论著

Padua预测评分和血清白蛋白水平在评估风湿病住院患者静脉血栓栓塞中的应用

  • 彭清 ,
  • 刘佳君 ,
  • 刘焱 ,
  • 尚华 ,
  • 唐果 ,
  • 韩雅欣 ,
  • 龙丽
展开
  • 1. 成都市第二人民医院风湿免疫科, 成都 610000
    2. 遵义医科大学第一临床学院, 贵州遵义 563000
    3. 重庆市璧山区人民医院风湿免疫科, 重庆 402760
    4. 成都市温江区人民医院风湿免疫科, 成都 610000
    5. 四川省人民医院风湿免疫科, 成都 610000

收稿日期: 2020-07-30

  网络出版日期: 2023-08-03

基金资助

成都市科技惠民技术研发项目(2015-HM01-00165-SF)

Application of Padua prediction score and serum albumin level in evaluating venous thromboembolism in rheumatic inpatients

  • Qing PENG ,
  • Jia-jun LIU ,
  • Yan LIU ,
  • Hua SHANG ,
  • Guo TANG ,
  • Ya-xin HAN ,
  • Li LONG
Expand
  • 1. Department of Rheumatology and Immunology, Chengdu Second People's Hospital, Chengdu 610000, China
    2. Zunyi Medical University, Zunyi 563000, Guizhou, China
    3. Department of Rheumatology and Immunology, The Bishan Hospital of Chongqing, Chongqing 402760, China
    4. Department of Rheumatology and Immunology, The Wenjiang Hospital of Chengdu, Chengdu 610000, China
    5. Department of Rheumatology and Immunology, Sichuan Provincial People's Hospital, Chengdu 610000, China

Received date: 2020-07-30

  Online published: 2023-08-03

Supported by

Chengdu Technology R&D Project of Benefiting People with Science and Technology(2015-HM01-00165-SF)

摘要

目的: 调查风湿病住院患者静脉血栓栓塞(venous thromboembolism,VTE)发生情况,探讨Padua预测评分是否适用于风湿病住院患者,并分析血清白蛋白是否与风湿病住院患者VTE发生相关。方法: 回顾性分析2018年9月至2019年9月四川省人民医院风湿免疫病住院患者资料,根据Padua预测评分进行VTE风险分层(≥4分为高危组,<4分为低危组),比较两组患者VTE发生情况及Padua预测评分与VTE事件的相关性。根据是否发生VTE事件分为VTE组及非VTE组,比较两组Padua预测评分差异,采用多因素Logistic回归模型分析Padua预测评分中的危险因素及血清白蛋白与VTE事件之间的关系。结果: 共1 547例风湿病住院患者纳入本研究,其中VTE 27例(1.7%),包括下肢深静脉血栓19例(1.2%)、肺血栓栓塞症6例(0.4%),肺血栓栓塞症合并下肢深静脉血栓2例(0.1%)。VTE组、非VTE组Padua预测评分分别为3.33±1.78和1.80±0.97(P<0.05),两组Padua预测评分≥4分的患者分别占37.0%(10/27)和4.3%(66/1 527)(P<0.01),VTE组平均血清白蛋白水平低于非VTE组[(29.79±6.36) g/L vs. (35.17±6.31) g/L,P<0.01]。VTE高危组76例,低危组1 471例,两组VTE发生率分别为13.2%和1.2%(P<0.001)。Logistic回归分析显示,激素治疗、近期创伤或手术、活动受限、年龄大于70岁及既往VTE病史为风湿病住院患者发生VTE的危险因素,OR值分别为7.11、7.07、3.40、2.40、2.00;血清白蛋白水平降低为风湿病住院患者发生VTE的危险因素(OR=0.88,P<0.01)。结论: 风湿病住院患者VTE发生率较高,与VTE相关的危险因素有激素治疗、近期创伤或手术、活动受限、年龄大于70岁及既往VTE病史,其中激素治疗是最高级别的危险因素,且血清白蛋白水平降低也是风湿病住院患者发生VTE的危险因素。Padua预测评分虽然能在一定程度上反映风湿病住院患者VTE的发生风险,但效能有限,将来可对其进行优化,以便对风湿病住院患者进行更精准的VTE风险评估。

本文引用格式

彭清 , 刘佳君 , 刘焱 , 尚华 , 唐果 , 韩雅欣 , 龙丽 . Padua预测评分和血清白蛋白水平在评估风湿病住院患者静脉血栓栓塞中的应用[J]. 北京大学学报(医学版), 2023 , 55(4) : 625 -630 . DOI: 10.19723/j.issn.1671-167X.2023.04.009

