title: Predictive score for estimating cancer after venous thromboembolism: a cohort study.
abstract: BACKGROUND
  Venous thromboembolism (VTE) has been associated with a higher risk of developing malignancy and mortality, and patients with VTE may therefore benefit from increased surveillance. We aimed to construct a clinical predictive score that could classify patients with VTE according to their risk for developing these outcomes.
  
  
  METHODS
  Observational cohort study using an existing clinical registry in a tertiary academic teaching hospital in Buenos Aires, Argentina. 1264 adult patients greater than 17 years of age presented new VTE between June 2006 and December 2011 and were included in the registry. We excluded patients with previous or incident cancer, those who died during the first month, and those with less than one year of follow up (< 5%). 540 patients were included. Primary outcome was new cancer diagnosis during one year of follow-up, secondary composite outcome was any new cancer diagnosis or death. The score was developed using a multivariable logistic regression model to predict cancer or death.
  
  
  RESULTS
  During follow-up, one-quarter (26.4%) of patients developed cancer (9.2%) or died (23.7%). Patients with the primary outcome had more comorbidities, were more likely to have previous thromboembolism and less likely to have recent surgery. The final score developed for predicting cancer alone included previous episode of VTE, recent surgery and comorbidity (Charlson comorbidity score), [AUC of 0.75 (95% CI 0.66-0.84) and 0.79 (95% CI 0.63-0.95) in the derivation and validation cohorts, respectively]. The version of this score developed to predict cancer or death included age, albumin level, comorbidity, previous episode of VTE, and recent surgery [AUC = 0.72 (95% CI 0.66-0.78) and 0.71 (95% CI 0.63-0.79) in the derivation and validation cohorts, respectively].
  
  
  CONCLUSIONS
  A simple clinical predictive score accurately estimates patients' risk of developing cancer or death following newly diagnosed VTE. This tool could be used to help reassure low risk patients, or to identify high-risk patients that might benefit from closer surveillance and additional investigations.
  
  
  BACKGROUND
  ClinicalTrials.gov: NCT01372514.
authors.affiliation: Internal Medicine Department, Hospital Italiano de Buenos Aires, Buenos Aires University, Buenos Aires, Argentina. bruno.ferreyro@hospitalitaliano.org.ar
authors.forename: Bruno L
authors.initials: BL
authors.lastname: Ferreyro
authors.forename: Federico
authors.initials: F
authors.lastname: Angriman
authors.forename: Diego
authors.initials: D
authors.lastname: Giunta
authors.forename: María Lourdes
authors.initials: ML
authors.lastname: Posadas-Martínez
authors.forename: Fernando
authors.initials: F
authors.lastname: Vazquez
authors.forename: Fernán Gonzalez Bernaldo
authors.initials: FG
authors.lastname: De Quirós
authors.forename: Andre C K B
authors.initials: AC
authors.lastname: Amaral
authors.forename: Damon C
authors.initials: DC
authors.lastname: Scales
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D019540:Area Under Curve; D015331:Cohort Studies; D015897:Comorbidity; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009369:Neoplasms / Q000150:complications* / Q000453:epidemiology*; D012372:ROC Curve; D012042:Registries; D054556:Venous Thromboembolism / Q000150:complications* / Q000453:epidemiology*