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Proffered Paper – Supportive and palliative care

824 - Prediction of serious complications in patients with cancer and pulmonary embolism: validation of the EPIPHANY index in a prospective cohort of patients from the PERSEO study.

Date

28 Sep 2019

Session

Proffered Paper – Supportive and palliative care

Presenters

Manuel Sanchez Canovas

Citation

Annals of Oncology (2019) 30 (suppl_5): v718-v746. 10.1093/annonc/mdz265

Authors

M. Sanchez Canovas1, A. Fernández Montes2, R. Morales Giménez3, M. Cejuela Solís4, D. Casado Elia5, E. Coma Salvans6, D. Gómez Sánchez7, C. Sánchez Cendra8, S. Sequero López9, M. Orrillo Sarmiento10, V. Arrazubi Arrula11, M. Justo De la Peña12, M. Biosca13, D. Fernández Garay14, A. Bernal Vidal15, D. Moreno Muñoz16, E. Martínez de Castro17, P. Jimenez-Fonseca7, A. Carmona Bayonas1

Author affiliations

  • 1 Hematology And Medical Oncology, Hospital Universitario Morales Meseguer, 30008 - Murcia/ES
  • 2 Medical Oncology, Complexo Hospitalario Universitario de Ourense, 32005 - Orense/ES
  • 3 Medical Oncology, Hospital General Universitario de Elche, 03203 - Elche/ES
  • 4 Medical Oncology, Hospital Universitario Insular de Gran Canaria, 35016 - Las Palmas de Gran Canaria/ES
  • 5 Medical Oncology, Complejo Hospitalario de Salamanca, 37007 - Salamanca/ES
  • 6 Medical Oncology, CO Institut Català d’Oncologia. Hospital Duran i Reynals, 08908 - Hospitalet de Llobregat/ES
  • 7 Medical Oncology, Hospital Universitario Central de Asturias, 33011 - Oviedo/ES
  • 8 Medical Oncology, Hospital Universitario de Fuenlabrada, 28942 - Fuenlabrada/ES
  • 9 Medical Oncology, Hospital Universitario San Cecilio, 18016 - Granada/ES
  • 10 Medical Oncology, Hospital del Mar, 08003 - Barcelona/ES
  • 11 Medical Oncology, Complejo Hospitalario de Navarra, 31008 - Pamplona/ES
  • 12 Medical Oncology, Hospital Universitari Son Espases, 07120 - Palma de Mallorca/ES
  • 13 Internal Medicine, Vall d'Hebron University Hospital, 08035 - BARCELONA/ES
  • 14 Medical Oncology, Complejo Hospitalario de Jaén, 23007 - Jaén/ES
  • 15 Medical Oncology, Hospital Universitario San Juan De Alicante, 03550 - San Juan de Alicante/ES
  • 16 Medical Oncology, Fundación Hospital Alcorcón, 28992 - Alcorcón/ES
  • 17 Medical Oncology, Hospital Universitario Marqués de Valdecilla, 39008 - Santander/ES

Resources

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Abstract 824

Background

The EPIPHANY decision tree is the first algorithm developed to predict serious complications in patients with cancer and pulmonary embolism (PE) (PMID: 28267709).

Methods

The objective is to evaluate the discriminatory ability of EPIPHANY in a prospective multicenter cohort. Patients with PE diagnosed by objective methods were recruited from October 2017 to April 2019. The association between the increase in prognostic category and in complications at 15 days was assessed using the linear by linear association test.

Results

The sample contains 463 patients with PE (39.7% suspected and 60.3% unsuspected). 68.3% (n = 316) showed clinical or haemodynamic instability, while 31.7% (n = 147) were normotensive PE with apparent clinical stability. The breakdown of initial risk criteria is: sudden or progressive dyspnea (58.7%), tachycardia >110 lpm (17.3%), hypotension <100 mmHg (9.9%), hypoxemia <90% (11%), elevated haemorrhagic risk (18.6%), tachypnea >30 rpm (3.2%), thrombopenia < 50000 (2.2%) and major bleeding (0.9%). Based on the entire decision tree, 21.8% were classified as low (n = 101), 22% as intermediate (n = 102), and 56.15% as high risk (n = 260). The serious complications rate at 15 days increased significantly throughout these prognostic categories: 3%, 5.9% and 26.5%, for low, intermediate and high-risk patients, respectively (p = 0.001). Serious complications occurred in 16.8% (n = 78) after a median of 5 days, being the most frequent: respiratory failure (56.4%), major bleeding (21.8%) and hypotension (20.5%). 28 patients died within the first 15 days post-PE, of which 2 belonged to the medium- and 26 to the high-risk group. The 3 main etiologies of exitus were: mixed origin (57.1%), complications of PE (32.1%) and progression of cancer (28.1%).

Conclusions

EPIPHANY is the only model available for the classification of patients with cancer and PE, based on their short-term risk of complications, with potential implications for decision making.

Clinical trial identification

Editorial acknowledgement

Legal entity responsible for the study

Asociación de Investigación de la Enfermedad Tromboembólica Venosa de la Región de Murcia.

Funding

Leo Academy.

Disclosure

M. Sanchez Canovas: Research grant / Funding (institution): Leo Pharma. All other authors have declared no conflicts of interest.

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