IM - ORIGINAL Clinical presentation and in-hospital death in acute pulmonary embolism: does cancer matter? Franco Casazza 1 • Cecilia Becattini 2 • Eliana Rulli 3 • Ilaria Pacchetti 3 • Irene Floriani 3 • Marco Biancardi 4 • Angela Beatrice Scardovi 5 • Iolanda Enea 6 • Amedeo Bongarzoni 1 • Luigi Pignataro 1 • Giancarlo Agnelli 2 Received: 14 November 2015 / Accepted: 28 February 2016 Ó SIMI 2016 Abstract Cancer is one of the most common risk factors for acute pulmonary embolism (PE), but only few studies report on the short-term outcome of patients with PE and a history of cancer. The aim of the study was to assess whether a cancer diagnosis affects the clinical presentation and short-term outcome in patients hospitalized for PE who were included in the Italian Pulmonary Embolism Registry. All-cause and PE-related in-hospital deaths were also analyzed. Out of 1702 patients, 451 (26.5 %) of patients had a diagnosis of cancer: cancer was known at presenta- tion in 365, or diagnosed during the hospital stay for PE in 86 (19 % of cancer patients). Patients with and without cancer were similar concerning clinical status at presenta- tion. Patients with cancer less commonly received throm- bolytic therapy, and more often had an inferior vena cava filter inserted. Major or intracranial bleeding was not dif- ferent between groups. In-hospital all-cause death occurred in 8.4 and 5.9 % of patients with and without cancer, respectively. At multivariate analysis, cancer (OR 2.24, 95 % CI 1.27–3.98; P = 0.006) was an independent pre- dictor of in-hospital death. Clinical instability, PE recur- rence, age C75 years, recent bed rest C3 days, but not cancer, were independent predictors of in-hospital death due to PE. Cancer seems a weaker predictor of all-cause in- hospital death compared to other factors; the mere presence of cancer, without other risk factors, leads to a probability of early death of 2 %. In patients with acute PE, cancer increases the probability of in-hospital all-cause death, but does not seem to affect the clinical presentation or the risk of in-hospital PE-related death. Keywords Pulmonary embolism Á Cancer Á Thrombosis Á Risk factors Á In-hospital death Introduction Venous thromboembolism (VTE) is a known cause of morbidity and mortality in patients with cancer [1]. The diagnosis of pulmonary embolism (PE) can be cumbersome in patients with cancer as symptoms like shortness of breath and chest pain are also caused by the cancer itself. The clinical management of PE in the acute phase can be influenced by the fear of bleeding compli- cations due to the underlying disease. The long-term clin- ical course of VTE in patients with cancer is also distinctive. These patients have an increased 4 to sevenfold risk for recurrence while on and off anticoagulant treatment compared to patients with VTE and no cancer [2]. Fur- thermore, patients with cancer have a high risk of bleeding complications while on anticoagulant treatment. While several studies investigated the risk of VTE in cancer Electronic supplementary material The online version of this article (doi:10.1007/s11739-016-1431-9) contains supplementary material, which is available to authorized users. & Cecilia Becattini cecilia.becattini@unipg.it 1 Cardiology Division, Ospedale San Carlo Borromeo, Milan, Italy 2 Internal and Cardiovascular Medicine-Stroke Unit, University of Perugia, Via G Dottori 1, Perugia, Italy 3 IRCCS-Istituto di Ricerche Farmacologiche Mario Negri, Milan, Italy 4 Division of Internal Medicine, Ospedale San Carlo Borromeo, Milan, Italy 5 Cardiology Division, Ospedale S. Spirito, Rome, Italy 6 UO Medicina d’Urgenza, AORN S. Anna e S. Sebastiano, Caserta, Italy 123 Intern Emerg Med DOI 10.1007/s11739-016-1431-9