Predicting mortality of pulmonary thromboembolism in cancer patients with a new scoring system: mPESI

Year 2024, Volume: 49 Issue: 3, 614 - 623, 30.09.2024

Feray Balkan , N. Rana Dişel , Senem Koca , Gülçin Dağlıoğlu , Ezgi Özyılmaz , Rabia Akıllı , Merve Türker , Ömer Taşkın , Ayça Açıkalın Akpınar

https://doi.org/10.17826/cumj.1460163

Abstract

Purpose: Although the Pulmonary Embolism Severity Index (PESI) is frequently used, assessing the severity of pulmonary thromboembolism in cancer patients is not sufficient for prognostic evaluation. In this study, we aimed to designate a scoring system to determine the prognosis of newly diagnosed pulmonary thromboembolism in adult cancer patients.
Materials and Methods: This prospective, cross-sectional, and descriptive study was held in an emergency department of a university hospital. Patients were classified according to their PESI scores. The echocardiography results, blood gas analyses, lactate, d-dimer, and N-terminus pro-Brain natriuretic peptide levels of the patients were evaluated to prognosticate mortality.
Results: Among 53 patients included, 13 mortalities occurred. The mortality was 38.8% (5/23) in PESI Class 3, 7.7% (1/12) in PESI Class 4, and 53.8% (7/10) in PESI Class 5 while none in the 8 patients in PESI Class 2. The mortality in the first 24 hours was 23%, 53.9% in the first month, and 23.1% in 1-3 months. According to the cut-off values determined, a scoring called ‘mPESI’ was developed by giving one point each for d-dimer >24.28 µg/mL, N-terminus pro-Brain natriuretic peptide >1340 pg/mL, blood pH <7.30 and presence of right heart failure. The 1–3-month survival rate was 97.3% if mPESI 2, while first month survival was 33.3% and 1–3 months survival was 16.7% in the patients with mPESI=3.
Conclusion: The mPESI scoring may help clinicians to predict the prognosis of cancer patients with pulmonary thromboembolism.

Keywords

PESI score, Pulmonary thromboembolism, right ventricular dysfunction, emergency department, cancer

Ethical Statement

This study approved by the Çukurova University’s Ethics Committee (Decision no:1, date: December 7th, 2018).

Supporting Institution

Çukurova University Scientific Research Projects Coordination Unit

Project Number

TTU 2019-11357

Kanser hastalarında pulmoner tromboemboli mortalitesini öngören yeni bir skorlama sistemi: mPESI

Abstract

Amaç: Pulmoner Emboli Şiddet İndeksi (PESI), sıklıkla kullanılsa da kanser hastalarında pulmoner tromboemboli şiddetini değerlendirmek prognostik değerlendirme yapmak için yeterli değildir. Bu çalışmada erişkin kanser hastalarında yeni tanı pulmoner tromboembolinin prognozunu belirlemek için bir skorlama geliştirmeyi amaçladık.
Gereç ve Yöntem: Bu prospektif, kesitsel ve tanımlayıcı çalışma bir üniversite hastanesinin acil servisinde gerçekleştirildi. Hastalar PESI skorlarına göre sınıflandırıldı. Hastaların ekokardiyografi sonuçları, kan gazı analizleri, laktat, d-dimer ve N Terminal pro B tip natriüretik peptit düzeyleri mortaliteyi öngörmek için değerlendirildi. Kesim değeri belirlemek için ROC analizi yapıldı.
Bulgular: Çalışmaya dahil edilen 53 hasta arasında 13 mortalite meydana geldi. PESI Sınıf 3'te mortalite %38,8 (5/23), PESI Sınıf 4'te %7,7 (1/12) ve PESI Sınıf 5'te %53,8 (7/10) iken PESI Sınıf 2'de 8 hastada mortalite görülmedi. İlk 24 saatte mortalite %23, ilk ayda %53,9 ve 1-3 ayda %23,1 idi. Kesim değerlerine göre; d-dimer >24,28 µg/mL; N Terminal pro B tip natriüretik peptit >1340 pg/mL; kan pH'sı <7,30 ve sağ kalp yetmezliği varlığına birer puan verilerek "mPESI" adı verilen bir skorlama geliştirildi. 1-3 aylık sağkalım oranı mPESI2 ise %97,3 iken, mPESI=3 olan hastalarda ilk ay sağkalım %33,3 ve 1-3 aylık sağkalım %16,7 idi.
Sonuç: mPESI skorlaması, pulmoner tromboembolili kanser hastalarının prognozunu öngörmede klinisyenlere katkıda bulunabilir.

Keywords

PESI skoru, acil servis, kanser, sağ ventrikül disfonksiyonu, Pulmoner tromboemboli

Project Number

TTU 2019-11357

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