Predictors of neoplasia in patients with acute PE

Abstract

BACKGROUND: A previously unknown neoplasia is sometimes diagnosed after the diagnosis of acute pulmonary embolism (PE). The identification of a group of patients with elevated probability of having occult underlying PE was never performed. We aimed to determine predictors of occult neoplasia in acute PE. PATIENTS AND METHODS: We retrospectively analysed a cohort of patients hospitalized with acute PE. Exclusion criteria: <18 years, venous embolism of veins other than pulmonary territory, no image confirmation of acute PE. Patients were grouped according to the timing of a neoplastic condition diagnosis: 1) known concomitant neoplasia, 2) neoplasia diagnosed during acute PE admission or in the following 2 years and, 3) no known neoplasia during follow-up. Predictors of concomitant neoplasia were determined using a logistic regression analysis. Multivariate models were built. RESULTS: We studied 562 patients, median age was 72 years and 219 (39.0%) were men. PE was considered idiopathic in 47.7%. Median d-dimer level was 7.98 (3.30-14.99) mcg/mL In 126 (22.4%) patients there was a known active neoplasia and in 47 (10.8%) a neoplastic condition was diagnosed after the diagnosis of acute PE. A total of 389 patients remained neoplasia-free during 2 years after acute PE. Elevated D-dimer levels were independently associated with already known neoplasia. D-dimers were independent predictors of posterior neoplastic condition: OR=1.07 ((95% CI:1.01-1.14) per each 5ng/mL increase; for patients with D-dimer > 15.0mcg/mL the OR was 2.10 (1.05-4.18) CONCLUSIONS: Patients with D-dimer > 15mcg/mL presented a more than 2-fold higher risk of being diagnosed with a neoplasic condition in the upcoming 2 years. D-dimer may help clinicians identifying which patients are at higher risk of occult neoplasia.