Value of Padua Risk Assessment Model in Evaluating Venous Thromboembolism of Hospitalized Patients in the Department of Internal Medicine
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摘要:
目的 调查内科住院患者静脉血栓栓塞症(venous thromboembolism, VTE)现状, 探究Padua风险评估模型是否适用于内科住院患者。 方法 回顾分析2016年5月17日至9月9日北京协和医院内科住院患者基本信息和VTE危险因素、预防措施及发生情况, 比较住院期间及出院后3个月内发生与未发生VTE患者的异同点, 评估危险因素与VTE事件相关性。使用Padua风险评估模型对患者进行VTE风险分层并采用Logistic回归分析评估其预测价值。 结果 共3115例患者纳入本研究, 症状性VTE发生率为2.5%。Padua模型敏感度为83.3%, 特异度为62.3%, 模型分层下高危患者占比38.8%。Padua模型中高龄、急性心肌梗死/缺血性卒中、肥胖、近期创伤和(或)手术这4项危险因素在VTE及非VTE患者间无统计学差别(P>0.05), 而模型未包含的危险因素如雌、孕激素、输血、机械通气与VTE发生显著相关(P均 < 0.01)。Padua模型高危患者接受抗凝药物预防及机械预防的比例显著高于低危患者(P < 0.01), 其中85.3%的高危患者未接受抗凝药物或机械预防, 亦未发生VTE。 结论 Padua模型特异度低, 模型中多项危险因素及其权重分布不合理, 对内科住院患者VTE风险分层的价值有限。 -
关键词:
- 静脉血栓栓塞症 /
- Padua风险评估模型 /
- 风险分层 /
- 预防
Abstract:Objective The aim of this study was to investigate the status of venous thromboembolism(VTE)in patients in the department of internal medicine and to evaluate whether Padua risk assessment modelcan be applied to this patient population. Methods Baseline information, risk factors, prevention, and the incidence of VTE in in-patients of the department of internal medicine were collected and analyzed at Peking Union Medical College Hospital from May 17, 2016, to September 9, 2016. Patients with or without VTE were compared during hospitalization and within 3 months after discharge. Correlations between risk factors and VTE events were calculated and risk stratification was calculated by Padua risk assessment model. The predictive value was assessed by Logistic regression analysis. Results A total of 3115 patients were enrolled in this study. The incidence of VTE was 2.5%(78/3115). The sensitivity and specificity of Padua risk assessment model were 83.3% and 62.3%, respectively, and 38.8% of patients had a high risk of VTE based on this model. The four risk factors embodied in the model including elderly age(≥ 70 years), acute myocardial infarction or ischemic stroke, obesity(body mass index ≥ 30 kg/m2), and recent(≤ 1 month)trauma and/or surgery, showed no statistical difference between patients with and without VTE(P>0.05). However, other risk factors that are not included in Padua risk assessment model, i.e. use of estrogen or progesterone, blood transfusion, and mechanical ventilation showed statistically different between VTE and non-VTE patients(P < 0.01). The ratio of receiving preventive treatment with anticoagulant drugs or machines was significantly higher in high-risk patients than those in low-risk ones(P < 0.01); 85.3% of high-risk patients did not receive anticoagulant or mechanical prevention and did not have VTE either. Conclusions Padua risk assessment model shows low specificity. Several risk factors and their weight distribution in the model are not suitable, which leads to the limitation of this model in VTE risk assessment for in-patients of the department of internal medicine. -
Key words:
- venous thromboembolism /
- Padua risk assessment model /
- risk stratification /
- prevention
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图 2 Padua风险评估模型分层后各科室患者VTE的风险、预防及事件分布
VTE:同表 1; ICU:重症监护病房
表 1 内科住院患者Padua风险评估模型分组比较
一般情况 高危组 低危组 P值 例数(n) 1209 1906 - 男性[n(%)] 692(57) 1031(54) >0.05 年龄(x±s, 岁) 55 ±17 52±16 <0.01 BMI(x±s, kg/m2) 23.3±4.1 23.6±4.3 >0.05 住院时间[M(Q), d] 11(6~19) 18(9~29) <0.01 VTE事件[n(%)] DVT 43(3.6) 8(0.4) <0.01 PTE 12(1.0) 4(0.2) <0.05 DVT合并PTE 10(0.8) 1(0.05) <0.01 BMI:体质量指数; VTE:静脉血栓栓塞症; DVT:深静脉血栓形成; PTE:肺血栓栓塞症 表 2 Padua风险评估模型危险因素与内科住院患者VTE相关性
模型中危险因素 VTE组[n(%)] 非VTE组[n(%)] OR值(95%置信区间) P值 例数(n) 78 3037 - - 活动性恶性肿瘤/化疗 35(44.8) 871(28.7) 2.0(1.3, 3.2) <0.01 既往VTE 28(35.9) 22(0.7) 76.7(41.1, 143.3) <0.01 活动减少 43(55.1) 1068(35.2) 2.3(1.4, 3.6) <0.01 已有血栓形成倾向 12(15.4) 56(1.9) 9.7(5.0, 19.0) <0.01 近期创伤/手术史 1(1.3) 108(3.6) 0.4(0.1, 2.6) >0.05 高龄(年龄≥70岁) 16(20.5) 435(14.3) 1.5(0.9, 2.7) >0.05 心脏/呼吸衰竭 13(16.7) 125(4.1) 4.7(2.5, 8.7) <0.01 急性心肌梗死/缺血性卒中 1(1.3) 46(1.6) 0.8(0.1, 6.2) >0.05 急性感染/风湿性疾病 37(47.4) 753(24.8) 2.7(1.7, 4.3) <0.01 肥胖(BMI≥30 kg/m2) 2(2.6) 170(5.6) 0.4(0.1, 1.8) >0.05 使用激素治疗 41(52.6) 1036(34.1) 2.1(1.4, 3.4) <0.01 VTE、BMI:同表 1 表 3 Padua风险评估模型未包含的危险因素与VTE相关性[n(%)]
危险因素 VTE组[n(%)] 非VTE组[n(%)] OR值(95%置信区间) P值 例数(n) 78 3037 - - 男性 31(39.7) 1361(44.8) 0.8(0.5, 1.3) >0.05 使用雌孕激素 3(3.9) 20(0.7) 6.0(1.8, 20.8) <0.01 VTE家族史 0(0) 1(0.03) ﹣ >0.05 高血压 31(39.7) 1029(33.9) 1.3(0.8, 2.0) >0.05 冠状动脉粥样硬化性心脏病 4(5.1) 381(12.6) 0.4(0.1, 1.0) >0.05 糖尿病 14(18.0) 586(19.3) 0.9(0.5, 1.6) >0.05 吸烟 26(33.3) 1081(35.6) 0.9(0.6, 1.5) >0.05 输血 14(18.0) 145(4.8) 4.4(2.4, 8.0) <0.01 机械通气 7(9.0) 77(2.5) 3.8(1.7, 8.5) <0.01 VTE:同表 1 表 4 Padua风险评估模型与VTE预防[n(%)]
VTE预防措施 高危组(n=1209) 低危组(n=1906) P值 阿司匹林预防 255(21.1) 413(21.7) >0.05 抗凝药物预防 105(8.7) 28(1.5) <0.01 机械预防 64(5.3) 38(2.0) <0.01 抗凝药物或机械预防 148(12.2) 61(3.2) <0.01 任意形式预防 292(24.2) 435(22.8) >0.05 VTE:同表 1 -
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