title: Clinical features and short-term outcomes of cancer patients with suspected and unsuspected pulmonary embolism: the EPIPHANY study.
abstract: The study aimed to identify predictors of overall 30-day mortality in cancer patients with pulmonary embolism including suspected pulmonary embolism (SPE) and unsuspected pulmonary embolism (UPE) events. Secondary outcomes included 30- and 90-day major bleeding and venous thromboembolism (VTE) recurrence.The study cohort included 1033 consecutive patients with pulmonary embolism from the multicentre observational ambispective EPIPHANY study (March 2006-October 2014). A subgroup of 497 patients prospectively assessed for the study were subclassified into three work-up scenarios (SPE, truly asymptomatic UPE and UPE with symptoms) to assess outcomes.The overall 30-day mortality rate was 14%. The following variables were associated with the overall 30-day mortality on multivariate analysis: VTE history, upper gastrointestinal cancers, metastatic disease, cancer progression, performance status, arterial hypotension <100 mmHg, heart rate >110 beats·min-1, basal oxygen saturation <90% and SPE (versus overall UPE).The overall 30-day mortality was significantly lower in patients with truly asymptomatic UPE events (3%) compared with those with UPE-S (20%) and SPE (21%) (p<0.0001). Thirty- and 90-day VTE recurrence and major bleeding rates were similar in all the groups.In conclusion, variables associated with the severity of cancer and pulmonary embolism were associated with short-term mortality. Our findings may help to develop pulmonary embolism risk-assessment models in this setting.
authors.affiliation: Medical Oncology Dept, IDIBAPS/Translational Genomics and Targeted Therapeutics in Solid Tumors, Hospital Clinic de Barcelona, Barcelona, Spain CFONT@clinic.ub.es.
authors.forename: Carme
authors.initials: C
authors.lastname: Font
authors.affiliation: Medical Oncology and Hematology Dept, Hospital Universitario Morales Meseguer, Murcia, Spain.
authors.forename: Alberto
authors.initials: A
authors.lastname: Carmona-Bayonas
authors.affiliation: Medical Oncology Dept, Hospital Nisa-Aljarafe, Sevilla, Spain.
authors.forename: Carmen
authors.initials: C
authors.lastname: Beato
authors.affiliation: Medical Oncology Dept, IDIBAPS/Translational Genomics and Targeted Therapeutics in Solid Tumors, Hospital Clinic de Barcelona, Barcelona, Spain.
authors.forename: Òscar
authors.initials: Ò
authors.lastname: Reig
authors.affiliation: Statistical Dept, Axioma Comunicaciones, Sevilla, Spain.
authors.forename: Antonia
authors.initials: A
authors.lastname: Sáez
authors.affiliation: Medical Oncology Dept, Hospital Universitario Central de Asturias, Oviedo, Spain.
authors.forename: Paula
authors.initials: P
authors.lastname: Jiménez-Fonseca
authors.affiliation: Radiology Dept, Hospital Universitario Morales Meseguer, Murcia, Spain.
authors.forename: Juana M
authors.initials: JM
authors.lastname: Plasencia
authors.affiliation: Radiology Dept, Hospital Universitario Central de Asturias, Oviedo, Spain.
authors.forename: David
authors.initials: D
authors.lastname: Calvo-Temprano
authors.affiliation: Radiodiagnostic Dept, Hospital Clinic de Barcelona, Barcelona, Spain.
authors.forename: Marcelo
authors.initials: M
authors.lastname: Sanchez
authors.affiliation: Radiodiagnostic Dept, Hospital Clinic de Barcelona, Barcelona, Spain.
authors.forename: Mariana
authors.initials: M
authors.lastname: Benegas
authors.affiliation: Medical Oncology Dept, Hospital Universitari Vall d'Hebron, Barcelona, Spain.
authors.forename: Mercedes
authors.initials: M
authors.lastname: Biosca
authors.affiliation: Radiology Dept, Hospital Universitari Vall d'Hebron, Barcelona, Spain.
authors.forename: Diego
authors.initials: D
authors.lastname: Varona
authors.affiliation: Medical Oncology and Hematology Dept, Hospital Universitario Morales Meseguer, Murcia, Spain.
authors.forename: Maria Angeles
authors.initials: MA
authors.lastname: Vicente
authors.affiliation: Medical Oncology Dept, Hospital Universitario Central de Asturias, Oviedo, Spain.
authors.forename: Laura
authors.initials: L
authors.lastname: Faez
authors.affiliation: Medical Oncology Dept, Hospital Universitario Central de Asturias, Oviedo, Spain.
