Title
Author
DOI
Article Type
Special Issue
Volume
Issue
High D-dimer is a predictor for short-term mortality in patients with active cancer and acute pulmonary embolism
1Department of Emergency Medicine, University of Ulsan College of Medicine, Asan Medical Center, 05505 Seoul, Republic of Korea
DOI: 10.22514/sv.2021.083 Vol.17,Issue 5,September 2021 pp.58-63
Submitted: 24 February 2021 Accepted: 19 March 2021
Published: 08 September 2021
*Corresponding Author(s): Yoon-Seon Lee E-mail: ysdoc@amc.seoul.kr
Objectives: Acute pulmonary embolism (PE) is the main cause of death in cancer patients, but there are limited prognostic tools for the patients with active cancer and acute PE. We aimed to identify prognostic factors of 30-day mortality in patients with active cancer and acute PE.
Methods: This retrospective observational study included all adult patients aged ≥18 years with active cancer and acute PE from February 2017 to February 2019 at the emergency department in tertiary care hospital, Seoul, Korea. The primary outcome is 30-day mortality.
Results: A total of 178 patients were included with a mean age of 63.9 years (SD 10.4) and males of 52.8%. The overall 30-day mortality rate was 30.9%. In a multivariable logistic analysis, high D-dimer, defined as ≥median value of 14.7 µg/mL, with odds ratio (OR) 2.47 (95% confidence interval [CI], 1.15–5.33), high Pulmonary Embolism Severity Index (PESI) scores with OR 2.95 (95% CI, 1.21–7.75) for class IV and OR 2.90 (95% CI, 1.06–7.90) for class V, and Eastern Cooperative Oncology Group (ECOG) performance status 3/4 with OR 3.22 (95% CI, 1.18–8.76) were independent predictors of 30-day mortality.
Conclusion: High D-dimer values, high PESI scores, and poor ECOG performance status may be reliable predictors of mortality in patients with active cancer and acute PE.
Cancer; D-dimer; Mortality; Prognosis; Pulmonary embolism
Eun-Ju Her,Hyojeong Kwon,Bora Chae,Youn-Jung Kim,Yoon-Seon Lee. High D-dimer is a predictor for short-term mortality in patients with active cancer and acute pulmonary embolism. Signa Vitae. 2021. 17(5);58-63.
[1] Lehnert P, Lange T, Møller CH, Olsen PS, Carlsen J. Acute pulmonary embolism in a national Danish cohort: increasing incidence and decreasing mortality. Thrombosis and Haemostasis. 2018; 118: 539–546.
[2] Goldhaber SZ, Visani L, de Rosa M. Acute pulmonary embolism: clinical outcomes in the International Cooperative Pulmonary Embolism Registry (ICOPER). Lancet. 1999; 353: 1386–389.
[3] Weeda ER, Hakamiun KM, Leschorn HX, Tran E. Comorbid cancer and use of thrombolysis in acute pulmonary embolism. Journal of Thrombosis and Thrombolysis. 2019; 47: 324–327.
[4] Aujesky D, Obrosky DS, Stone RA, Auble TE, Perrier A, Cornuz J, et al. Derivation and validation of a prognostic model for pulmonary embolism. American Journal of Respiratory and Critical Care Medicine. 2005; 172: 1041–1046.
[5] Donzé J, Le Gal G, Fine MJ, Roy P, Sanchez O, Verschuren F, et al. Prospective validation of the Pulmonary Embolism Severity Index. A clinical prognostic model for pulmonary embolism. Thrombosis and Haemostasis. 2008; 100: 943–948.
[6] Jiménez D, Aujesky D, Moores L, Gómez V, Lobo JL, Uresandi F, et al. Simplification of the pulmonary embolism severity index for prognostication in patients with acute symptomatic pulmonary embolism. Archives of Internal Medicine. 2010; 170: 1383–1389.
[7] Weeda ER, Caranfa JT, Lyman GH, Kuderer NM, Nguyen E, Coleman CI, et al. External validation of three risk stratification rules in patients presenting with pulmonary embolism and cancer. Supportive Care in Cancer. 2019; 27: 921–925.
[8] Kline JA, Roy P, Than MP, Hernandez J, Courtney DM, Jones AE, et al. Derivation and validation of a multivariate model to predict mortality from pulmonary embolism with cancer: the POMPE-C tool. Thrombosis Research. 2012; 129: e194–e199.
[9] Font C, Carmona-Bayonas A, Fernández-Martinez A, Beato C, Vargas A, Gascon P, et al. Outpatient management of pulmonary embolism in cancer: data on a prospective cohort of 138 consecutive patients. Journal of the National Comprehensive Cancer Network. 2014; 12: 365–373.
[10] Mickey RM, Greenland S. The impact of confounder selection criteria on effect estimation. American Journal of Epidemiology. 1989; 129: 125–137.
