Predictive and Associative Models to Identify Hospitalized Medical Patients at Risk for VTE
Predictive and Associative Models to Identify Hospitalized Medical Patients at Risk for VTE
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DOI：
10.1378/chest.10-1944
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发表时间：
2011-09-01
期刊：
影响因子：
9.6
通讯作者：
Spencer, Frederick A.
中科院分区：
文献类型：
--
作者：
Spyropoulos, Alex C.;Anderson, Frederick A., Jr.;Spencer, Frederick A.
背景：危重住院的内科患者有患静脉血栓栓塞症的风险。我们在国际医学预防登记处关于静脉血栓栓塞症的观察性研究中评估了VTE的发生率，并得出了入院时的VTE风险评估评分和住院期间的相关VTE评分。方法：对15,156名内科患者的数据进行分析，以确定入院后3个月临床观察到的VTE的累积发生率。多元回归分析确定了与VTE风险相关的因素。结果：在184例出现症状性VTE的患者中，76例发生了肺血栓，67例出现了下肢深静脉血栓。累积VTE发生率为1.0%；45%的事件发生在出院后。与VTE独立相关的因素是既往的VTE、已知的血栓形成、癌症、年龄和60岁、下肢瘫痪、制动和7天，以及住进ICU或冠状动脉护理病房(前四个在入院时可用)。每个被识别的因素都被分配了分数，以给出每个患者的总风险分数。入院时，67%的患者的评分为1。住院期间，31%的患者评分为2；评分为2或3时，观察到的VTE风险为1.5%，评分为4的患者为5.7%。两种模型的观察率和预测率相似(C统计分别为0.65和0.69)。在住院期间，<gt；=2分与较高的总体和VTE相关死亡率相关。结论：入院时根据四个临床危险因素得出的加权VTE风险评分可以预测急症住院内科患者的VTE风险。住院期间从七个临床因素得出的评分可能有助于我们进一步了解症状性VTE的风险。这些分数需要外部验证。《胸部》2011；140(3)：706-714
Background: Acutely ill hospitalized medical patients are at risk for VTE. We assessed the incidence of VTE in the observational International Medical Prevention Registry on Venous Thromboembolism (IMPROVE) study and derived VTE risk assessment scores at admission and associative VTE scores during hospitalization.Methods: Data from 15,156 medical patients were analyzed to determine the cumulative incidence of clinically observed VTE over 3 months after admission. Multiple regression analysis identified factors associated with VTE risk.Results: Of the 184 patients who developed symptomatic VTE, 76 had pulmonary embolism, and 67 had lower-extremity DVT. Cumulative VTE incidence was 1.0%; 45% of events occurred after discharge. Factors independently associated with VTE were previous VTE, known thrombophilia, cancer, age >60 years, lower-limb paralysis, immobilization >= 7 days, and admission to an ICU or coronary care unit (first four were available at admission). Points were assigned to each factor identified to give a total risk score for each patient. At admission, 67% of patients had a score >= 1. During hospitalization, 31% had a score >= 2; for a score of 2 or 3, observed VTE risk was 1.5% vs 5.7% for a score >= 4. Observed and predicted rates were similar for both models (C statistic, 0.65 and 0.69, respectively). During hospitalization, a score >= 2 was associated with higher overall and VTE-related mortality.Conclusions: Weighted VTE risk scores derived from four clinical risk factors at hospital admission can predict VTE risk in acutely ill hospitalized medical patients. Scores derived from seven clinical factors during hospitalization may help us to further understand symptomatic VTE risk. These scores require external validation. CHEST 2011; 140(3):706-714