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Validation of the EPIPHANY index for predicting risk of serious complications in cancer patients with incidental pulmonary embolism

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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.

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Authors and Affiliations

  1. Department of Emergency Medicine, Cancer Emergency Room, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea

    Shin Ahn

  2. Department of Emergency Medicine, Division of Internal Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX, USA

    Shin Ahn & Terry W. Rice

  3. Department of Acute and Critical Care, The Christie, Manchester, UK

    Tim Cooksley

  4. Department of Emergency Medicine, Baylor College of Medicine, Houston, TX, USA

    Srinivas Banala

  5. Morehouse School of Medicine, Atlanta, GA, USA

    Luke Buffardi

Authors
  1. Shin Ahn
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  2. Tim Cooksley
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  3. Srinivas Banala
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  4. Luke Buffardi
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  5. Terry W. Rice
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Corresponding author

Correspondence to Terry W. Rice.

Ethics declarations

This study was approved by the institutional review board at each organization (MD Anderson clinical research protocol DR08-0066, Asan Medical Center protocol 2017-1025).

Conflict of interest

The authors declared that they have no conflicts of interest.

The authors have full control of all primary data and agree to allow the journal to review the data if requested.

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Ahn, S., Cooksley, T., Banala, S. et al. Validation of the EPIPHANY index for predicting risk of serious complications in cancer patients with incidental pulmonary embolism. Support Care Cancer 26, 3601–3607 (2018). https://doi.org/10.1007/s00520-018-4235-9

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  • DOI: https://doi.org/10.1007/s00520-018-4235-9

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