Frequency, risk factors, and trends for venous thromboembolism among hospitalized cancer patients
Frequency, risk factors, and trends for venous thromboembolism among hospitalized cancer patients
复制标题
DOI：
10.1002/cncr.23062
复制
发表时间：
2007-11-15
期刊：
影响因子：
6.2
通讯作者：
Lyman, Gary H.
中科院分区：
文献类型：
--
作者：
Khorana, Alok A.;Francis, Charles W.;Lyman, Gary H.
背景。静脉血栓栓塞症（VTE）导致癌症患者发病和死亡，是抗癌治疗的常见并发症。在当前研究中，对住院癌症患者中VTE的发生频率、风险因素及相关趋势进行了研究。
方法。利用大学医疗系统联盟的出院数据库进行了一项回顾性队列研究。其中包括1995年至2003年期间美国133家医疗中心的1824316次住院病例。
结果。在1015598名癌症患者中，34357人（3.4%）被诊断为深静脉血栓形成，11515人患有肺栓塞（PE）（1.1%），总体VTE发生率为4.1%。VTE发生率最高的癌症患者亚组包括黑人种族（每次住院5.1%）以及接受化疗的患者（4.9%）。VTE发生率最高的癌症部位包括胰腺（8.1%）、肾脏（5.6%）、卵巢（5.6%）、肺（5.1%）和胃（4.9%）。在血液系统恶性肿瘤中，骨髓瘤（5%）、非霍奇金淋巴瘤（4.8%）和霍奇金病（4.6%）的VTE发生率最高。VTE发生率增加了28%，这是由于肺栓塞发生率从0.8%近乎翻倍至1.5%（P <.0001）。在接受化疗的患者中，VTE发生率从3.9%上升至5.7%，增加了47%（P <.0001）。在多变量分析中，与VTE相关的风险因素包括年龄≥65岁、女性、黑人种族、使用化疗、癌症原发部位、合并症的存在以及入院年份。
结论。VTE，尤其是肺栓塞，是癌症患者住院时日益常见的并发症。黑人种族患者、特定癌症部位患者或接受化疗的患者面临的风险过高。
BACKGROUND. Venous thromboembolism (VTE) contributes to morbidity and mortality in cancer patients and is a frequent complication of anticancer therapy. In the current study, the frequency, risk factors, and trends associated with VTE were examined among hospitalized cancer patients.METHODS. A retrospective cohort study was conducted using the discharge database of the University HealthSystem Consortium. This included 1,824,316 hospitalizations between 1995 and 2003 at 133 U.S. medical centers.RESULTS. Among 1,015,598 cancer patients, 34,357 (3.4%) were diagnosed with deep venous thrombosis and 11,515 with pulmonary embolism (PE) (1.1%) for an overall VTE rate of 4.1%. Subgroups of cancer patients with the highest rates included black ethnicity (5.1% per hospitalization) and those receiving chemotherapy (4.9%). Sites of cancer with the highest rates of VTE included pancreas (8.1%), kidney (5.6%), ovary (5.6%), lung (5.1%), and stomach (4.9%). Among hematologic malignancies, myeloma (5%), non-Hodgkin lymphoma (4.8%), and Hodgkin disease (4.6%) had the highest rates of VTE. The rate of VTE increased by 28%, secondary to a near-doubling of PE rates from 0.8% to 1.5% (P < .0001). Among patients receiving chemotherapy, the rates of VTE rose from 3.9% to 5.7%, an increase of 47% (P < .0001). In multivariate analysis, risk factors associated with VTE included age >= 65 years, female sex, black ethnicity, use of chemotherapy, primary site of cancer, presence of comorbidities, and year of admission.CONCLUSIONS. VTE, particularly PE, is an increasingly frequent complication of hospitalization in cancer patients. Patients with black ethnicity, specific sites of cancer, or those receiving chemotherapy are disproportionately at risk.