Abstract

Objective: To investigate the status of venous thromboembolism (VTE) in rheumatic inpatients, and to explore the efficiency of Padua prediction score (PPS) in the patient population. In addition, to analyze the relationship between serum albumin and VTE in rheumatic inpatients. Methods: Data of inpatients with rheumatology were retrospectively collected and analyzed at Sichuan Provincial People's Hospital from September 2018 to September 2019. Occurrence of VTE was compared between high (PPS≥4) and low (PPS < 4) risk groups. PPS were analyzed in the VTE and non-VTE patients. Multivariate Logistic regression model was used to analyze the risk factors in PPS and the relationship between serum albumin and VTE. Results: A total of 1 547 patients were included in this study, and 27 (1.7%) had symptomatic VTE. Among the symptomatic VTE cases, 19 (1.2%) had deep vein thrombosis (DVT) only, 6 (0.4%) had pulmonary thromboembolism (PTE) only, and 2 (0.1%) were diagnosed with DVT and PTE. PPS in the VTE and non-VTE groups were 3.33±1.78 and 1.80±0.97 respectively (P < 0.05).The number of patients with PPS≥4 in the VTE group and non-VTE group was 37.0% and 4.3% respectively (P < 0.01). The average serum albumin level in the VTE group was lower than that in non-VTE group [(29.79±6.36) g/L vs. (35.17±6.31) g/L, P < 0.001]. Seventy-six cases was divided into high-risk group of VTE, while 1 471 cases were in the low-risk group, and the incidence of VTE was 13.2% and 1.2% respectively (P < 0.001). Logistic regression analysis showed that ongoing hormonal treatment, age≥70 years, trauma and/or surgery ≤30 d, reduced mobility and previous VTE were risk factors of VTE in the rheumatology patients, OR values were 7.11, 7.07, 3.40, 2.40 and 2.00, respectively. Lower serum albumin level was the risk factor of VTE in the rheumatology patients [OR=0.88 (95%CI: 0.82-0.94)]. Conclusion: The incidence of VTE was relatively higher in the hospitalized patients in Department of Rheumatology and Immunology. Glucocorticoid therapy was the highest risk factor of VTE and lower serum albumin level also was the risk factor. Although the PPS can reflect the risk of VTE in rheumatic inpatients to some extent, its effectiveness is limited. PPS can be optimized for quantitative VTE risk assessment of rheumatic inpatients in the future.

