Shin Ahn1,2, Tim Cooksley3, Srinivas Banala4, Luke Buffardi5, Terry W Rice6. 1. Department of Emergency Medicine, Cancer Emergency Room, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea. 2. Department of Emergency Medicine, Division of Internal Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX, USA. 3. Department of Acute and Critical Care, The Christie, Manchester, UK. 4. Department of Emergency Medicine, Baylor College of Medicine, Houston, TX, USA. 5. Morehouse School of Medicine, Atlanta, GA, USA. 6. Department of Emergency Medicine, Division of Internal Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX, USA. TWRice@mdanderson.org.
Abstract
PURPOSE: The EPIPHANY index was developed to classify cancer associated pulmonary embolism (PE) into different risk categories using decision tree modeling. In this study, we tried to externally validate this index in a distinct group of patients solely composed of incidental PE (IPE). METHODS: A retrospective study of patients diagnosed with IPE in two Emergency Departments in the USA and South Korea from 2013 to 2014 was performed. The primary outcome was the occurrence of a serious medical complication within 15 days of presentation to ED. Thirty-day complication was the secondary outcome. Cumulative hazard curves for each prognostic category were drawn to show the change in hazards over time. RESULTS: A total of 258 patients with IPE were included (193 from MD Anderson Cancer Center and 65 from Asan Medical Center). Serious complication within 15 days occurred in 23 (8.9%) patients. The risk of overall 15-day and 30-day serious complications increased with each category (low, intermediate, and high risk: 3.4, 8.9, and 23.8%, P = 0.033; 6.9, 9.5, and 33.3%, P = 0.011). Cumulative hazard curves for each prognostic category were drawn and the survival functions factored by prognostic categories were significantly different over 15 days (P = 0.015) and 30 days (P = 0.001). CONCLUSIONS: Our study suggests the EPIPHANY index could be a useful adjunct tool in risk stratification of cancer patients with IPE.
PURPOSE: The EPIPHANY index was developed to classify cancer associated pulmonary embolism (PE) into different risk categories using decision tree modeling. In this study, we tried to externally validate this index in a distinct group of patients solely composed of incidental PE (IPE). METHODS: A retrospective study of patients diagnosed with IPE in two Emergency Departments in the USA and South Korea from 2013 to 2014 was performed. The primary outcome was the occurrence of a serious medical complication within 15 days of presentation to ED. Thirty-day complication was the secondary outcome. Cumulative hazard curves for each prognostic category were drawn to show the change in hazards over time. RESULTS: A total of 258 patients with IPE were included (193 from MD Anderson Cancer Center and 65 from Asan Medical Center). Serious complication within 15 days occurred in 23 (8.9%) patients. The risk of overall 15-day and 30-day serious complications increased with each category (low, intermediate, and high risk: 3.4, 8.9, and 23.8%, P = 0.033; 6.9, 9.5, and 33.3%, P = 0.011). Cumulative hazard curves for each prognostic category were drawn and the survival functions factored by prognostic categories were significantly different over 15 days (P = 0.015) and 30 days (P = 0.001). CONCLUSIONS: Our study suggests the EPIPHANY index could be a useful adjunct tool in risk stratification of cancerpatients with IPE.
Authors: Jeffrey A Kline; Pierre-Marie Roy; Martin P Than; Jackeline Hernandez; D Mark Courtney; Alan E Jones; Andrea Penaloza; Charles V Pollack Journal: Thromb Res Date: 2012-04-03 Impact factor: 3.944
Authors: A Carmona-Bayonas; C Font; P Jiménez-Fonseca; Francisco Fenoy; R Otero; C Beato; J Plasencia; M Biosca; M Sánchez; M Benegas; D Calvo-Temprano; D Varona; L Faez; M A Vicente; I de la Haba; M Antonio; O Madridano; A Ramchandani; E Castañón; P J Marchena; M J Martínez; M Martín; G Marín; F Ayala de la Peña; V Vicente Journal: Thromb Res Date: 2016-05-12 Impact factor: 3.944
Authors: A Carmona-Bayonas; P Jiménez-Fonseca; C Font; F Fenoy; R Otero; C Beato; J M Plasencia; M Biosca; M Sánchez; M Benegas; D Calvo-Temprano; D Varona; L Faez; I de la Haba; M Antonio; O Madridano; M P Solis; A Ramchandani; E Castañón; P J Marchena; M Martín; F Ayala de la Peña; V Vicente Journal: Br J Cancer Date: 2017-03-07 Impact factor: 7.640
Authors: Diego Muñoz-Guglielmetti; Tim Cooksley; Shin Ahn; Carmen Beato; Mario Aramberri; Carmen Escalante; Carme Font Journal: Support Care Cancer Date: 2022-05-17 Impact factor: 3.359
Authors: Tim Cooksley; Carme Font; Florian Scotte; Carmen Escalante; Leslie Johnson; Ronald Anderson; Bernardo Rapoport Journal: Support Care Cancer Date: 2020-11-23 Impact factor: 3.603