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

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

doi:10.17826/cumj.1460163

TR EN

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

Öz

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.

Anahtar Kelimeler

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

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

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

Kaynakça

Konstantinides S, Goldhaber SZ. Pulmonary embolism: risk assessment and management. Eur Heart J. 2012;33:3014-22.
Kline JA. Diagnosis and exclusion of pulmonary embolism. Thromb Res. 2018;163:207-20.
Samad M, Malempati S, Restini CBA. Natriuretic peptides as biomarkers: narrative review and considerations in cardiovascular and respiratory dysfunctions. Yale J Biol Med. 2023;96:137-49.
Donzé J, Le Gal G, Fine MJ, Roy P-M, Sanchez O, Verschuren F et al. Prospective validation of the pulmonary embolism severity index. Thromb Haemost. 2008;100:943-8.
Cepoi MR, Duca ST, Chetran A, Costache AD, Spiridon MR, Afrăsânie I et al. Chronic kidney disease associated with ischemic heart disease: to what extent do biomarkers help? Life (Basel). 2023 Dec 25;14(1):34..
Sandal A, Korkmaz E T, Aksu F, Köksal D, Toros Selçuk Z, Demir A U et al. Performance of pulmonary embolism severity index in predicting long-term mortality after acute pulmonary embolism. Anatol J Cardiol. 2021;25:544-54.
Carmona-Bayonas A, Jiménez-Fonseca P, Font C, Fenoy F, Otero R, Beato C et al. Predicting serious complications in patients with cancer and pulmonary embolism using decision tree modelling: the EPIPHANY Index. Br J Cancer. 2017;116:994-1001.
Kline JA, Roy PM, 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. Thromb Res. 2012;129:e194-e99.
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. Eur Respir J. 2017;49:1600282.
Norton L, Cooper G, Sheerins O, Mac A' Bháird K, Roditi G, Adamson M et al. Clinical and radiological characteristics of acute pulmonary embolus in relation to 28-day and 6-month mortality. PLoS One. 2021;16:e0258843.

Geibel A, Zehender M, Kasper W, Olschewski M, Klima C, Konstantinides S. Prognostic value of the ECG on admission in patients with acute major pulmonary embolism. Eur Respir J. 2005;25:843-8.
Akgüllü Ç, Ömürlü İK, Eryılmaz U, Avcil M, Dağtekin E, Akdeniz M et al. Predictors of early death in patients with acute pulmonary embolism. Am J Emerg Med. 2015;33:214-21.
Shrivastava S, Ridker P, Glynn R, Goldhaber S, Moll S, Bounameaux H et al. D‐dimer, factor VIII coagulant activity, low‐intensity warfarin and the risk of recurrent venous thromboembolism. J Thromb Haemost. 2006;4:1208-14.
Agterof MJ, van Bladel ER, Schutgens RE, Snijder RJ, Tromp EA, Prins MH et al. Risk stratification of patients with pulmonary embolism based on pulse rate and D-dimer concentration. Thromb Haemost. 2009;102:683-7.
Lobo J, 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. J Thromb Haemost. 2009;7:1795-801.
Yılmaz S, Topçu F, Şen HS, Abakay Ö, Yılmaz Z. Combination of Wells clinical score and high D-dimer levels in the diagnosis of pulmonary embolism. J Clin Exp Invest. 2014;5:557-562
Tanabe Y, Obayashi T, Yamamoto T, Takayama M, Nagao K. Predictive value of biomarkers for the prognosis of acute pulmonary embolism in Japanese patients: Results of the Tokyo CCU Network registry. J Cardiol. 2015;66:460-5.
Meusel M, Pätz T, Gruber K, Kupp S, Jensch PJ, Saraei R et al. Predictive value of combined pre-test probability and blood gas analysis In pulmonary embolism-the EMBOLISM study. Intern Emerg Med. 2022;17:2245-52.
Kurose M, Yoshimura M, Yasue H. Raised plasma BNP in a patient with acute pulmonary thromboembolism. Heart. 1997;78:320-1.
Nagaya N, Nishikimi T, Uematsu M, Satoh T, Kyotani S, Sakamaki F et al. Plasma brain natriuretic peptide as a prognostic indicator in patients with primary pulmonary hypertension. Circulation. 2000;102:865-70.
Pruszczyk P. N-terminal pro-brain natriuretic peptide as an indicator of right ventricular dysfunction. J Card Fail. 2005;11:65-9.
Vuilleumier N, Le Gal G, Cornily JC, Hochstrasser D, Bounameaux H, Aujesky D et al. Is N-terminal pro-brain natriuretic peptide superior to clinical scores for risk stratification in non-massive pulmonary embolism? J Thromb Haemost. 2010;8:1433-5.
Kucher N, Goldhaber SZ. Management of massive pulmonary embolism. Circulation. 2005;112:28-32.
Binder L, Pieske B, Olschewski M, Geibel A, Klostermann B, Reiner C et al. N-terminal pro-brain natriuretic peptide or troponin testing followed by echocardiography for risk stratification of acute pulmonary embolism. Circulation. 2005;112:1573-9.
Dresden S, Mitchell P, Rahimi L, Leo M, Rubin-Smith J, Bibi S et al. Right ventricular dilatation on bedside echocardiography performed by emergency physicians aids in the diagnosis of pulmonary embolism. Ann Emerg Med. 2014;63:16-24.
Janata KM, Leitner JM, Holzer-Richling N, Janata A, Laggner AN, Jilma B. Troponin T predicts in-hospital and 1-year mortality in patients with pulmonary embolism. Eur Respir J. 2009;34:1357-63.

Ayrıntılar

Birincil Dil

İngilizce

Konular

Acil Tıp , Göğüs Hastalıkları , Klinik Onkoloji

Bölüm

Araştırma Makalesi

Yazarlar

Feray Balkan
0000-0002-4020-8848
Türkiye

N. Rana Dişel
0000-0003-2381-3066
Türkiye

Senem Koca
0000-0003-2495-782X
Türkiye

Gülçin Dağlıoğlu
0000-0003-2454-3723
Türkiye

Ezgi Özyılmaz
0000-0002-4535-705X
Türkiye

Rabia Akıllı
0000-0003-4922-6556
Türkiye

Merve Türker
0000-0003-3311-818X
Türkiye

Ömer Taşkın ^*
0000-0003-0517-8484
Türkiye

Ayça Açıkalın Akpınar
0000-0002-1259-3398
Türkiye

Yayımlanma Tarihi

30 Eylül 2024

Gönderilme Tarihi

28 Mart 2024

Kabul Tarihi

6 Temmuz 2024

Yayımlandığı Sayı

Yıl 2024 Cilt: 49 Sayı: 3

DOI

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

IZ

https://izlik.org/JA53BT33XF

MLA

Balkan, Feray, vd. “Predicting mortality of pulmonary thromboembolism in cancer patients with a new scoring system: mPESI”. Cukurova Medical Journal, c. 49, sy 3, Eylül 2024, ss. 614-23, doi:10.17826/cumj.1460163.

Bu eser Creative Commons Atıf-Gayriticari-Türetilemez 4.0 Uluslararası Lisansı ile lisanslanmıştır.

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

Öz

Anahtar Kelimeler

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

Abstract

Keywords

Kaynakça

Ayrıntılar

Birincil Dil

Konular

Bölüm

Yazarlar

Yayımlanma Tarihi

Gönderilme Tarihi

Kabul Tarihi

Yayımlandığı Sayı

DOI

IZ

Kaynak Göster