Pulmonary Embolism Mortality POMPE-C Score

POMPE-C explained

This is a mortality stratification tool that determines risk of adverse outcome in the following 30-days from evaluation, in patients with cancer, who are diagnosed with pulmonary embolism.

The score consists of two types of predictor variables:

■ Five dichotomies (items 1 to 5);

■ Three continuous variables (items 6, 7 and 8).

The 8 items in the POMPE-C are described in the table below:

The first five items of the score are weighted as 0 or 1 in the formula (1 if present) whilst the last three answers are input in the formula as provided by the user.

The POMPE-C score is based on the following formula:

POMPE-C score = 100 x (1 - 1 / (1 + Exp(3.718 + DNR x 1.55171 + RespD x 0.79961 + ULS x 0.73433 + AMS x 1.47345 + HR x 1.02789 + (RR x 0.04422) + (O₂ sat x (-0.063)) + (W in lbs x ( -0.01161)))))

Results are provided as percentage and patients that score below 5% are considered to be low risk. In their case, anticoagulation therapy can be initiated as outpatient. High scores (greater than 50%) are suggestive of ICU admission.

About the study

A cohort of 408 patients with active cancer was involved in a study conducted by Kline et al. in 2012. 25 variables were collected and their independent predictive value was analysed.

These variables included results from laboratory, EKG and radiology determination. Patients with cancer were classed as having active cancer, metastatic malignancy or inactive cancer.

Logistic regression was used to create a model that ended up involving 8 variables. The model was compared with the pulmonary embolism severity index (PESI) in terms of the outcome predictive value.

In the derivation cohort, the area under the ROC curve for POMPE-C was 0.84, significantly greater than that of PESI (0.68).

None of the patients with scores less or equal to 5% has died whilst 77% (10 out of 13) of patients who scored more than 50% died within 30 days.

The POMPE-C model has shown good prognostic accuracy and better performance than PESI in patients with active cancer.

POMPE-C score and malignancy

This is the only pulmonary embolism mortality score that was found to have a high correlation between results and statistical evidence, in contrast to other scores, such as PESI.

Active cancer is considered a significant risk factor for PE adverse outcome, less relevant in patients with cancer in remission.

Please note however, that clinical judgment should prevail and that additional pathologies, risk factors or comorbidities should be taken in consideration even in patients with low scores.

Original source

Kline JA, Roy PM, Than MP, Hernandez J, Courtney DM, Jones AE, Penaloza A, Pollack CV Jr. Derivation and validation of a multivariate model to predict mortality from pulmonary embolism with cancer: The POMPE-C tool. Thromb Res. 2012; 129(5):e194-9.

Validation

van der Hulle T, den Exter PL, Kooiman J, van der Hoeven JJ, Huisman MV, Klok FA. Meta-analysis of the efficacy and safety of new oral anticoagulants in patients with cancer-associated acute venous thromboembolism. J Thromb Haemost. 2014; 12(7):1116-20.

Other references

1. Nendaz M, Spirk D, Kucher N, Aujesky D, Hayoz D, Beer JH, Husmann M, Frauchiger B, Korte W, Wuillemin WA, Jäger K, Righini M, Bounameaux H. Multicentre validation of the Geneva Risk Score for hospitalised medical patients at risk of venous thromboembolism. Explicit Assessment of Thromboembolic RIsk and Prophylaxis for Medical PATients in SwitzErland (ESTIMATE). Thromb Haemost. 2014; 111(3):531-8.

2. Maestre A, Trujillo-Santos J, Riera-Mestre A, Jiménez D, Di Micco P, Bascuñana J, Vela JR, Peris L, Malfante PC, Monreal M; RIETE Investigators. Identification of Low-Risk Patients with Acute Symptomatic Pulmonary Embolism for Outpatient Therapy. Ann Am Thorac Soc. 2015; 12(8):1122-9.