Risk factors for presence and severity of pulmonary embolism in patients with deep venous thrombosis
Risk factors for presence and severity of pulmonary embolism in patients with deep venous thrombosis
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DOI：
10.1016/j.jvsv.2017.08.015
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发表时间：
2018-01-01
影响因子：
3.2
通讯作者：
Chaar, Cassius Lyad Ochoa
中科院分区：
文献类型：
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作者：
Huynh, Nancy;Fares, Wassim H.;Chaar, Cassius Lyad Ochoa
目的：Caprini模型通过30个不同的因素估计患者发生静脉血栓栓塞症的风险。血流动力学意义重大的肺栓塞(PE)，定义为高危(大面积)或中危(亚大面积)PE，具有较高的发病率和死亡率。本研究检验Caprini模型和深静脉血栓形成(DVT)特征是否与DVT患者的PE发生率和血流动力学意义上的PE相关。方法：对2013年1月至2014年8月在三级护理中心诊断为DVT的患者进行回顾性分析。用多变量分析确定PE和血流动力学有意义的PE的预测因素。结果：在838例DVT患者中。217例(25.9%)表现为伴发PE，其中135例有血流动力学意义的PE(101例次大面积PE，34例大面积PE)。平均年龄为65岁，其中51.0%为女性。年龄或性别与PE或血流动力学显着PE的发生无明显关系。PE患者不太可能接受近期手术(18.4%比30.3%；P=.001)，不太可能有脓毒症(4.6%比11.8%：P=.002)，且Caprini评分较高(6.1比6.5；P=.047)。DVT患者近期手术后发生血流动力学显着PE的可能性较小(13.3%比27.2%；P=.011)，但更有可能发生血流动力学显着的PE(80.7%比64.2%)。Caprini评分与血流动力学有意义的PE之间无相关性(6.3vs5.7：P=.171)。结论：在DVT患者中，Caprini模型与PE或血流动力学有意义的PE的相关性较差。在所有DVT患者中，合并PE或血流动力学意义显著的PE在脓毒症或最近接受手术的患者中较少见，但在近端DVT患者中较常见。
Objective: The Caprini model estimates patients' risk for venous thromboembolism by 30 different factors. Hemodynamically significant pulmonary embolism (PE), defined as high-risk (massive) or intermediate-risk (submassive) PE, has high morbidity and mortality rates. This study tests whether the Caprini model and deep venous thrombosis (DVT) characteristics correlate with the prevalence of PE and hemodynamically significant PE in patients with DVT.Methods: A retrospective review of patients diagnosed with DVT between January 2013 and August 2014 in a tertiary care center was performed. Multivariable analysis was used to determine predictors of PE and hemodynamically significant PE.Results: Of 838 consecutive patients with DVT. 217 (25.9%) had concomitant PE at presentation, of whom 135 had hemodynamically significant PE (101 submassive PE, 34 massive PE). The mean age was 65 years, and 51.0% were women. There was no significant relation between age or gender and the occurrence of PE or hemodynamically significant PE. Patients with PE were less likely to have undergone recent surgery (18.4% vs 30.3%; P = .001), to have sepsis (4.6% vs 11.8%: P = .002), and to have higher Caprini scores (6.1 vs 6.5; P = .047). Patients with DVT were less likely to have hemodynamically significant PE after recent surgery (13.3% vs 27.2%; P = .011) but more likely to have hemodynamically significant PE with proximal DVT (80.7% vs 64.2%). There was no association between Caprini score and hemodynamically significant PE (6.3 vs 5.7: P = .171).Conclusions: The Caprini model has a poor association with PE or hemodynamically significant PE in patients with DVT. Among all patients with DVT, a concomitant diagnosis of PE or hemodynamically significant PE is less common in those with sepsis or undergoing recent surgery but more common in those with proximal DVT.