恶性肿瘤合并静脉血栓栓塞症临床特征分析及预测模型的评估

Analysis of clinical characteristics of malignant tumors complicated with venous thromboembolism and evaluation of predictive models

目的探讨恶性肿瘤并发静脉血栓栓塞症(VTE)的临床特征,验证COMPASS-CAT及Khorana评分的预测价值。方法收集2016年1月—2020年1月在蚌埠医学院第一附属医院住院确诊恶性肿瘤合并VTE的患者128例为VTE组,以同期年龄、性别及肿瘤类型相匹配的恶性肿瘤未合并VTE的患者256例为对照组。采用logistic回归模型分析发生VTE的风险因素。比较COMPASS-CAT及Khorana评分的预测价值,并尝试构建一种更为有效的预测模型来指导肿瘤患者的血栓预防。结果 (1)D-二聚体>0.55 mg/L、中心静脉导管、心血管危险因素是肿瘤发生VTE的高风险因素(均P<0.05)。(2)COMPASS-CAT评分≥7分在VTE组与对照组中的占比差异有统计学意义(P<0.001)。COMPASS-CAT评分为高风险患者发生VTE的几率是低风险患者的4.051倍。Khorana评分≥3分在VTE组与对照组中的占比差异无统计学意义(P>0.05)。COMPASS-CAT评分的ROC曲线下面积(AUC)高于Khorana评分(AUC:0.670 vs. 0.583,P<0.05)。(3)在COMPASS-CAT评分的基础上纳入D-二聚体>3.83 mg/L构建联合预测模型,其AUC为0.879,与COMPASS-CAT评分相比,联合预测模型的AUC增加了0.209,差异有统计学意义(P<0.001)。结论 COMPASS-CAT评分能较好地预测肿瘤患者发生VTE的风险,而Khorana评分预测价值有限。将COMPASS-CAT评分和D-二聚体>3.83 mg/L联合构建新预测模型可提高肿瘤相关VTE的预测效能。

Objective The aim of this study was to investigate the clinical characteristics of malignant tumors complicat-ed with venous thromboembolism(VTE)and verify the predictive value of COMPASS-CAT and Khorana score.Methods A total of 128 patients who were diagnosed with malignant tumors and VTE in the First Affiliated Hospital of Bengbu Medical College from January 2016 to January 2020 were collected as the VTE group,and a total of 256 patients with malignant tumor without VTE matched by age,sex and tumor type were selected as the control group.Logistic re-gression model was used to analyze the risk factors of VTE.The predictive value of COMPASS-CAT and Khorana risk score(KRS)for venous thromboembolism in cancer patients was compared,to construct a more effective predictive model to guide thrombosis prevention in patients with malignant tumors.Results(1)D-dimer>0.55 mg/L,central venous catheter,and cardiovascular risk factors were high risk factors for VTE in patients with malignant tumors(P values were less than 0.05).(2)The proportion of COMPASS-CAT score≥7 was statistically significant between the VTE group and the control group(P<0.001).The probability was 4.051 times higher in high risk patients than in low risk patients by COMPASS-CAT score.There was no statistically significant difference in the proportion of Khorana score≥3 points in the VTE group and the control group(P>0.05).The area under ROC curve(AUC)of COMPASS-CAT score was higher than that of Khorana score(AUC:0.670 vs.0.583,P<0.05).(3)On the basis of COMPASS-CAT score,including D-dimer>3.83 mg/L to a joint prediction model was constructed,its AUC was 0.879.Compared with the COMPASS-CAT score,the AUC of the joint prediction model increased by 0.209,and the difference was statistically significant(P<0.001).Conclusion The COMPASS-CAT score can better predict the risk of VTE in patients with malignant tumors,while the KRS has limited predictive value.Combining COMPASS-CAT score and D-dimer>3.83 mg/L to con-struct a new prediction model can improve the prediction performance of malignant tumor-related VTE.