Laporte et al identified risk factors for a fatal pulmonary embolism (PE) within 3 months of an episode of symptomatic venous thromboembolism. These can help to identify a patient who may benefit from more aggressive management. the authors are from multiple hospitals in Spain participating in the Registro Informatizado de la Enfermedad ThromboEmbolica venosa (RIETE) registry.
Outcome: fatal pulmonary embolism within 3 months of presentation
Parameters:
(1) age in years
(2) history of cancer
(3) history of immobilization for neurological disease
(4) type of venous thromboembolism at initial presentation
|
Parameter |
Findings |
Odds Ratio |
|
age |
<= 75 years |
1 |
|
|
> 75 years |
2.5 |
|
history of cancer |
no |
1 |
|
|
yes |
2 |
|
history of immobilization |
none |
1 |
|
|
<= 4 days |
1 |
|
|
> 4 days |
4.9 |
|
index venous thromboembolism |
distal deep vein thrombosis |
1 |
|
|
proximal deep vein thrombosis |
1 |
|
|
symptomatic nonmassive PE |
5.4 |
|
|
massive PE |
17.5 |
where:
• The odds ratios were slightly different between the training and validation models. The abstract referenced the odds ratios from the validation model.
• The history of cancer probably refers to metastatic visceral cancer, excluding tumors such as basal cell carcinoma or squamous cell carcinoma of the skin and tumors that have been completely excised.
cumulative odds ratio =
= PRODUCT(odds ratios for all of the parameters)
Interpretation:
• minimum cumulative OR: 1
• maximum cumulative OR: 428.75
• The higher the cumulative odds ratio the greater the risk of a fatal PE within 3 months.
|
Cumulative OR |
Risk Fatal PE |
|
1 |
0.2% |
|
5.4 |
1.2% |
|
13.5 |
3% |
|
66 |
10% |
|
214 |
25% |
A line that approximates this data is:
risk of fatal PE in percent =
= (-0.000220 * ((cumulative OR)^2)) + (0.1615 * (cumulative OR)) + 0.4872
Specialty: Pulmonology
ICD-10: ,
