title: A clinical prognostic model for the identification of low-risk patients with acute symptomatic pulmonary embolism and active cancer.
abstract: BACKGROUND
  Physicians 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). The objective of this study was to develop a simple risk score for predicting 30-day mortality in patients with PE and 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 Registro Informatizado de la Enfermedad TromboEmbólica 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, which contained six variables: age > 80 years, heart rate ≥ 110/min, systolic BP < 100 mm Hg, body weight < 60 kg, recent immobility, and presence of metastases. In the internal validation cohort (n = 508), the 22.2% of patients (113 of 508) classified as low risk by the prognostic model had a 30-day mortality of 4.4% (95% CI, 0.6%-8.2%) compared with 29.9% (95% CI, 25.4%-34.4%) in the high-risk group. In the external validation cohort, the 18% of patients (47 of 261) classified as low risk by the prognostic model had a 30-day mortality of 0%, compared with 19.6% (95% CI, 14.3%-25.0%) in the high-risk group.
  
  
  CONCLUSIONS
  The developed clinical prediction rule accurately identifies low-risk patients with cancer and acute PE.
authors: Leiden University Medical Center, Leiden, The Netherlands.
authors: Paul L
authors: PL
authors: den Exter
authors: Medicine Department, Ramón y Cajal Hospital, Instituto Ramón y Cajal de Investigación Sanitaria, Madrid, Spain.
authors: Vicente
authors: V
authors: Gómez
authors: Respiratory Department, Ramón y Cajal Hospital, Instituto Ramón y Cajal de Investigación Sanitaria, Madrid, Spain. Electronic address: djc_69_98@yahoo.com.
authors: David
authors: D
authors: Jiménez
authors: Medicine Department, Santa Lucía Hospital, Cartagena, Murcia, Spain.
authors: Javier
authors: J
authors: Trujillo-Santos
authors: Biostatistics Department, Ramón y Cajal Hospital, Instituto Ramón y Cajal de Investigación Sanitaria, Madrid, Spain.
authors: Alfonso
authors: A
authors: Muriel
authors: Leiden University Medical Center, Leiden, The Netherlands.
authors: Menno V
authors: MV
authors: Huisman
authors: Medicine Department, Germans Trias I Pujol Hospital, Badalona, Barcelona, Spain.
authors: Manuel
authors: M
authors: Monreal
mesh_terms: D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D015331:Cohort Studies; D003661:Decision Support Techniques; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009369:Neoplasms / Q000150:complications* / Q000401:mortality; D011379:Prognosis; D011655:Pulmonary Embolism / Q000150:complications / Q000175:diagnosis* / Q000401:mortality; D011897:Random Allocation; D015203:Reproducibility of Results; D012189:Retrospective Studies; D018570:Risk Assessment / Q000379:methods; D012307:Risk Factors; D012720:Severity of Illness Index