急性中毒合并医院相关性静脉血栓栓塞症危险因素及多指标预测价值

Analysis of risk factors and the predictive value of combined multiple indicators for acute poisoning with hospital-associated venous thromboembolism

目的探讨医院相关性静脉血栓栓塞症(HA-VTE)相关危险因素,以进一步提升急性中毒患者静脉血栓栓塞症(VTE)临床处理能力。方法收集2012年1月1日—2023年6月30日南京医科大学第一附属医院收治的急性中毒患者的临床资料,根据影像学结果分为VTE组和非VTE组,采用χ2检验、t检验或Mann-Whitney U检验比较两组患者的临床资料特征。通过单因素和多因素Logistic回归分析筛选危险因素,采用受试者工作特征曲线(ROC)分析危险因素的临床预测效果。结果共纳入86例急性中毒患者,年龄、毒性分级、服用抗精神类药物、肺部感染、使用糖皮质激素、C-反应蛋白(CRP)、超敏肌钙蛋白T(cTnT)、D-二聚体、中毒严重程度评分(PSS)、Padua预测评分(PPS)、Wells评分、改良早期预警评分(MEWS)等12个变量在组间和单因素Logistic回归分析中差异有统计学意义(P<0.05)。Padua预测评分是最有价值的独立危险因素。联合多指标具有较高预测价值,综合性能最佳。结论Padua预测评分、MEWS评分、D-二聚体、PSS评分、毒性分级是急性中毒患者发生HA-VTE的独立危险因素,为早期预测及预防提供临床参考,有助于进一步优化临床医师对急性中毒患者合并HA-VTE的诊治处理能力。

Objective To investigate the risk factors associated with hospital-associated venous thromboembolism(HAVTE)for further enhancing the clinical management ability of acute poisoning with VTE.Methods Clinical data of acute poisoning patients admitted to the First Affiliated Hospital of Nanjing Medical University from January 1,2012 to June 30,2023 were collected and divided into VTE group and non-VTE group according to the imaging findings.Theχ2 test,t-test,or Mann-Whitney U test were used to compare the clinical characteristics of two groups,the risk factors were screened by univariate and multivariate Logistic regression analyses,and the clinical predictive effect of the risk factors were analyzed by the receiver operator characteristic curve(ROC).Results The results showed that among 86 patients with acute poisoning in this study,a total of 12 risk factors including age,toxicity grade,antipsychotic drug use,pulmonary infection,glucocorticoid use,CRP,cTnT,Ddimer,poisoning severity score(PSS),Padua predictive score(PPS),Wells score,and modified early warning score(MEWS)were statistically significant in intergroup differences and univariate Logistic regression analyses(P<0.05);the Padua predictive score was the most valuable independent risk factor,while the combination of multiple indicators had a high predictive value and with the best comprehensive performance.Conclusion The results suggested that Padua predictive score,MEWS,D-dimer,PSS,and toxicity grade are the independent risk factors for the occurrence of HA-VTE in patients with acute poisoning,which provided a clinical reference for early prediction and prevention,and helpful to further optimize the diagnostic and treatment ability of clinical physicians for acute poisoning patients with HA-VTE.