Assessment of the Risk of Venous Thromboembolism in Medical Inpatients using the Padua Prediction Score and Caprini Risk Assessment Model.
Assessment of the Risk of Venous Thromboembolism in Medical Inpatients using the Padua Prediction Score and Caprini Risk Assessment Model.
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DOI：
10.5551/jat.43653
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发表时间：
2018-11-01
影响因子：
4.4
通讯作者：
Yi Q
中科院分区：
文献类型：
--
作者：
Zhou H;Hu Y;Li X;Wang L;Wang M;Xiao J;Yi Q
目的：临床住院患者静脉血栓栓塞（VTE）风险分层的最佳风险评估模型（RAM）尚不明确。我们检查并比较了帕多瓦预测评分（PPS）和卡普里尼RAM对住院患者静脉血栓栓塞风险的分层效果。方法：我们对中国一家大型综合医院住院4年的患者进行回顾性病例对照研究。住院期间确诊静脉血栓栓塞902例，随机选取902例对照，按医疗服务匹配病例。结果：静脉血栓栓塞（VTE）风险随PPS评分和capriini评分的升高而显著增高。PPS和capriini RAM“高风险”分类分别与静脉血栓栓塞风险增加5.01倍和4.10倍相关。然而，根据美国胸科医师学会指南，capritini RAM可以识别84.3%的静脉血栓栓塞病例，而PPS只能识别49.1%的静脉血栓栓塞病例。在研究的住院病人中，在静脉血栓栓塞病例中比在对照中更常见的5个危险因素在capritini RAM中没有包括在PPS中。卡普里尼RAM风险水平与住院和6个月死亡率几乎完全相关。结论：PPS和capriti RAM均可有效地对住院患者静脉血栓栓塞风险进行分层，但capriti RAM由于纳入了综合危险因素、对哪些患者可能需要进行预防的敏感性更高、以及预测死亡率的潜力，可作为综合医院的首选方法。
Aim: The optimal risk assessment model (RAM) to stratify the risk of venous thromboembolism (VTE) in medical inpatients is not known. We examined and compared how well the Padua Prediction Score (PPS) and the Caprini RAM stratify VTE risk in medical inpatients. Methods: We undertook a retrospective case-control study among medical inpatients admitted to a large general hospital in China during a 4-year period. In total, 902 cases were confirmed to have VTE during hospitalization and 902 controls were selected randomly to match cases by medical service. Results: The VTE risk increased significantly with an increase of the cumulative PPS or Caprini RAM score. A PPS and Caprini RAM “high risk” classification was, respectively, associated with a 5.01-fold and 4.10-fold increased VTE risk. However, the Caprini RAM could identify 84.3% of the VTE cases to receive prophylaxis according to American College of Chest Physicians guidelines, whereas the PPS could only identify 49.1% of the VTE cases. In the medical inpatients studied, five risk factors seen more frequently in VTE cases than in controls in the Caprini RAM were not included in the PPS. The Caprini RAM risk levels were linked almost perfectly to in-hospital and 6-month mortality. Conclusions: Both the PPS and Caprini RAM can be used to stratify the VTE risk in medical inpatients effectively, but the Caprini RAM may be considered as the first choice in a general hospital because of its incorporation of comprehensive risk factors, higher sensitivity to identify patients who may benefit from prophylaxis, and potential for prediction of mortality.