Email Alert | RSS

Journal of Peking University (Health Sciences) ›› 2023, Vol. 55 ›› Issue (4): 625-630. doi: 10.19723/j.issn.1671-167X.2023.04.009

Previous Articles     Next Articles

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

Qing PENG1,2,Jia-jun LIU2,Yan LIU2,Hua SHANG2,Guo TANG3,Ya-xin HAN4,Li LONG2,5,*()   

  1. 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:2020-07-30 Online:2023-08-18 Published:2023-08-03
  • Contact: Li LONG E-mail:llllyyyy2012@sina.com
  • Supported by:
    Chengdu Technology R&D Project of Benefiting People with Science and Technology(2015-HM01-00165-SF)

RICH HTML

   

PDF (PC)

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.

Key words: Venous thromboembolism, Padua prediction score, Rheumatic diseases

CLC Number: 

  • R593.2

Table 1

Risk factors for Padua predictive score"

Component Score
Active cancer 3
Previous VTE 3
Reduced mobility 3
Known thrombophilic condition 3
Trauma/surgery < 30 d 2
Age≥70 years 1
Heart/respiratory failure 1
Acute MI or ischemic stroke 1
Acute infection/rehum disorder 1
Obesity (BMI≥30 kg/m2) 1
Ongoing hormonal treatment 1

Table 2

Types and number of diseases of 1 547 patients"

Disease type n (%)
Rheumatoid arthritis 335 (21.7)
Primary Sjögren’s syndrome 249 (16.1)
Systemic lupus erythematosus 244 (15.8)
Osteoarthritis 195 (12.6)
Idiopathic inflammatory myositis 108 (7.0)
Spondyloarthritis 107 (6.9)
Gout 101 (6.5)
Overlap syndrome 84 (5.4)
Vasculitis 51 (3.3)
Systemic sclerosis 34 (2.2)
Adult Still’s disease 24 (1.6)
Panniculitis 15 (0.9)

Table 3

Comparison of general conditions of VTE and non-VTE group"

Items VTE group (n=27) Non-VTE group (n=1 520) P
Gender, n(%) 0.19
  Male 10 (37.0) 394 (25.9)
  Female 17 (63.0) 1 126 (74.1)
Age, n(%) 0.01
  ≥60 years 16 (59.3) 480 (31.6)
   < 60 years 11 (40.7) 1 041 (68.4)
Hypertension, n(%) 6 (13.9) 211 (16.0) 0.33
Diabetes, n(%) 3 (11.1) 91 (6.0) 0.48
BMI/(kg/m2), ${\bar x}$±s 23.24±4.56 22.50±3.46 0.15
Hospitalization days, ${\bar x}$±s 15.35±6.64 11.47±4.89 0.03
PPS, ${\bar x}$±s 3.33±1.78 1.80±0.97 < 0.001
Serum albumin/(g/L), ${\bar x}$±s 29.79±6.36 35.17±6.31 < 0.001

Table 4

Association of PPS with risk of VTE in binomial Logistic regression models"

PPS VTE (n=27), n (%) Non-VTE (n=1 520), n (%) OR (95%CI) P
0-1 2 (7.4) 580 (38.1) 1 (reference category)
2 11 (40.8) 718 (47.2) 4.43 (0.98, 20.12) 0.053
3 4 (14.8) 156 (10.3) 7.43 (1.35, 40.97) 0.021
4 2 (7.4) 32 (2.1) 18.12 (2.47, 132.86) 0.004
5 3 (11.1) 25 (1.7) 34.8 (5.56, 217.68) 0.001
≥6 5 (18.5) 9 (0.6) 161.11 (27.52, 943.07) 0.001

Table 5

Analysis of risk factors in PPS by Logistic regression model"

Risk factor OR(95%CI) P
Ongoing hormonal treatment 7.11 (2.13, 23.73) 0.001
Age≥70 years 2.40 (1.00, 5.76) 0.049
Trauma/surgery < 30 d 7.07 (1.55，32.24) 0.012
Reduced mobility 3.40 (2.37, 4.87) < 0.001
Previous VTE 2.00 (1.20, 3.33) 0.008

Table 6

Association of serum albumin categories with risk of incidence VTE in Logistic regression models"

Serum albumin categories VTE (n=27) Non-VTE (n=1 520) OR (95%CI) P
Serum albumin ≥ 40.0 g/L 1 29 1 (reference category)
30.00 g/L ≤ Serum albumin < 40.00 g/L 15 77 6.05 (0.79, 45.98) 0.08
25.00 g/L ≤ Serum albumin < 30.00 g/L 6 179 11.89 (1.42, 99.59) 0.02
20.00 g/L ≤ Serum albumin < 25.00 g/L 3 880 13.83 (1.42, 134.77) 0.02
Serum albumin < 20.00 g/L 2 355 24.48 (2.16, 278.13) 0.01
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.
doi: 10.4065/76.11.1102
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.
doi: 10.1016/j.ccm.2010.07.005
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.
doi: 10.1111/j.1538-7836.2010.04044.x
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.
doi: 10.3760/cma.j.issn.1001-0939.2015.07.002
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.
doi: 10.3760/cma.j.issn.0376-2491.2018.36.002
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.
doi: 10.1111/jth.12108
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.
doi: 10.1007/s11739-019-02264-4
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.
doi: 10.1007/s11239-016-1358-z
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.
doi: 10.3760/cma.j.issn.1673-436X.2018.08.005
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.
doi: 10.3969/j.issn.1674-4136.2018.04.008
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.
doi: 10.3390/jcm9103177
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.
doi: 10.1093/ndt/gfw227
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.
doi: 10.1186/s12916-016-0738-8
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.
doi: 10.1177/1358863X15573838
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.
doi: 10.1016/j.zefq.2018.11.005
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.
doi: 10.1016/j.thromres.2020.05.014
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.
[1] Xiaofei TANG,Yonghong LI,Qiuling DING,Zhuo SUN,Yang ZHANG,Yumei WANG,Meiyi TIAN,Jian LIU. Incidence and risk factors of deep vein thrombosis in patients with rheumatoid arthritis [J]. Journal of Peking University (Health Sciences), 2024, 56(2): 279-283.
[2] Wei ZHANG,Pei-xun ZHANG. Analysis of prophylactic effect of extended-duration anticoagulant drugs in elderly patients undergoing hip fracture [J]. Journal of Peking University(Health Sciences), 2019, 51(3): 501-504.
Viewed
Full text


Abstract

Cited
  Shared   
  Discussed   
No Suggested Reading articles found!
Copyright © Journal of Peking University (Health Sciences), All Rights Reserved.
Powered by Beijing Magtech Co. Ltd