Preditores de risco trombótico e mortalidade em pacientes ambulatoriais com neoplasias malignas

Abstract

Introduction: Venous thrombosis is a common complication in patients with cancer, leading to increased morbidity and mortality. identifying risk predictors for venous thrombosis in this population is crucial to optimize prophylaxis and management of thromboembolic events. objectives: to evaluate the incidence of venous thrombosis and mortality, their risk factors, and the predictive capacity of the Khorana and PROTECHT scores in outpatient cancer patients prior to the initiation of oncologic treatment. Methods: This was a prospective cohort study. Adult patients with a recent cancer diagnosis attending the oncology outpatients’ clinic of the University Hospital, Universidade Federal de Minas Gerais (HC-UFMG), were invited to participate. Clinical, demographic, oncologic, anthropometric, and laboratory variables were assessed, including age, sex, comorbidities, personal and family history of venous thrombosis, prior risk factors, body mass index (BMI), complete blood count, tumor site and stage, and planned therapeutic regimen. Thromboembolic risk was classified at the first consultation using the Khorana and PROTECHT scores. Patients were followed for six months. logistic regression models, both univariate and multivariate, were used to evaluate venous thrombosis incidence, mortality, and venous thrombosis prediction. Odds ratios (OR) and 95% confidence intervals (CI) were estimated. Model fit was assessed using the Hosmer-Lemeshow test. The Fine-Gray model was used for competing risk analysis (death). Analyses were performed using STATA (version 16). Results: A total of 145 patients were included between July 2021 and August 2022. The median age was 61 years, and the majority were female (58%). Ten (6.9%) venous thrombosis events occurred. family history of venous thrombosis (OR 12.77; 95% CI 1.51–107.96), use of gemcitabine (OR 41.08; 95% CI 3.87–435.75), and presence of metastases (OR 8.59; 95% CI 1.17–62.99) were independent predictors of venous thrombosis. the combination of these three variables conferred a 96.4% probability of venous thrombosis. Khorana score ≥3 (present in 7.3% of the population) was associated with increased venous thrombosis risk (OR 11.14; 95% CI 0.91–136.42), corresponding to a 27.3% probability of venous thrombosis. Competing risk analysis confirmed these findings. Seventeen patients (11.7%) died. For early mortality (within six months of treatment initiation), previous venous thrombosis (OR 13.72; 95% CI 1.17–160.40), PROTECHT score ≥3 (OR 28.18; 95% CI 4.87–162.99), and clinical decision for palliative care (OR 41.95; 95% CI 7.00–251.45) were independent predictors. The combination of these three factors resulted in a 99.08% probability of mortality. Conclusion: Family history of venous thrombosis, use of gemcitabine, and presence of metastases were independent predictors of venous thrombosis. previous venous thrombosis, elevated PROTECHT score, and palliative care were independent predictors of early mortality. These findings underscore the need for individualized assessment of thrombotic and mortality risk in oncology patients.