authors.forename: Maria Del Pilar
authors.initials: MD
authors.lastname: Solís
authors.affiliation: Medical Oncology Dept, Hospital Duran i Reynals, Institut Catalàd'Oncologia, Hospitalet de Llobregat, Barcelona, Spain.
authors.forename: Irma
authors.initials: I
authors.lastname: de la Haba
authors.affiliation: Medical Oncology Dept, Hospital Duran i Reynals, Institut Catalàd'Oncologia, Hospitalet de Llobregat, Barcelona, Spain.
authors.forename: Maite
authors.initials: M
authors.lastname: Antonio
authors.affiliation: Internal Medicine Dept, Hospital Infanta Sofía. San Sebastian de los Reves, Madrid, Spain.
authors.forename: Olga
authors.initials: O
authors.lastname: Madridano
authors.affiliation: Medical Oncology Dept, Clinica Universidad de Navarra, Pamplona, Spain.
authors.forename: Eduardo
authors.initials: E
authors.lastname: Castañon
authors.affiliation: Medical Oncology Dept, Hospital Santa Lucía, Cartagena, Murcia, Spain.
authors.forename: María Jose
authors.initials: MJ
authors.lastname: Martinez
authors.affiliation: Internal Medicine Dept, Hospital Sant Joan de Deu, Esplugues de Llobregat, Barcelona, Spain.
authors.forename: Pablo
authors.initials: P
authors.lastname: Marchena
authors.affiliation: Medical Oncology Dept, Hospital Insular de Gran Canaria, Las Palmas, Spain.
authors.forename: Avinash
authors.initials: A
authors.lastname: Ramchandani
authors.affiliation: Radiology Dept, Hospital Nisa-Aljarafe, Sevilla, Spain.
authors.forename: Angel
authors.initials: A
authors.lastname: Dominguez
authors.affiliation: Radiology Dept, Hospital Reina Sofía, Murcia, Spain.
authors.forename: Alejandro
authors.initials: A
authors.lastname: Puerta
authors.affiliation: Radiology Dept, Hospital Duran i Reynals, InstitutCatalàd'Oncologia, Hospitalet de Llobregat, Barcelona, Spain.
authors.forename: David
authors.initials: D
authors.lastname: Martinez de la Haza
authors.affiliation: Radiology Dept, Clinica Universidad de Navarra, Pamplona, Spain.
authors.forename: Jesus
authors.initials: J
authors.lastname: Pueyo
authors.affiliation: Radiology Dept, Hospital Infanta Sofía. San Sebastian de los Reves, Madrid, Spain.
authors.forename: Susana
authors.initials: S
authors.lastname: Hernandez
authors.affiliation: Radiology Dept, Hospital Santa Lucía, Cartagena, Murcia, Spain.
authors.forename: Angela
authors.initials: A
authors.lastname: Fernandez-Plaza
authors.affiliation: Radiology Dept, Hospital Santa Lucía, Cartagena, Murcia, Spain.
authors.forename: Lourdes
authors.initials: L
authors.lastname: Martinez-Encarnacion
authors.affiliation: Internal Medicine Dept, Hospital Infanta Sofía. San Sebastian de los Reves, Madrid, Spain.
authors.forename: Mar
authors.initials: M
authors.lastname: Martin
authors.affiliation: Medical Oncology Dept, Hospital Clínico Universitario Virgen de la Arrixaca, Murcia, Spain.
authors.forename: Gema
authors.initials: G
authors.lastname: Marin
authors.affiliation: Medical Oncology and Hematology Dept, Hospital Universitario Morales Meseguer, Murcia, Spain.
authors.forename: Francisco
authors.initials: F
authors.lastname: Ayala
authors.affiliation: Medical Oncology and Hematology Dept, Hospital Universitario Morales Meseguer, Murcia, Spain.
authors.forename: Vicente
authors.initials: V
authors.lastname: Vicente
authors.affiliation: Dept of Pneumology, Hospital Universitario Virgen del Rocío (HUVR-IBiS). CIBERES, Sevilla, Spain.
authors.forename: Remedios
authors.initials: R
authors.lastname: Otero
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015331:Cohort Studies; D005260:Female; D006470:Hemorrhage / Q000453:epidemiology; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009369:Neoplasms / Q000150:complications* / Q000401:mortality*; D011655:Pulmonary Embolism / Q000000981:diagnostic imaging* / Q000453:epidemiology*; D018570:Risk Assessment; D012307:Risk Factors; D013030:Spain / Q000453:epidemiology; D013997:Time Factors; D014057:Tomography, X-Ray Computed; D054556:Venous Thromboembolism / Q000000981:diagnostic imaging* / Q000453:epidemiology*; D055815:Young Adult