基于COMPASS-CAT风险评估模型的非小细胞肺癌患者静脉血栓栓塞症风险预测

Risk prediction of venous thromboembolism in non-small cell lung cancer patients based on COMPASS-CAT risk assessment model

目的:探讨COMPASS-CAT风险评估模型以及新建立的预测概率模型对非小细胞肺癌(NSCLC)患者静脉血栓栓塞症(VTE)的风险预测价值。方法:收集2013年3月至2017年6月在中国医学科学院肿瘤医院住院治疗的373例NSCLC患者的临床资料,根据是否发生VTE分为VTE组(63例)和非VTE组(310例)。依据COMPASS-CAT评估模型对所有患者进行评分和危险度分级。计数资料的比较采用 χ2检验,采用logistic回归模型分析影响VTE发生的危险因素。基于COMPASS-CAT模型纳入D-二聚体≥1.03 mg/L、血红蛋白<10 g/dl变量,构建新的COMPASS-CAT预测概率模型,分别绘制受试者工作特征(ROC)曲线,应用MedCalc软件比较ROC曲线差异,分析不同风险评估模型对预测NSCLC患者VTE风险的应用价值。 结果:全组患者VTE的发生率为16.9%(63/373)。VTE组患者的COMPASS-CAT评分为(6.37±3.40)分,高于非VTE组[(2.74 ±2.04)分],差异有统计学意义( P<0.001)。VTE组COMPAS-CAT评分≥7分、卡氏体力状态评分≤80分、心血管疾病合并症≥2种、中心静脉置管、高脂血症、血红蛋白<10 g/dl、D-二聚体≥1.03 mg/L、临床分期Ⅲ~Ⅳ期患者的比例均高于非VTE组,差异均有统计学意义(均 P<0.05)。logistic回归分析显示,D-二聚体≥1.03 mg/L、COMPAS-CAT评分≥7和血红蛋白<10 g/dl均为影响VTE发生的独立危险因素(均 P<0.05)。COMPASS-CAT模型和新构建的COMPASS-CAT预测概率模型的ROC曲线下面积(AUC)分别为0.745和0.804,与COMPASS-CAT模型比较,COMPASS-CAT预测概率模型的AUC增加0.059,差异有统计学意义( P=0.007)。 结论:对于住院治疗的NSCLC患者,COMPASS-CAT风险评估模型对VTE发生风险具有较好的预测价值,COMPASS-CAT模型纳入D-二聚体、血红蛋白变量构建新的预测概率模型可提高NSCLC患者VTE危险因素预测的准确性。

Objective To verify the risk prediction efficacies of COMPASS-cancer associated thrombosis(COMPASS-CAT)risk assessment model and the new prediction probability model established based on COMPASS-CAT for venous thromboembolism(VTE)in hospitalized patients with non-small cell lung cancer(NSCLC).Methods We retrospectively collected the clinical data of 373 patients with NSCLC admitted to National Clinical Research Center for Cancer/Cancer Hospital from March 2013 to June 2017.All of them were divided into VTE group(63 cases)and non-VTE group(310 cases)according to VTE occurred or not.According to the COMPASS-CAT risk assessment model,all patients were scored and classified by risk.Chi-square test was used to compare the clinical features between two groups,and multivariate logistic regression analysis was used to evaluate the independent risk factors of VTE in NSCLC patients.Based on the COMPASS-CAT risk assessment model,D-dimer≥1.03 mg/L and hemoglobin<10 g/dl were included to construct a new COMPASS-CAT prediction probability model,the ROC curve was also drawn.We used MedCalc software to compare the difference of ROC curves and analyze the application value of different risk assessment models in predicting VTE risk of NSCLC patients.Results The incidence of VTE was 16.9%(63/373).The COMPASS-CAT score of VTE group was 6.37±3.40,which was higher than 2.74±2.04 of non-VTE group(P<0.001).Univariate analysis showed that the proportion of patients with KPS≤80,COMPASS-CAT≥7,D-dimer≥1.03 mg/L,central venous catheter(CVC),hemoglobin<10 g/L,cardiovascular complications≥2,hyperlipidemia,clinical stagesⅢandⅣ,KPS≤80 in VTE group was significantly higher than that in non-VTE group(P<0.05).Logistic regression analysis showed that D-dimer≥1.03 mg/L,compass-cat score≥7 and hemoglobin<10 g/dL were independent risk factors for VTE.Based on the COMPASS-CAT risk assessment model,a new risk assessment model of COMPASS-CAT was constructed by incorporating the variables of D-dimer≥1.03 mg/L and hemoglobin<10 g/dl.The area under ROC curve(AUC)of COMPASS-CAT model and new COMPASS-CAT prediction probability model were 0.745 and 0.804,respectively.Compared with COMPASS-CAT model,AUC of new COMPASS-CAT prediction probability model increased by 0.059,with statistically significant difference(P=0.007).Conclusion COMPASS-CAT risk assessment model can predict the risk of VTE in NSCLC patients,and the new COMPASS-CAT prediction probability model constructed by COMPASS-CAT model combined with D-dimer and hemoglobin variables can improve the accuracy of screening VTE risk factors in NSCLC patient.