参考文献

1 Geerts WH , Bergqvist D , Pineo GF , et al. Prevention of venous thromboembolism: American College of Chest Physicians evidence-based clinical practice guidelines (8th edition)[J]. Chest, 2008, 133 (Suppl 6): 381S- 453S.
2 Heit JA , Melton LJ 3rd , Lohse CM , et al. Incidence of venous thromboembolism in hospitalized patients versus community residents[J]. Mayo Clin Proc, 2001, 76 (11): 1102- 1110.
3 Stevens SM , Douketis JD . Deep vein thrombosis prophylaxis in hospitalized medical patients: Current recommendations, general rates of implementation, and initiatives for improvement[J]. Chin Chest Med, 2010, 31 (4): 675- 689.
4 Barbar S , Noventa F , Rossetto V , et al. A risk assessment model for the identification of hospitalized medical patients at risk for venous thromboembolism: The Padua prediction score[J]. Thromb Haemost, 2010, 8 (11): 2450- 2457.
5 Kahn SR , Lim W , Dunn AS , et al. Prevention of VTE in nonsurgical patients: Antithrombotic therapy and prevention of thrombosis, 9th ed: American College of Chest Physicians evidence-based clinical practice guidelines[J]. Chest, 2012, 141 (Suppl 2): e195S- e226S.
6 内科住院患者静脉血栓栓塞症预防中国专家建议写作组, 中华医学会呼吸病学分会, 中华医学会老年医学分会, 《中华结核和呼吸杂志》编辑委员会, 《中华老年医学杂志》编辑委员会. 内科住院患者静脉血栓栓塞症预防中国专家建议(2015)[J]. 中华结核和呼吸杂志, 2015, 38 (7): 484- 491.
7 《中国血栓性疾病防治指南》专家委员会. 中国血栓性疾病防治指南[J]. 中华医学杂志, 2018, 98 (36): 2861- 2888.
8 Vardi M , Ghanem-Zoubi NO , Zidan R , et al. Venous thromboembolism and the utility of the Padua prediction score in patients with sepsis admitted to internal medicine departments[J]. J Thromb Haemost, 2013, 11 (3): 467- 473.
9 Arpaia GG , Caleffi A , Marano G , et al. Padua prediction score and IMPROVE score do predict in-hospital mortality in internal medicine patients[J]. Intern Emerg Med, 2020, 15 (6): 997- 1003.
10 Germini F , Agnelli G , Fedele M , et al. Padua prediction score or clinical judgment for decision making on antithrombotic prophy-laxis: A quasi-randomized controlled trial[J]. J Thromb Thrombolysis, 2016, 42 (3): 336- 339.
11 Nendaz M , Spirk D , Kucher N , et al. Multicentre validation of the Geneva risk score for hospitalised medical patients at risk of venous thromboembolism. Explicit assessment of thromboembolic risk and prophylaxis for medical patients in SwitzErland (ESTIMATE)[J]. Thromb Haemost, 2014, 111 (3): 531- 538.
12 Lukaszuk RF , Dolna-Michno J , Plens K , et al. The comparison between Caprini and Padua VTE risk assessment models for hospitalised cancer patients undergoing chemotherapy at the tertiary oncology department in Poland: Is pharmacological thromboprophylaxis overused[J]. Contemp Oncol (Pozn), 2018, 22 (1): 31- 36.
13 刘恒, 刘春丽, 卿思敏, 等. Padua风险评估模型对评估呼吸内科患者静脉血栓栓塞症风险有效性研究[J]. 国际呼吸杂志, 2018, 38 (8): 590- 593.
14 张新娣, 龚萍, 刘建红. 比较Autar和Padua两种风险模型在预测癌症患者静脉血栓栓塞症的评估效果[J]. 中国肿瘤外科杂志, 2018, 10 (4): 237- 240.
15 李金玉, 程爱斌, 部璇, 等. Padua评分预测重症患者静脉血栓栓塞症风险的价值[J]. 中国现代医学杂志, 2018, 28 (31): 95- 99.
16 Folsom AR , Lutsey PL , Heckbert SR , et al. Serum albumin and risk of venous thromboembolism[J]. Thromb Haemost, 2010, 104 (1): 100- 104.
17 Henry N , Brilland B , Wacrenier S , et al. Incidence and risk factors of venous thromboembolic events in patients with ANCA-glomerulonephritis: A cohort study from the Maine-Anjou registry[J]. J Clin Med, 2020, 9 (10): 3177.
18 Gyamlani G , Molnar MZ , Lu JL , et al. Association of serum albumin level and venous thromboembolic events in a large cohort of patients with nephrotic syndrome[J]. Nephrol Dial Transplant, 2017, 32 (1): 157- 164.
19 中华医学会风湿病学分会. 2016中国痛风诊疗指南[J]. 中华内科杂志, 2016, 55 (11): 892- 899.
20 中华医学会风湿病学分会. 结节性脂膜炎诊治指南(草案)[J]. 中华风湿病学杂志, 2004, 8 (4): 253- 255.
21 Ruscitti P , Cipriani P , Masedu F , et al. Aduit-onset Still's di-sease: Evaluation of prognostic tolls and validation of the systemic score by analysis of 100 cases from three centers[J]. BMC Med, 2016, 14 (1): 194.
22 Tamaki H , Khasnis A . Venous thromboembolism in systemic autoimmune diseases: A narrative review with emphasis on primary systemic vasculitides[J]. Vasc Med, 2015, 20 (4): 369- 376.
23 Ohlmeier C , Leverkus F , Kloss S , et al. Estimating the incidence of venous thromboembolism (VTE) using various types of routine data of the German healthcare system[J]. Z Evid Fortbild Qual Gesundhwes, 2018, 139, 46- 52.
24 Rahmani J , Haghighian Roudsari A , et al. Relationship between body mass index, risk of venous thromboembolism and pulmonary embolism: A systematic review and dose-response meta-analysis of cohort studies among four million participants[J]. Thromb Res, 2020, 192, 64- 72.
25 White RH , Keenan CR . Effects of race and ethnicity on the incidence of venous thromboembolism[J]. Thromb Res, 2009, 123 (Suppl 4): S11- S17.
26 王欣, 洪新宇, 李金玉, 等. Padua风险评估模型对内科住院患者静脉血栓栓塞症的评估价值[J]. 协和医学杂志, 2018, 9 (3): 234- 241.
27 Johannesdottir SA , Horváth-Puhó E , Dekkers OM , et al. Use of glucocorticoids and risk of venous thromboembolism: A nationwide population-based case-control study[J]. JAMA Intern Med, 2013, 173 (9): 743- 752.
28 Coelho MC , Santos CV , Vieira Neto L , et al. Adverse effects of glucocorticoids: Coagulopathy[J]. Eur Endocrinol, 2015, 173 (4): M11- M21.
29 van Zaane B , Nur E , Squizzato A , et al. Systematic review on the effect of glucocorticoid use on procoagulant, anti-coagulant and fibrinolytic factors[J]. Thromb Haemost, 2010, 8 (11): 2483- 2493.
30 Lee JJ , Pope JE . A meta-analysis of the risk of venous thromboembolism in inflammatory rheumatic diseases[J]. Arthritis Res Ther, 2014, 16 (5): 435.
31 Mikhailidis DP , Ganotakis ES . Plasma albumin and platelet function: Relevance to atherogenesis and thrombosis[J]. Platelets, 1996, 7 (3): 125- 137.
文章导航

/