogRank 6.27, p=0.043).</span></span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><span style="color:#000000"><strong>Conclusion</strong></span></span></span><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><span style="color:#000000">: Clinical course of cancer patients differs from those without cancer, and malignancy itself may contribute to a substantial proportion of the risk of death. Thus, cancer-specific PE prognostic scores (POMPE-C and Ottawa) performed better than generic scales (original PESI and sPESI).</span></span></span></p>
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