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Advisor(s)
Abstract(s)
Introdução: O TEP é 7 vezes mais comum em doentes oncológicos. Os doentes com suspeita de TEP são estratificados com RPCs e D-dímeros, para guiar a seleção de exames para confirmar o diagnóstico. No entanto, doentes oncológicos têm níveis de D-dímeros mais elevados, que compromete a deteção de TEP. Um TEP pode causar várias anomalias em ECG que podem ser quantificadas pelo score ECG de Daniel. O objetivo deste trabalho é verificar se o score ECG de Daniel pode ser usado na marcha diagnóstica de TEP em doentes oncológicos. Métodos: Análise retrospetiva de doentes oncológicos submetidos a ATCP por suspeita de TEP entre Abril de 2019 e Setembro de 2021 num hospital terciário de Portugal. As RPCs e score ECG de Daniel foram calculados à admissão no DE. Analisámos o diagnóstico de TEP. Avaliámos a capacidade discriminatória de cada score de predição de TEP usando a curva ROC.
Resultados: Foram analisados 290 doentes oncológicos (idade média 67,48 ± 18,69 anos e 50,7% sexo feminino). Confirmou-se PE em 41,7% (n=121). Um cut-off age-adjusted de D-dímeros diminuiu a sensibilidade (94.21%, p = 0.500) e aumentou a especificidade com o score de Wells e Geneva (29.59% e 28.99%, p < 0.001). Ambos algoritmos YEARS e PEGeD tiveram especificidades mais altas (p < 0.001) e sensibilidades mais baixas (p = 0.002 e p = 0.008; p < 0.001 para o cut-off 500 ng/mL; p = 0.004 para o cut-off age-adjusted) que os scores de Wells e Geneva. O score ECG de Daniel com cut-off ≥ 6 teve uma sensibilidade de 30.58% e especificidade de 81.07% (p < 0.001 para ambos). Conclusão: Neste estudo demonstrámos que as RPCs são eficazes em excluir o diagnóstico de TEP e que o score ECG de Daniel pode refinar a suspeita de TEP em doentes oncológicos.
Introduction: Pulmonary embolism (PE) is 7 times more common in cancer patients. Patients with PE suspicion are stratified using clinical prediction rules (CPR) and D-dimers, to guide the selection of tests to confirm diagnosis. However, cancer patients have higher D-dimer levels, which compromises PE detection. PE can cause various abnormalities on ECG that can be quantified by the Daniel ECG score. We hypothesized that the Daniel ECG score could be used in the diagnostic work-up of PE in cancer patients. Methods: Retrospective analysis of cancer patients that underwent Computed Tomography Pulmonary Angiogram (CTPA) due to PE suspicion between April of 2019 and September of 2021 in a tertiary-care hospital in Portugal. CPRs and Daniel ECG score were calculated at ED admission. We analyzed PE diagnosis. We assessed the discriminatory ability of each score to predict PE diagnosis using the receiver operating characteristic (ROC) curve. Results: 290 cancer patients were analyzed (mean age 67,48 ± 18,69 years and 50,7% female). PE was confirmed in 41,7% (n=121). An age-adjusted D-dimer cut-off decreased sensitivity (94.21%, p = 0.500) and increased specificity with both Wells and Geneva scores (29.59% and 28.99%, p < 0.001). Both YEARS and PEGeD algorithms had higher specificities (p < 0.001) and lower sensitivities (p = 0.002 and p = 0.008; p < 0.001 for 500 ng/mL cut-off; p = 0.004 for age-adjusted cut-off) than Wells and Geneva scores. The Daniel ECG score with a cut-off ≥ 6 had a sensitivity of 30.58% and specificity of 81.07% (p < 0.001 for both). Conclusion: In our study, we demonstrated that CPRs were effective in excluding PE diagnosis and that the Daniel ECG score may refine PE suspicion in cancer patients.
Introduction: Pulmonary embolism (PE) is 7 times more common in cancer patients. Patients with PE suspicion are stratified using clinical prediction rules (CPR) and D-dimers, to guide the selection of tests to confirm diagnosis. However, cancer patients have higher D-dimer levels, which compromises PE detection. PE can cause various abnormalities on ECG that can be quantified by the Daniel ECG score. We hypothesized that the Daniel ECG score could be used in the diagnostic work-up of PE in cancer patients. Methods: Retrospective analysis of cancer patients that underwent Computed Tomography Pulmonary Angiogram (CTPA) due to PE suspicion between April of 2019 and September of 2021 in a tertiary-care hospital in Portugal. CPRs and Daniel ECG score were calculated at ED admission. We analyzed PE diagnosis. We assessed the discriminatory ability of each score to predict PE diagnosis using the receiver operating characteristic (ROC) curve. Results: 290 cancer patients were analyzed (mean age 67,48 ± 18,69 years and 50,7% female). PE was confirmed in 41,7% (n=121). An age-adjusted D-dimer cut-off decreased sensitivity (94.21%, p = 0.500) and increased specificity with both Wells and Geneva scores (29.59% and 28.99%, p < 0.001). Both YEARS and PEGeD algorithms had higher specificities (p < 0.001) and lower sensitivities (p = 0.002 and p = 0.008; p < 0.001 for 500 ng/mL cut-off; p = 0.004 for age-adjusted cut-off) than Wells and Geneva scores. The Daniel ECG score with a cut-off ≥ 6 had a sensitivity of 30.58% and specificity of 81.07% (p < 0.001 for both). Conclusion: In our study, we demonstrated that CPRs were effective in excluding PE diagnosis and that the Daniel ECG score may refine PE suspicion in cancer patients.
Description
Trabalho Final do Curso de Mestrado Integrado em Medicina, Faculdade de Medicina, Universidade de Lisboa, 2022
Keywords
Pulmonary embolism Clinical prediction rules D-dimers Daniel ECG score Cardiologia