Abstract
BackgroundVenous thromboembolism (VTE) has been associated with a higher risk of developing malignancy and mortality, and patients with VTE may therefore benefit from increased surveillance. We aimed to construct a clinical predictive score that could classify patients with VTE according to their risk for developing these outcomes.MethodsObservational cohort study using an existing clinical registry in a tertiary academic teaching hospital in Buenos Aires, Argentina. 1264 adult patients greater than 17 years of age presented new VTE between June 2006 and December 2011 and were included in the registry. We excluded patients with previous or incident cancer, those who died during the first month, and those with less than one year of follow up (< 5%). 540 patients were included. Primary outcome was new cancer diagnosis during one year of follow-up, secondary composite outcome was any new cancer diagnosis or death. The score was developed using a multivariable logistic regression model to predict cancer or death.ResultsDuring follow-up, one-quarter (26.4%) of patients developed cancer (9.2%) or died (23.7%). Patients with the primary outcome had more comorbidities, were more likely to have previous thromboembolism and less likely to have recent surgery. The final score developed for predicting cancer alone included previous episode of VTE, recent surgery and comorbidity (Charlson comorbidity score), [AUC of 0.75 (95% CI 0.66-0.84) and 0.79 (95% CI 0.63-0.95) in the derivation and validation cohorts, respectively]. The version of this score developed to predict cancer or death included age, albumin level, comorbidity, previous episode of VTE, and recent surgery [AUC = 0.72 (95% CI 0.66-0.78) and 0.71 (95% CI 0.63-0.79) in the derivation and validation cohorts, respectively].ConclusionsA simple clinical predictive score accurately estimates patients’ risk of developing cancer or death following newly diagnosed VTE. This tool could be used to help reassure low risk patients, or to identify high-risk patients that might benefit from closer surveillance and additional investigations.Trial registrationClinicalTrials.gov: NCT01372514.
Highlights
Venous thromboembolism (VTE) has been associated with a higher risk of developing malignancy and mortality, and patients with VTE may benefit from increased surveillance
We excluded 494 (40.8%) patients who had previously been diagnosed with cancer, 132 (10.9%) who died during the incident hospital admission or during the first month of follow-up, and 45 (3.7%) who were diagnosed with VTE during the last year of the study
Patient characteristics During one-year of follow-up, nearly one-quarter (92; 26.4%, 95% 95% confidence interval (CI) 21.4% - 30.6%) of patients died (83; 23.7%, 95% CI 18.5% – 27.4%) or developed cancer (32; 9.2%, 95% CI 18.5% – 27.4%)
Summary
Venous thromboembolism (VTE) has been associated with a higher risk of developing malignancy and mortality, and patients with VTE may benefit from increased surveillance. We aimed to construct a clinical predictive score that could classify patients with VTE according to their risk for developing these outcomes. According to a systematic review, up to 10% of patients presenting with idiopathic VTE are subsequently diagnosed with cancer during the first year of follow up [7,8]. Mortality at one year is higher in patients with VTE that develop cancer compared to those that do not [5,9,10]. Suspicion of underlying cancer may lead clinicians to screen for cancer and provide closer surveillance following an acute episode of VTE [7,9,11,12].
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