Caprini和Padua血栓风险评估模型在肿瘤住院患者合并静脉血栓栓塞症的临床验证

The Clinical Validation of the Caprini and Padua Thromboembolism Risk Assessment Model in Hospitalized Cancer Patients with Venous Thromboembolism

目的验证Caprini和Padua血栓风险评估模型在中国肿瘤住院患者合并静脉血栓栓塞症的临床有效性。方法回顾性收集了2019年1月至2021年12月入住云南省普洱市人民医院和首都医科大学附属北京世纪坛医院的合并静脉血栓栓塞症(venous thromboembolism,VTE)的肿瘤患者473例,非VTE的肿瘤患者471例。结果肿瘤合并VTE组患者中卧床、肿瘤转移、肿瘤分期为Ⅲ或Ⅳ期、糖尿病、冠心病、中心静脉置管、糖尿病、下肢水肿和D-二聚体升高的人数明显高于非VTE组。肿瘤合并VTE患者中肺癌(22.41%)患者最多,其次是结肠癌(19.66%)、胃癌(11.84%)。随着Caprini累积风险评分的增加VTE的发生率亦增加,两者成线性关系,在累积分数为9~10分时VTE患者人数最多。肿瘤合并VTE患者Caprini累积分数绝大部分≥5分,特别是≥9分。肿瘤合并VTE患者Caprini累积分数明显高于肿瘤非VTE患者(P<0.0001)。采用Caprini血栓风险评估模型评估为高危-极高危患者的累积分数(8.23±2.72)显著高于非VTE组(1.52±1.64)(P<0.0001);采用Padua血栓风险评估模型评估为高危患者中的累积分数亦高于非VTE组(P<0.0001)。Caprini血栓风险评估模型的AUC值(95.7%)显著高于Padua血栓风险评估模型的AUC值(88.9%)(P<0.05)。结论在住院的肿瘤患者中Caprini血栓风险评估模型比Padua血栓风险评估模型具有更好的VTE的预测能力。

Objective To evaluate the clinical effectiveness of the Caprini and Padua thrombus risk assessment model in hospitalized cancer patients with venous thromboembolism in China.Methods A retrospective study was conducted on 473 tumor patients with combined VTE who were admitted to Pu’er People’s Hospital in Yunnan Province and Beijing Shijitan Hospital from January,2019 to December,2021,while 471 non-VTE tumor patients were enrolled as the control group.Results The results revealed that the number of patients with tumor combined with VTE who were bedridden,had tumor metastasis,with tumor stage Ⅲ or Ⅳ,diabetes,coronary heart disease,central vein catheterization,diabetes,lower limb edema,and D-dimer elevation was significantly higher than that of the non-VTE group.Among patients with tumor associated VTE,lung cancer(22.41%)was the most common comorbidity,followed by colon cancer(19.66%)and gastric cancer(11.84%).As Caprini cumulative risk score increased,the incidence of VTE also increased,and there was a linear relationship between the two measurements.The number of VTE patients was highest when the cumulative score was 9-10.The majority of cancer patients with VTE had a cumulative Caprini score of≥5 points,especially≥9 points.The cumulative Caprini score in patients with tumor associated VTE was significantly higher than that in non-tumor VTE patients(P<0.001).The cumulative score(8.23±2.72)of high-risk to extremely high-risk patients evaluated using Caprini thrombus risk assessment model was significantly higher than that of non-VTE group(1.52±1.64)(P<0.001);The cumulative score in high-risk patients evaluated using Padua thrombus risk assessment model was also higher than that in the non-VTE group(P<0.001).AUC value of Caprini thrombus risk assessment model(95.7%)was significantly higher than that of Padua thrombus risk assessment model(88.9%)(P<0.05).Conclusion Caprini thrombus risk assessment model shows a better predictive ability for VTE events than Padua thrombus risk assessment model in hospitalized cancer patients.