Patients with pulmonary embolism as the first manifestation of cancer had a significantly higher hospital mortality rate compared to patients without cancer (HR 3.440).
Observational (n=1,745)
Yes
Does the presence of newly diagnosed or known cancer increase hospital mortality and affect clinical presentation in patients with acute pulmonary embolism?
Acute pulmonary embolism as the first manifestation of cancer is associated with significantly higher hospital mortality, and patients with known cancer are less likely to receive thrombolysis despite having more severe presentations.
Effect estimate: HR 3.440 (95% CI 1.795-6.591)
Absolute Event Rate: 22.7% vs 9.6%
p-value: p=<0.001
BACKGROUND: Newly or already diagnosed cancer might significantly influence the clinical presentation, outcome, and therapy of acute pulmonary embolism (PE). METHODS: Out of 1745 patients with acute PE, 66 patients were diagnosed with cancer during an initial hospitalization due to acute PE (where PE was the first clinical manifestation of cancer), 165 patients had known cancer treated in the last 6 months, and 1514 patients had acute PE without known or suspected cancer. The primary end-point of the present study was all-cause hospital death. The secondary end-points were the proportion of patients treated with thrombolysis and who had severe disease, and the ocurrence of major or clinically relevant nonmajor bleeding. RESULTS: Patients with PE as the first presentation of cancer had the highest hospital mortality rate compared to the other two groups (HR for the mortality rate in patients without cancer as a reference, adjusted to four-stratum mortality risk, and Charlson's comorbidity index was 3.440; 95% confidence interval (CI), 1.795-6.591; p < 0.001). Patients with known cancer before PE had a significantly lower chance of being treated with thrombolysis than patients without cancer (OR, 0.523; 95% CI, 0.339-0.807; p = 0.003); additionally, this difference was attenuated but remained when the OR was adjusted to age (OR, 0.542; 95% CI, 0.351-0.838; p = 0.006). Patients with known cancer had a higher frequency of high-risk PE compared with patients without cancer (18.2% vs. 12.8%; p < 0.001). Patients with PE as the first manifestation of cancer had a higher frequency of intermediate-high-risk PE than those without (36.4% vs. 30.9%; p < 0.001). There was no significant difference in bleeding during hospitalization between groups. CONCLUSION: Patients with cancer had a more severe presentation of acute PE than patients without. Furthermore, patients with PE as the first manifestation of cancer had the highest hospital mortality rate, and patients with known cancer were least likely to be treated with thrombolysis.
Šalinger-Martinović et al. (Fri,) conducted a observational in Acute pulmonary embolism with or without cancer (n=1,745). Pulmonary embolism as the first manifestation of cancer vs. Pulmonary embolism without known cancer was evaluated on All-cause hospital death (HR 3.440, 95% CI 1.795-6.591, p=<0.001). Patients with pulmonary embolism as the first manifestation of cancer had a significantly higher hospital mortality rate compared to patients without cancer (HR 3.440).