住院恶性肿瘤患者Khorana评分分布调查及模型改良

Distribution and modification of Khorana score in hospitalized patients with malignant tumors

目的调查住院恶性肿瘤患者Khorana评分分布,分析住院恶性肿瘤患者发生静脉血栓栓塞(venous thromboembolism,VTE)的危险因素,探讨改良Khorana评分模型预测住院恶性肿瘤患者VTE风险的价值。方法回顾性分析2019年11月至2022年10月潍坊市人民医院收治的389例恶性肿瘤患者的临床资料,其中男性233例、女性156例,年龄(57.95±11.71)岁。采用Khorana评分进行VTE风险评估,统计患者VTE发生情况。采用独立样本t检验、χ^(2)检验、logistic回归分析、受试者操作特征曲线(receiver operating characteristic curve,ROC)进行分析。结果389例恶性肿瘤患者中19例发生VTE,发生率为4.88%。Khorana评分0、1、2、≥3分患者占比分别为36.25%(141/389)、37.79%(147/389)、19.54%(76/389)、6.43%(25/389),对应VTE发生率为2.84%(4/141)、4.08%(6/147)、7.89%(6/76)、12.00%(3/25),Khorana评分越高VTE发生率也更高,但差异无统计学意义(χ^(2)=4.936,P=0.177)。有、无饮酒史患者Khorana评分≤2分的占比分别为95.16%(118/124)、92.83%(246/265)(P<0.05)。冠心病、高危VTE癌种及高D-二聚体为住院恶性肿瘤患者发生VTE的危险因素(OR=3.844、2.010、1.102,均P<0.05),其中冠心病为独立危险因素(校正OR=4.048,P=0.023)。改良Khorana评分对住院恶性肿瘤患者VTE发生风险的预测灵敏度、特异度和约登指数分别为68.421%、68.378%和0.368(P<0.01),其曲线下面积(0.684)较Khorana评分(0.549)增加了0.135,预测价值更高(Z=2.251,P=0.018)。结论住院恶性肿瘤患者Khorana评分越高,VTE发生率越高,但Khorana评分预测价值不高,冠心病是住院恶性肿瘤患者发生VTE的独立危险因素,结合D-二聚体的改良Khorana评分对住院恶性肿瘤患者VTE发生风险的预测价值高于Khorana评分。

Objective To investigate the distribution of Khorana score and risk factors of venous thromboembolism(VTE)in hospitalized patients with malignant tumors,and to explore the value of modified Khorana score model in predicting the risk of VTE in hospitalized patients with malignant tumors.Methods The clinical data of 389 hospitalized patients with malignant tumors admitted to Weifang People's Hospital from November 2019 to October 2022 were retrospectively analyzed,including 233 males and 156 females,aged(57.95±11.71)years.The Khorana score was used to assess the risk of VTE,and the incidence of VTE was calculated.Independent sample t test,χ^(2) test,logistic regression analysis,and receiver operating characteristic curve(ROC)were used for analysis.Results Among the 389 patients,19 occurred VTE,with an overall incidence of 4.88%.The proportions of the patients with Khorana score of 0,1,2,and≥3 points were 36.25%(141/389),37.79%(147/389),19.54%(76/389),and 6.43%(25/389),respectively.The corresponding incidences of VTE were 2.84%(4/141),4.08%(6/147),7.89%(6/76),and 12.00%(3/25).The higher the Khorana score was,the higher the incidence of VTE was,but the difference was not statistically significant(χ^(2)=4.936,P=0.177).The rates of Khorana score≤2 points in the patients with or without drinking history were 95.16%(118/124)and 92.83%(246/265)(P<0.05).Coronary heart disease,high-risk VTE cancer,and high D-dimer were the risk factors for VTE in hospitalized patients with malignant tumors(OR=3.844,2.010,and 1.102,all P<0.05),among which coronary heart disease was an independent risk factor(OR=4.048,P=0.023).The sensitivity,specificity,and Youden index of modified Khorana score for predicting the risk of VTE in hospitalized patients with malignant tumors were 68.421%,68.378%,and 0.368(P<0.01),respectively,and the area under the curve(AUC)was increased by 0.135 compared with the original score,with higher predicted value(Z=2.251,P=0.018).Conclusions The higher the Khorana score,the higher the incidence of VTE,but its predictive value is not high.Coronary heart disease is an independent risk factor for VTE in hospitalized patients with malignant tumors.Modified Khorana score combined with D-dimer has a higher predictive value for the risk of VTE in in hospitalized patients with malignant tumors than the original score.