Risk Assessment of Recurrence in Patients With Unprovoked Deep Vein Thrombosis or Pulmonary Embolism The Vienna Prediction Model
Risk Assessment of Recurrence in Patients With Unprovoked Deep Vein Thrombosis or Pulmonary Embolism The Vienna Prediction Model
复制标题
DOI：
10.1161/circulationaha.109.925214
复制
发表时间：
2010-04-13
期刊：
影响因子：
37.8
通讯作者：
Kyrle, Paul A.
中科院分区：
文献类型：
--
作者：
Eichinger, Sabine;Heinze, Georg;Kyrle, Paul A.
背景——预测个体患者复发性静脉血栓栓塞 (VTE) 的风险通常是不可行的。我们的目的是开发一个简单的风险评估模型，以提高复发风险的预测。方法和结果-在一项前瞻性队列研究中，929 名首次无端 VTE 的患者在停止抗凝治疗后进行了中位随访 43.3 个月。我们排除了具有严重血栓形成缺陷的患者，例如天然抑制剂缺乏、狼疮抗凝剂以及纯合子或组合缺陷。共有 176 名患者 (18.9%) 出现复发性 VTE。在 Cox 比例风险模型中分析预选的临床和实验室变量（年龄、性别、VTE 位置、体重指数、V 因子 Leiden、凝血酶原 G20210A 突变、D-二聚体和体外凝血酶生成），并使用那些与复发显着相关的变量来计算风险评分。男性（相对于女性的风险比为 1.90，95% 置信区间为 1.31 至 2.75）、近端深静脉血栓形成（相对于远端的风险比为 2.08，95% 置信区间为 1.16 至 3.74）、肺栓塞（相对于远端血栓的风险比为 2.60，95% 置信区间为 1.49 至 4.53）以及 D-二聚体水平升高（每倍的风险比为 1.27，95% 置信区间为 1.08 至 1.51）与较高的复发风险相关。利用这些变量，我们开发了一个列线图，可用于计算风险评分并估计个体患者复发的累积概率。该模型经过交叉验证，并根据患者的风险评分将其分配到不同的风险类别。复发率与不同的风险类别具有良好的对应性。结论——通过使用简单的评分系统，可以改善对首次无端 VTE 且无强血栓形成缺陷的患者的复发风险评估。 （流通。2010 年；121：1630-1636。）
Background-Predicting the risk of recurrent venous thromboembolism (VTE) in an individual patient is often not feasible. We aimed to develop a simple risk assessment model that improves prediction of the recurrence risk.Methods and Results-In a prospective cohort study, 929 patients with a first unprovoked VTE were followed up for a median of 43.3 months after discontinuation of anticoagulation. We excluded patients with a strong thrombophilic defect such as a natural inhibitor deficiency, the lupus anticoagulant, and homozygous or combined defects. A total of 176 patients (18.9%) had recurrent VTE. Preselected clinical and laboratory variables (age, sex, location of VTE, body mass index, factor V Leiden, prothrombin G20210A mutation, D-dimer, and in vitro thrombin generation) were analyzed in a Cox proportional hazards model, and those variables that were significantly associated with recurrence were used to compute risk scores. Male sex (hazard ratio versus female sex 1.90, 95% confidence interval 1.31 to 2.75), proximal deep vein thrombosis (hazard ratio versus distal 2.08, 95% confidence interval 1.16 to 3.74), pulmonary embolism (hazard ratio versus distal thrombosis 2.60, 95% confidence interval 1.49 to 4.53), and elevated levels of D-dimer (hazard ratio per doubling 1.27, 95% confidence interval 1.08 to 1.51) were related to a higher recurrence risk. Using these variables, we developed a nomogram that can be used to calculate risk scores and to estimate the cumulative probability of recurrence in an individual patient. The model was cross validated, and patients were assigned to different risk categories based on their risk score. Recurrence rates corresponded well with the different risk categories.Conclusions-By use of a simple scoring system, the assessment of the recurrence risk in patients with a first unprovoked VTE and without strong thrombophilic defects can be improved. (Circulation. 2010; 121: 1630-1636.)