title: Clinical presentation and in-hospital death in acute pulmonary embolism: does cancer matter?
abstract: Cancer is one of the most common risk factors for acute pulmonary embolism (PE), but only few studies report on the short-term outcome of patients with PE and a history of cancer. The aim of the study was to assess whether a cancer diagnosis affects the clinical presentation and short-term outcome in patients hospitalized for PE who were included in the Italian Pulmonary Embolism Registry. All-cause and PE-related in-hospital deaths were also analyzed. Out of 1702 patients, 451 (26.5 %) of patients had a diagnosis of cancer: cancer was known at presentation in 365, or diagnosed during the hospital stay for PE in 86 (19 % of cancer patients). Patients with and without cancer were similar concerning clinical status at presentation. Patients with cancer less commonly received thrombolytic therapy, and more often had an inferior vena cava filter inserted. Major or intracranial bleeding was not different between groups. In-hospital all-cause death occurred in 8.4 and 5.9 % of patients with and without cancer, respectively. At multivariate analysis, cancer (OR 2.24, 95 % CI 1.27-3.98; P = 0.006) was an independent predictor of in-hospital death. Clinical instability, PE recurrence, age ≥75 years, recent bed rest ≥3 days, but not cancer, were independent predictors of in-hospital death due to PE. Cancer seems a weaker predictor of all-cause in-hospital death compared to other factors; the mere presence of cancer, without other risk factors, leads to a probability of early death of 2 %. In patients with acute PE, cancer increases the probability of in-hospital all-cause death, but does not seem to affect the clinical presentation or the risk of in-hospital PE-related death.
authors.affiliation: Cardiology Division, Ospedale San Carlo Borromeo, Milan, Italy.
authors.forename: Franco
authors.initials: F
authors.lastname: Casazza
authors.affiliation: Internal and Cardiovascular Medicine-Stroke Unit, University of Perugia, Via G Dottori 1, Perugia, Italy. cecilia.becattini@unipg.it.
authors.forename: Cecilia
authors.initials: C
authors.lastname: Becattini
authors.affiliation: IRCCS-Istituto di Ricerche Farmacologiche Mario Negri, Milan, Italy.
authors.forename: Eliana
authors.initials: E
authors.lastname: Rulli
authors.affiliation: IRCCS-Istituto di Ricerche Farmacologiche Mario Negri, Milan, Italy.
authors.forename: Ilaria
authors.initials: I
authors.lastname: Pacchetti
authors.affiliation: IRCCS-Istituto di Ricerche Farmacologiche Mario Negri, Milan, Italy.
authors.forename: Irene
authors.initials: I
authors.lastname: Floriani
authors.affiliation: Division of Internal Medicine, Ospedale San Carlo Borromeo, Milan, Italy.
authors.forename: Marco
authors.initials: M
authors.lastname: Biancardi
authors.affiliation: Cardiology Division, Ospedale S. Spirito, Rome, Italy.
authors.forename: Angela Beatrice
authors.initials: AB
authors.lastname: Scardovi
authors.affiliation: UO Medicina d'Urgenza, AORN S. Anna e S. Sebastiano, Caserta, Italy.
authors.forename: Iolanda
authors.initials: I
authors.lastname: Enea
authors.affiliation: Cardiology Division, Ospedale San Carlo Borromeo, Milan, Italy.
authors.forename: Amedeo
authors.initials: A
authors.lastname: Bongarzoni
authors.affiliation: Cardiology Division, Ospedale San Carlo Borromeo, Milan, Italy.
authors.forename: Luigi
authors.initials: L
authors.lastname: Pignataro
authors.affiliation: Internal and Cardiovascular Medicine-Stroke Unit, University of Perugia, Via G Dottori 1, Perugia, Italy.
authors.forename: Giancarlo
authors.initials: G
authors.lastname: Agnelli
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000925:Anticoagulants / Q000627:therapeutic use; D016009:Chi-Square Distribution; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D007558:Italy / Q000453:epidemiology; D008297:Male; D045265:Natriuretic Peptides / Q000032:analysis / Q000097:blood; D009369:Neoplasms / Q000150:complications* / Q000453:epidemiology / Q000401:mortality; D011655:Pulmonary Embolism / Q000453:epidemiology / Q000209:etiology* / Q000401:mortality; D012008:Recurrence; D012307:Risk Factors; D015912:Thrombolytic Therapy / Q000379:methods; D019210:Troponin I / Q000032:analysis / Q000097:blood; D020107:Troponin T / Q000032:analysis / Q000097:blood; D054556:Venous Thromboembolism / Q000188:drug therapy / Q000401:mortality
chemical_list: D000925:Anticoagulants; D045265:Natriuretic Peptides; D019210:Troponin I; D020107:Troponin T
keywords: Cancer; In-hospital death; Pulmonary embolism; Risk factors; Thrombosis