[11] Konstantinides S. Clinical practice. Acute pulmonary embolism. The New England Journal of Medicine. 2008; 359: 2804–2813.
[12] Tapson VF. Acute pulmonary embolism. The New England Journal of Medicine. 2008; 358: 1037–1052.
[13] Carrier M, Righini M, Djurabi RK, Huisman M, Perrier A, Wells P, et al. VIDAS D-dimer in combination with clinical pre-test probability to rule out pulmonary embolism. Thrombosis and Haemostasis. 2009; 101: 886–892.
[14] Kruip MJHA, Slob MJ, Schijen JHEM, van der Heul C, Büller HR. Use of a clinical decision rule in combination with D-dimer concentration in diagnostic workup of patients with suspected pulmonary embolism. Archives of Internal Medicine. 2002; 162: 1631.
[15] Aujesky D, Roy PM, Guy M, Cornuz J, Sanchez O, Perrier A. Prognostic value of D-dimer in patients with pulmonary embolism. Thrombosis and Haemostasis. 2006; 96: 478–482.
[16] Grau E, Tenías JM, Soto MJ, Gutierrez MR, Lecumberri R, Pérez JL, et al. D-dimer levels correlate with mortality in patients with acute pulmonary embolism: findings from the RIETE registry. Critical Care Medicine. 2007; 35: 1937–1941.
[17] Lobo JL, Zorrilla V, Aizpuru F, Grau E, Jiménez D, Palareti G, et al. D-dimer levels and 15-day outcome in acute pulmonary embolism. Findings from the RIETE Registry. Journal of Thrombosis and Haemostasis. 2009; 7: 1795–1801.
[18] Geissenberger F, Schwarz F, Probst M, Haberl S, Gruetzner S, Kroencke T, et al. D-dimer predicts disease severity but not long-term prognosis in acute pulmonary embolism. Clinical and Applied Thrombosis/Hemostasis. 2019; 25: 107602961986349.
[19] Keller K, Beule J, Balzer JO, Dippold W. D-dimer and thrombus burden in acute pulmonary embolism. The American Journal of Emergency Medicine. 2019; 36: 1613–1618.
[20] Becattini C, Lignani A, Masotti L, Forte MB, Agnelli G. D-dimer for risk stratification in patients with acute pulmonary embolism. Journal of Thrombosis and Thrombolysis. 2012; 33: 48–57.
[21] Bozas G, Jeffery N, Ramanujam-Venkatachala D, Avery G, Stephens A, Moss H, et al. Prognostic assessment for patients with cancer and incidental pulmonary embolism. Thrombosis Journal. 2018; 16: 8.
[22] Ahn S, Lee Y, Kim WY, Lim KS, Lee J. Prognostic value of treatment setting in patients with cancer having pulmonary embolism: comparison with the pulmonary embolism severity index. Clinical and Applied Thrombosis/Hemostasis. 2017; 23: 615–621.
[23] Weeda ER, Caranfa JT, Zeichner SB, Coleman CI, Nguyen E, Kohn CG. External validation of generic and cancer-specific risk stratification tools in patients with pulmonary embolism and active cancer. Journal of the National Comprehensive Cancer Network. 2017; 15: 1476–1482.
[24] den Exter PL, Gómez V, Jiménez D, Trujillo-Santos J, Muriel A, Huisman MV, et al. A clinical prognostic model for the identification of low-risk patients with acute symptomatic pulmonary embolism and active cancer. Chest. 2013; 143: 138–145.
[25] Fuentes HE, Tafur AJ, Caprini JA, Alatri A, Trujillo-Santos J, Farge-Bancel D, et al. Prediction of early mortality in patients with cancer-associated thrombosis in the RIETE Database. International Angiology. 2019; 38: 173–184.
[26] Font C, Carmona-Bayonas A, Fernández-Martinez A, Beato C, Vargas A, Gascon P, et al. Outpatient management of pulmonary embolism in cancer: data on a prospective cohort of 138 consecutive patients. Journal of the National Comprehensive Cancer Network. 2014; 12: 365–373.
[27] Font C, Carmona-Bayonas A, Beato C, Reig Ò, Sáez A, Jiménez-Fonseca P, et al. Clinical features and short-term outcomes of cancer patients with suspected and unsuspected pulmonary embolism: the EPIPHANY study. The European Respiratory Journal. 2017; 49: 1600282.
[28] Ay C, Dunkler D, Pirker R, Thaler J, Quehenberger P, Wagner O, et al. High D-dimer levels are associated with poor prognosis in cancer patients. Haematologica. 2012; 97: 1158–1164.
[29] Li W, Tang Y, Song Y, Chen S, Sisliyan N, Ni M, et al. Prognostic role of pretreatment plasma D-dimer in patients with solid tumors: a systematic review and meta-analysis. Cellular Physiology and Biochemistry. 2018; 45: 1663–1676.
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