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The EPIPHANY Index Assesses Risk of Short-Term Serious Complications in Patients with Cancer and Pulmonary Embolism

The EPIPHANY index was validated in a prospective PERSEO study
28 Sep 2019
Supportive and Palliative Care

The EPIPHANY model can be used as a prognostic assessment tool of the short-term risk of serious complications in patients with cancer and pulmonary embolism (PE), according to findings presented at the ESMO Congress 2019 in Barcelona, Spain.

The EPIPHANY decision tree has been developed to predict serious complications in patients with cancer and PE.1 However, data from prospective evaluation of this model are scarce, prompting Manuel Sanchez Canovas, Haematology and Medical Oncology, Hospital Universitario Morales Meseguer, Murcia, Spain and a research team to assess the discriminatory ability of EPIPHANY in a prospective multicentre cohort.

The investigators recruited 615 patients with cancer and PE participating in the prospective PERSEO study from October 2017 to August 2019. Of these patients, 36% had suspected PE and 64% had unsuspected PE. Clinical or haemodynamic instability was observed in 400 (65%) patients, whereas 215 (35%) patients were classified as normotensive PE with apparent clinical stability. Characterisation of patients according to initial risk criteria showed 37.6% of patients with risk of sudden or progressive dyspnoea, 19% elevated haemorrhagic risk, 16.6% tachycardia >110 lpm, 8.9% hypotension <100 mmHg, 8.6% hypoxemia <90%, 2.6% tachypnea >30 rpm, 2.3% thrombopenia <50000, and 0.8% major bleeding.

The primary objective of the analysis was determination of the association between the increase in prognostic category and in complications at 15 days, which was assessed using the linear by linear association test.

Short-term serious complication rates were consistent with the initial risk classifications

Using the entire decision tree contained in the algorithm, 154 (25%) patients were classified as low risk, 132 (24%) as intermediate, and 315 (51%) patients were determined to be at high risk of serious complications.

At a median 5 days, serious complications occurred in 96 (16%) patients. The most frequently reported complications were respiratory failure in 59.4% of patients, major bleeding in 22.9%, and hypotension in 18.8% of patients.

At 15 days, the rates of serious complications increased significantly according to the prognostic categories; the rates of serious complications were 2.6%, 9.59%, and 24.76% in patients classified as low, intermediate, and high risk, respectively (p = 0.001).

Canovas ESMO 2019 News

Rate of serious complications at 15 days after PE diagnosis. The p-value indicates the association between the risk group of the EPIPHANY Index and the development of complications 15 days after diagnosis of PE.

© Manuel Sanchez Canovas.

Within 30 days after PE diagnosis, 67 patients died; among the fatalities, 10 patients had been classified as medium-risk and 57 patients were in the high-risk group. The 3 primary causes of death were mixed origin in 25% of patients, complications of PE in 18%, and cancer progression in 52% of patients.


The investigators concluded that EPIPHANY is the only model available for the classification of patients with cancer and PE that is based on the patients’ short-term risk of complications. This model has potential implications for decision making regarding the short-term treatment of patients with cancer and PE.


Carmona-Bayonas A, Jimenez-Fonseca P, Font C, et al. Br J Cancer 2017; 116(8):994–1001.


Funding was disclosed from the Leo Academy.


1754O - Sanchez Canovas M, Fernández Montes A, Morales Giménez R, et al. Prediction of serious complications in patients with cancer and pulmonary embolism: validation of the EPIPHANY index in a prospective cohort of patients from the PERSEO study.

Last update: 28 Sep 2019

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