脑卒中病人深静脉血栓风险预测模型的系统评价

Risk prediction models for deep vein thrombosis in stroke patients:a systematic review

目的:系统评价脑卒中病人深静脉血栓风险预测模型,为临床实践提供参考。方法:全面检索PubMed、the Cochrane Library、Embase、CINAHL、中国知网、维普数据库、中国生物医学文献数据库(SinoMed)、万方数据知识服务平台等数据库中有关脑卒中病人深静脉血栓风险预测模型的文献,检索时间为建库至2023年10月。由2名研究者独立筛选文献和提取数据,应用预测模型研究的偏倚风险评估工具(PROBAST)分析文献的偏倚风险和适用性。结果:共纳入18项脑卒中病人深静脉血栓风险预测模型,建模队列的受试者工作特征曲线下面积(AUC)为0.610~0.912,验证队列AUC为0.550~0.840。高龄、D-二聚体、女性、恶性肿瘤、出血性脑卒中是出现频次较高的预测因子。结论:脑卒中病人深静脉血栓风险预测模型的开发及应用还处于发展阶段,未来研究者可运用不同建模方法,严格遵照预测模型偏倚风险评价工具对模型的开发及应用进行设计。临床医务人员应审慎地选择相应预测模型应用于临床,尽早识别脑卒中病人深静脉血栓的发生风险并采取相应的预防措施。

Objective:To systematically evaluate the risk prediction models for deep vein thrombosis in stroke patients and provide reference for clinical practice.Methods:Comprehensively searched literatures on deep vein thrombosis risk prediction models in stroke patients from PubMed,the Cochrane Library,Embase,CINAHL,CNKI,VIP database,SinoMed,Wanfang Data Knowledge Service Platform and other databases.The retrieval period was from the establishment of the database to October 2023.Two researchers independently screened literature and extracted data.The bias risk assessment tool(PROBAST)for predictive model studies was used to analyze the risk of bias and applicability for literature.Results:A total of 18 models for predicting the risk of deep vein thrombosis in stroke patients were included.The AUC of the modeling cohort ranged from 0.610 to 0.912,and that of the validation cohort ranged from 0.550 to 0.840.Older age,D-dimer,female,malignant tumor,hemorrhagic stroke were the predictors of higher frequency.Conclusions:The development and application of deep vein thrombosis risk prediction model for stroke patients are still in the development stage.In the future,researchers can use different modeling methods and strictly follow the predictive model bias risk assessment tool to design the development and application of the model.The clinical staff should carefully select the corresponding prediction model for clinical application,identify the risk of deep vein thrombosis in stroke patients as early as possible and take corresponding preventive measures.