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Journal of Peking University (Health Sciences) ›› 2024, Vol. 56 ›› Issue (2): 279-283. doi: 10.19723/j.issn.1671-167X.2024.02.012

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Incidence and risk factors of deep vein thrombosis in patients with rheumatoid arthritis

Xiaofei TANG1,Yonghong LI2,Qiuling DING1,Zhuo SUN1,Yang ZHANG1,Yumei WANG1,Meiyi TIAN1,Jian LIU1,*()   

  1. 1. Department of Rheumatology and Immunology, Aerospace Center Hospital, Beijing 100049, China
    2. Department of Internal Medicine, Hebei Yixian People's Hospital, Yixian 074200, Hebei, China
  • Received:2022-06-27 Online:2024-04-18 Published:2024-04-10
  • Contact: Jian LIU E-mail:2120044180@qq.com

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Abstract:

Objective: To investigate the incidence and risk factors of deep vein thrombosis (DVT) in patients with rheumatoid arthritis (RA). Methods: The clinical data of RA patients who were hospi-talized in the Department of Rheumatology and Immunology of Aerospace Center Hospital from May 2015 to September 2021 was retrospectively analyzed, including demographic characteristics, concomitant diseases, laboratory examinations (blood routine, biochemistry, coagulation, inflammatory markers, rheumatoid factor, antiphospholipid antibodies and lupus anticoagulant, etc.) and treatment regimens. The patients were compared according to the presence or absence of DVT, and the t test, Mann-Whitney U test or Chi-square test were applied to screen for relevant factors for DVT, followed by Logistic regression analysis to determine risk factors for DVT in patients with RA. Results: The incidence of DVT in the RA patients was 9.6% (31/322); the median age of RA in DVT group was significantly older than that in non-DVT group [64 (54, 71) years vs. 50 (25, 75) years, P < 0.001]; the level of disease activity score using 28 joints (DAS28)-erythrocyte sedimentation rate (ESR) in DVT group was higher than that in non-DVT group [5.2 (4.5, 6.7) vs. 4.5(4.5, 5.0), P < 0.001]; the incidence of hypertension, chronic kidney disease, fracture or surgery history within 3 months, and varicose veins of the lower extremities in DVT group was higher than that in non-DVT group (P < 0.001). The levels of hemoglobin and albumin in DVT group were significantly lower than that in non-DVT group (P=0.009, P=0.004), while the D-dimer level and rheumatoid factor positive rate in DVT group were significantly higher than that in non-DVT group (P < 0.001). The use rate of glucocorticoid in DVT group was higher than that in non-DVT group (P=0.009). Logistic regression analysis showed that the age (OR=1.093, P < 0.001), chronic kidney disease (OR=7.955, P=0.005), fracture or surgery history within 3 months (OR=34.658, P=0.002), DAS28-ESR (OR=1.475, P=0.009), and the use of glucocorticoid (OR=5.916, P=0.003) were independent risk factors for DVT in RA patients. Conclusion: The incidence of DVT in hospitalized RA patients was significantly increased, in addition to traditional factors, such as age and chronic kidney disease, increased DAS28-ESR level and the use of glucocorticoid were also independent risk factors for DVT.

Key words: Rheumatoid arthritis, Venous thrombosis, Venous thromboembolism

CLC Number: 

  • R593.22

Table 1

Comparison of clinical data between RA patients with and without DVT"

Variables RA (n=322) RA with DVT (n=31) RA without DVT (n=291) P
Demographics
  Age/years 65 (55, 73) 64 (54, 71) 50 (25, 75) ＜0.001
  Female 263 (81.7) 25 (80.6) 238 (81.8) 0.876
  Duration/months 84 (24, 216) 156 (12, 240) 84 (24, 204) 0.304
  BMI/ (kg/m2) 23.4 (21.7, 24.8) 23.4 (19.5, 24.2) 23.4 (21.9, 24.8) 0.172
  Smoke 53 (16.5) 8 (25.8) 45 (15.5) 0.140
Complication
  Hypertension 129 (40.1) 22 (71.0) 107 (36.8) ＜0.001
  Diabetes 54 (16.8) 5 (16.1) 49 (16.8) 0.920
  CKD 14 (4.3) 6 (19.4) 8 (2.7) ＜0.001
  CHD 45 (14.0) 5 (16.1) 40 (13.7) 0.927
  Fracture or surgery 8 (2.5) 7 (22.6) 1 (0.3) ＜0.001
  Malignancy 13 (4.0) 2 (6.5) 11 (3.8) 0.812
  Varicose veins 7 (2.2) 3 (9.7) 4 (1.4) 0.022
  APS 3 (0.9) 3 (9.7) 0 ＜0.001
Laboratory data
  Hemoglobin/(g/L) 112.0 (100.0, 123.0) 98.0 (86.0, 118.0) 113.0 (102.0, 124.0) 0.003
  Albumin/(g/L) 35.6 (32.8, 38.3) 32.4 (30.1, 35.9) 35.6 (33.3, 38.5) ＜0.001
  D-dimer/(μg/L) 405.5 (181.8, 838.5) 831.0 (528.0, 1 731.0) 367.0 (167.0, 798.0) ＜0.001
  CRP/(mg/L) 15.1 (5.6, 41.1) 13.5 (5.5, 53.0) 15.3 (5.7, 40.5) 0.919
  ESR/(mm/h) 43.5 (22.0, 70.0) 51.0 (22.0, 90.0) 43.0 (22.0, 68.0) 0.256
  IgG/(mg/dL) 1 355.0 (1 087.5, 1 062.5) 1 340.0 (1 050.0, 1 490.0) 1 360.0 (1 110.0, 1 610.0) 0.548
  RF 255 (79.2) 29 (93.5) 226 (77.7) 0.038
  Anti-CCP 255 (79.2) 25 (80.6) 230 (79.0) 0.834
  ACA 24 (7.5) 3 (9.7) 21 (7.2) 0.892
  Anti-β2-GP1 22 (6.8) 4 (12.9) 18 (6.2) 0.301
  LAC 8 (2.5) 1 (3.2) 7 (2.4) 0.559
DAS28-ESR 4.5 (4.5, 5.8) 5.2 (4.5, 6.7) 4.5 (4.5, 5.0) 0.036
Therapy
  Glucocorticoid 149 (46.3) 25 (80.6) 124 (42.6) ＜0.001
  JAK inhibitors 11 (3.4) 0 11 (3.8) 0.561
  MTX 138 (42.9) 12 (18.7) 126 (43.3) 0.624
  LEF 112 (34.8) 13 (41.9) 99 (34.0) 0.379
  HCQ 47 (14.6) 4 (12.9) 43 (14.8) 0.989

Table 2

Risk factors of DVT in patients with RA"

Variables OR 95%CI P
Age 1.093 1.044，1.146 ＜0.001
CKD 7.955 1.854，34.131 0.005
Fracture or surgery 34.658 3.774，318.310 0.002
DAS28-ESR 1.475 1.104，1.972 0.009
Glucocorticoid 5.916 1.867，18.744 0.003
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