Caprini和Rogers风险评估模型联合使用可以提高胸外科术后患者筛选静脉血栓栓塞症的准确性
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摘要
目的验证Caprini和Rogers风险评估模型在胸外科手术后患者中筛选静脉血栓栓塞症(VTE)的有效性。方法采用单中心回顾性研究,以2016年7—12月首都医科大学附属北京朝阳医院胸外科行手术治疗的194例患者为样本,以Caprini和Rogers风险评估模型对所有患者进行回顾性血栓风险评分,并通过Logistic二分类回归分析得到Caprini和Rogers联合使用后的预测概率值,分别绘制受试者工作特征(ROC)曲线,计算曲线下面积(AUC),进行两两比较,以Youden指数最大的分界点作为最佳诊断分界点。结果胸外科术后总的VTE发生率为13.4%。Caprini模型AUC为(0.713±0.043,P<0.001),Rogers模型AUC为(0.577±0.062,P=0.207),预测概率模型AUC为(0.730±0.041,P<0.001)。Caprini模型分别与Rogers和预测概率模型AUC比较,差异均无统计学意义(P>0.05);但预测概率模型较Rogers模型AUC显著增加,差异有统计学意义(P=0.015)。Caprini模型在Youden指数为0.393时,敏感度为0.923,特异度为0.47;Rogers模型在Youden指数为0.135时,敏感度为0.385,特异度为0.75;预测概率模型在Youden指数为0.444时,敏感度为0.962,特异度为0.48。结论 Caprini和Rogers风险评估模型联合使用可以提高胸外科手术后患者筛选VTE的准确性。
Objective To verify the efficacy of Caprini and Rogers risk assessment models of screening for venous thromboembolism(VTE)in patients undergoing thoracic surgery.Methods A single center retrospective study was performed in the department of thoracic surgery in Beijing Chao-Yang Hospital affiliated to Capital Medical University from July to December in 2016.The Caprini and Rogers risk score were recorded retrospectively for each patient.Meanwhile,by using of logistic bivariate regression analysis,we have obtained the predicted probability of Caprini and Rogers in combination diagnosis.We have drawn receiver operating characteristic curves(ROC)respectively,and calculated the area under the curve(AUC),then we have done pairwise comparison severally.The Youden index was taken as the cutoff point.Results The total incidence of VTE after thoracic surgery was 13.4%.The AUC for the the Caprini model,the Rogers model and the predictive probability model were 0.713±0.043(P<0.001),0.577±0.062(P=0.207)and 0.730±0.041(P<0.001)respectively.There was no significant difference in AUC between Caprini model and the other two models(P>0.05);while the AUC of the predictive probability model was significantly higher than that of the Rogers model(P=0.015).Caprini model had a sensitivity of 0.923 and a specificity of 0.47 when the Youden index was 0.393.The Rogers model had a sensitivity of 0.385 and a specificity of 0.75 when the Youden index was 0.135.The predictive probability model had a sensitivity of 0.962 and a specificity of 0.48 when the Youden index was 0.444.Conclusions The combined use of Caprini and Rogers risk assessment model can improve the accuracy of screening for venous thromboembolism in patients undergoing thoracic surgery.
Objective To verify the efficacy of Caprini and Rogers risk assessment models of screening for venous thromboembolism(VTE)in patients undergoing thoracic surgery.Methods A single center retrospective study was performed in the department of thoracic surgery in Beijing Chao-Yang Hospital affiliated to Capital Medical University from July to December in 2016.The Caprini and Rogers risk score were recorded retrospectively for each patient.Meanwhile,by using of logistic bivariate regression analysis,we have obtained the predicted probability of Caprini and Rogers in combination diagnosis.We have drawn receiver operating characteristic curves(ROC)respectively,and calculated the area under the curve(AUC),then we have done pairwise comparison severally.The Youden index was taken as the cutoff point.Results The total incidence of VTE after thoracic surgery was 13.4%.The AUC for the the Caprini model,the Rogers model and the predictive probability model were 0.713±0.043(P<0.001),0.577±0.062(P=0.207)and 0.730±0.041(P<0.001)respectively.There was no significant difference in AUC between Caprini model and the other two models(P>0.05);while the AUC of the predictive probability model was significantly higher than that of the Rogers model(P=0.015).Caprini model had a sensitivity of 0.923 and a specificity of 0.47 when the Youden index was 0.393.The Rogers model had a sensitivity of 0.385 and a specificity of 0.75 when the Youden index was 0.135.The predictive probability model had a sensitivity of 0.962 and a specificity of 0.48 when the Youden index was 0.444.Conclusions The combined use of Caprini and Rogers risk assessment model can improve the accuracy of screening for venous thromboembolism in patients undergoing thoracic surgery.
引文
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2 Goldhaber SZ.Risk factors for venous thromboembolism[J].J Am Coll Cardiol,2010,56(1):1-7.
3 Spencer FA,Emery C,Lessard D,et al.The Worcester Venous Thromboembolism study:apopulation-based study of the clinical epidemiology of venous thromboembolism[J].J Gen Intern Med,2006,21(7):722-727.
