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. 2024 Dec 27;28(1):10.
doi: 10.1007/s11102-024-01482-0.

Can we predict the risk of venous thromboembolism in patients with Cushing's syndrome: a nationwide cohort analysis

Yaron Rudman #  1   2 , Michal Michaelis #  2   3 , Ilan Shimon  1   2 , Idit Dotan  1   2 , Tzippy Shochat  2   4 , Shiri Kushnir  2   5 , Maria Fleseriu  6 , Amit Akirov  7   8
Affiliations

Can we predict the risk of venous thromboembolism in patients with Cushing's syndrome: a nationwide cohort analysis

Yaron Rudman et al. Pituitary. .

Abstract

Purpose: Patients with Cushing's syndrome (CS) have an increased venous thromboembolism (VTE) risk with most studies focusing on the perioperative period. The purpose of this study was to assess the 5-year VTE risk and identify predictors of VTE at CS diagnosis.

Methods: A comparative nationwide retrospective cohort study of 609 patients (mean age 48.1 ± 17.2 years, 65.0% women) with CS, and 3018 age-, sex-, body mass index-, and socioeconomic status-individually matched controls. Ectopic CS and adrenal cancer were excluded. The time-to-event of pulmonary embolism (PE) or deep vein thrombosis (DVT) within 5 years of CS diagnosis was examined. VTE risk was calculated with death as competing event.

Results: VTE occurred in 16 cases (2.6%), compared to 17 (0.56%) controls (hazard ratio [HR] 4.71, 95% CI, 2.38-9.33). The 5-year HRs for PE and DVT were 7.47 (95% CI, 2.66-20.98) and 3.32 (95% CI, 1.36-8.12), respectively. After excluding patients and controls with current or prior malignancy the risk for VTE was 7.57 (95% CI, 2.98-19.20). Patients with CS ≥ 60 years at diagnosis (HR, 3.49; 95% CI, 1.30-9.35), with hypertension (HR, 5.53; 95% CI, 1.26-24.27), ischemic heart disease (HR, 3.60; 95% CI, 1.25-10.36), kidney disease (HR, 4.85; 95% CI, 1.39-16.90), or VTE event prior to CS diagnosis (HR, 33.65; 95% CI, 10.07-112.42) had an increased risk of VTE within five years.

Conclusions: In this large cohort of patients with CS, the 5-year VTE risk was 5 times higher compared with matched controls. Key baseline predictors included age ≥ 60, hypertension, heart/kidney disease, and prior VTE.

Keywords: Cushing’s syndrome; Deep vein thrombosis; Hypercoagulability; Pulmonary embolism; Venous thromboembolism.

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Conflict of interest statement

Declarations. Competing interests: Michal Michaelis, Yaron Rudman, Idit Dotan, Tzipora Shochat, and Shiri Kushnir do not have any financial or personal relationships with other people or organizations to disclose. Ilan Shimon has been an investigator for Xeris Biopharma and has received occasional scientific fee for scientific consulting and advisory boards from Medison, CTS pharma, and Neopharm. Maria Fleseriu has been a PI with research funding to university from Crinetics, and Sparrow and has received occasional scientific fee for scientific consulting and advisory boards from Crinetics, Recordati, Sparrow and Xeris. Amit Akirov has received occasional scientific fee for scientific consulting and advisory boards from Medison, CTS pharma, and Neopharm. All authors declare no competing interests.

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