Testing Clinical Scores to Diagnose Incident Deep Vein Thrombosis in Patients Hospitalized in a Department of Medicine: Can Biomarkers Improve Accuracy?
Testing Clinical Scores to Diagnose Incident Deep Vein Thrombosis in Patients Hospitalized in a Department of Medicine: Can Biomarkers Improve Accuracy?
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DOI：
10.1177/0003319715586289
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发表时间：
2016-03-01
期刊：
影响因子：
2.8
通讯作者：
Stancanelli, Benedetta
中科院分区：
文献类型：
--
作者：
Malatino, Lorenzo;Cardella, Antonella M.;Stancanelli, Benedetta
将背景从急诊科转移到内科，我们比较了在内科住院的几种合并症患者中诊断深静脉血栓形成（DVT）的不同评分。我们前瞻性地招募了178名连续住院的患者，这些患者的临床怀疑DVT是通过Wells DVT修正评分、Hamilton、Kahn和St Andre医院评分来评估的。85例（48%）患者通过超声多普勒和血管计算机断层扫描证实深静脉血栓形成。基于症状和临床体征的风险评分的使用用处不大（曲线下面积[AUC]: 0.69，阳性预测值：59%，阴性预测值：74%）。与没有DVT的患者相比，DVT患者血清白蛋白和蛋白S水平显著（P < 0.0001）降低。血清蛋白S （AUC: 0.82）和白蛋白百分比（AUC: 0.80）对诊断DVT的准确性优于临床评分（P < 0.001）。因此，血清白蛋白和蛋白S提高了某内科住院患者诊断突发DVT的临床评分的准确性。
Shifting the context from the emergency department to the department of medicine, we compared different scores to diagnose deep vein thrombosis (DVT) in patients with several comorbidities, hospitalized in a department of internal medicine. We prospectively recruited 178 consecutive hospitalized patients in whom clinical suspicion of DVT was assessed by Wells modified score for DVT, Hamilton, Kahn, and St Andre Hospital scores. Deep vein thrombosis was confirmed in 85 (48%) patients by both echocolor Doppler and angiocomputed tomography scan. The use of risk scores based on symptoms and clinical signs was weakly useful (area under the curve [AUC]: 0.69, positive predictive value: 59%, and negative predictive value: 74%). Patients with DVT had significantly (P < .0001) lower serum albumin and protein S levels compared to those without DVT. Moreover, serum protein S (AUC: 0.82) and albumin in percentage (AUC: 0.80) showed a better accuracy than clinical scores (P < .001) in assessing the diagnosis of DVT. Therefore, serum albumin and protein S improved the accuracy of clinical scores for the diagnosis of incident DVT in patients hospitalized in a department of medicine.