4 Nelson RE,Grosse SD,Waitzman NJ,et al.Using multiple sources of data for surveillance of postoperative venous thromboembolism among surgical patients treated in Department of Veterans Affairs hospitals,2005-2010[J].Thromb Res,2015,135(4):636-642.
5 Merkow RP,Bilimoria KY,McCarter MD,et al.Postdischarge venous thromboembolism after cancer surgery:extending the case for extended prophylaxis[J].Ann Surg,2011,254(1):131-137.
6 Agnelli G,Bolis G,Capussotti L,et al.A clinical outcomebased prospective study on venous thromboembolism after cancer surgery:the@RISTOS project[J].Ann Surg,2006,243(1):89-95.
7 Caprini JA.Thrombosis risk assessment as a guide to quality patient care[J].Dis Mon,2005,51(2-3):70-78.
8 Rogers SO,Kilaru RK,Hosokawa P,et al.Multivariable predictors of postoperative venous thromboembolic events after general and vascular surgery:results from the patient safety in surgery study[J].J Am Coll Surg,2007,204(6):1211-1121.
9 Hachey KJ,Sterbling H,Choi DS,et al.Prevention of Postoperative Venous Thromboembolism in Thoracic Surgical Patients:Implementation and Evaluation of a Caprini Risk Assessment Protocol[J].J Am Coll Surg,2016,222(6):1019-1027.
10 Kearon C,Akl EA,Ornelas J,et al.Antithrombotic Therapy for VTE Disease:CHEST Guideline and Expert Panel Report[J].Chest,2016,149(2):315-352.
11 Gould MK,Garcia DA,Wren SM,et al.Prevention of VTE in nonorthopedic surgical patients:Antithrombotic Therapy and Prevention of Thrombosis,9th ed:American College of Chest Physicians Evidence-Based Clinical Practice Guidelines[J].Chest,2012,141(2Suppl):e227S-e277S.
12 Hachey KJ,Hewes PD,Porter LP,et al.Caprini venous thromboembolism risk assessment permits selection for postdischarge prophylactic anticoagulation in patients with resectable lung cancer[J].J Thorac Cardiovasc Surg,2016,151 (1):37-44.e1.
13 Hewes PD,Hachey KJ,Zhang XW,et al.Evaluation of the Caprini Model for Venothromboembolism in Esophagectomy Patients[J].Ann Thorac Surg,2015,100(6):2072-2078.
2 Goldhaber SZ.Risk factors for venous thromboembolism[J].J Am Coll Cardiol,2010,56(1):1-7.
3 Spencer FA,Emery C,Lessard D,et al.The Worcester Venous Thromboembolism study:apopulation-based study of the clinical epidemiology of venous thromboembolism[J].J Gen Intern Med,2006,21(7):722-727.
4 Nelson RE,Grosse SD,Waitzman NJ,et al.Using multiple sources of data for surveillance of postoperative venous thromboembolism among surgical patients treated in Department of Veterans Affairs hospitals,2005-2010[J].Thromb Res,2015,135(4):636-642.
5 Merkow RP,Bilimoria KY,McCarter MD,et al.Postdischarge venous thromboembolism after cancer surgery:extending the case for extended prophylaxis[J].Ann Surg,2011,254(1):131-137.
6 Agnelli G,Bolis G,Capussotti L,et al.A clinical outcomebased prospective study on venous thromboembolism after cancer surgery:the@RISTOS project[J].Ann Surg,2006,243(1):89-95.
7 Caprini JA.Thrombosis risk assessment as a guide to quality patient care[J].Dis Mon,2005,51(2-3):70-78.
8 Rogers SO,Kilaru RK,Hosokawa P,et al.Multivariable predictors of postoperative venous thromboembolic events after general and vascular surgery:results from the patient safety in surgery study[J].J Am Coll Surg,2007,204(6):1211-1121.
9 Hachey KJ,Sterbling H,Choi DS,et al.Prevention of Postoperative Venous Thromboembolism in Thoracic Surgical Patients:Implementation and Evaluation of a Caprini Risk Assessment Protocol[J].J Am Coll Surg,2016,222(6):1019-1027.
10 Kearon C,Akl EA,Ornelas J,et al.Antithrombotic Therapy for VTE Disease:CHEST Guideline and Expert Panel Report[J].Chest,2016,149(2):315-352.
11 Gould MK,Garcia DA,Wren SM,et al.Prevention of VTE in nonorthopedic surgical patients:Antithrombotic Therapy and Prevention of Thrombosis,9th ed:American College of Chest Physicians Evidence-Based Clinical Practice Guidelines[J].Chest,2012,141(2Suppl):e227S-e277S.
12 Hachey KJ,Hewes PD,Porter LP,et al.Caprini venous thromboembolism risk assessment permits selection for postdischarge prophylactic anticoagulation in patients with resectable lung cancer[J].J Thorac Cardiovasc Surg,2016,151 (1):37-44.e1.
13 Hewes PD,Hachey KJ,Zhang XW,et al.Evaluation of the Caprini Model for Venothromboembolism in Esophagectomy Patients[J].Ann Thorac Surg,2015,100(6):2072-2078.