Padua预测评分在AECOPD住院患者VTE风险因素分析中的应用

目的应用Padua预测评分分析慢性阻塞性肺疾病急性加重期(AECOPD)住院患者VTE的危险因素,探讨对VTE筛选的价值。方法回顾性调查呼吸科198例次AECOPD住院患者,均做过VTE的影像学检查。选取其中合并VTE的患者65例作为VTE组,133例不存在VTE的住院患者为无VTE组,采用回顾性病例对照分析研究,统计相关危险因素,进行Padua预测评分,分析高危、低危(Padua评分≥4分、4分)与实际发生VTE的相关性。结果 Padua预测评分≥4分的患者有130例(65.65%),多元线性回归分析显示:高Padua得分的相关因素有6个,包括活动度降低≥3天、活动性肿瘤、激素治疗、高龄(≥70岁)、心/呼吸衰竭、急性感染,与性别无关;VTE组和无VTE组进行OR值(95%CI)分析提示高危级发生VTE的风险较高,具有统计学意义。结论 AECOPD患者存在较高的VTE风险,应用Padua评分可以有效地进行VTE危险评估,评估方法量化、方便,适用于临床。     

Autar与Padua风险评估模型在VTE患者的预防效果分析

目的探讨Autar与Padua风险评估模型在静脉血栓栓塞(VTE)的预防效果。方法选取我院2011年1月-2017年12月收治的320例神经内科、心内科、呼吸内科、肿瘤科、血液科等内科病区确诊为VTE者患者作为观察组,随机选取同期神经内科、心内科、呼吸内科、肿瘤科、血液科等内科病区未发生VTE的320例患者作为对照组。记录患者的临床资料,分别采用Padua风险评估模型和Autar风险评估模型对两组患者进行VTE风险评分。结果两组患者出血量、住院时间差异无统计学意义(P>0.05);观察组年龄、BMI与对照组相比差异显著,具有统计学意义(P<0.05)。Autar风险模型ROC曲线下面积、灵敏度和特异性为0.523、0.092和0.976,Pudua风险模型ROC曲线下面积、灵敏度和特异性为0.568、0.052和0.992。结论Pudua风险模型ROC曲线下面积高于Autar风险模型,更适用于评估和筛查静脉血栓栓塞高危患者。     

Padua评分联合D-dimer对呼吸内科住院患者VTE的风险评估价值研究

目的 探讨Padua评分联合D-dimer对呼吸内科住院患者静脉血栓栓塞症(VTE)的风险评估价值。方法 纳入179例高度疑似VTE的呼吸内科住院患者。以CTPA和/或V/Q或双下(上)肢加压静脉彩超的阳性结果作为确诊VTE的金标准,采集所有纳入患者的一般资料,包括性别、年龄、现病史、吸烟史、体重指数,均行Padua评分并收集D-dimer检测值,运用受试者工作特征曲线(ROC)分析比较Padua评分、D-dimer及二者联合对呼吸内科住院患者中VTE的风险评估价值。结果 179例呼吸内科高度疑似VTE住院患者中有83例确诊,确诊率为46.4%。一般资料中VTE组和非VTE组的Padua评分和D-dimer检测相比,差异有显著统计学意义(P<0.01)。Padua评分对其预测的ROC曲线下面积(AUC)为0.784[95%CI(0.710～0.858)],最佳临界值为3.5分,≥3.5分时灵敏度为69.9%,特异度为86.5%,Youden指数为0.563;D-dimer检测对其预测的AUC为0.898[95%CI(0.852～0.943)],最佳临界值为553μg/L,≥553...     

Padua评分联合D-二聚体对COVID-19患者发生静脉血栓栓塞症的预测价值研究

目的 Padua评分联合D-二聚体在预测新型冠状病毒感染(COVID-19)患者发生静脉血栓栓塞症(VTE)中的价值。方法 收集2022年12月—2023年2月于承德医学院附属医院内科住院的COVID-19患者441例，其中VTE组195例，无VTE组246例。分析两组患者基本资料，绘制Padua评分、D-二聚体以及两者联合时预测COVID-19患者发生VTE的受试者工作特征曲线(ROC曲线),并比较三种方法曲线下面积(AUC)。应用Logistic回归分析探讨Padua评分危险分层(Padua评分≥4分)和D-二聚体水平与VTE发生风险关系。结果 VTE组患者Padua评分和D-二聚体均高于无VTE组。Padua评分、D-二聚体预测COVID-19发生VTE的最佳截断值分别为4.5分和1.485μg/mL,约登指数为0.446和0.484,灵敏度为0.641和0.744,特异度为0.805和0.740,AUC为0.789和0.804,两者AUC比较差异无统计学意义(Z=0.512,P=0.609);COVID-19患者，其VTE发生风险随评分(Padua评分≥4分者)的升高而增加，随...     

非手术住院肺栓塞患者Padua量表特征分析

目的分析肺血栓栓塞症(PTE)患者Padua评分特征,完善肺栓塞临床风险评估。方法回顾性分析2012年1月1日～2018年6月30日在我院内科住院治疗的肺栓塞患者的临床资料,回顾性地对每位患者进行Padua血栓风险评估模型评分。Padua4分为低危组,Padua≥4分为高危组。结果本研究纳入肺血栓栓塞症159人,Padua评分平均值为(3.3±2.5),56.6%的患者为低危组,43.4%的患者是高危组。Padua评分项目活动性肿瘤、肥胖、正在性激素治疗,在低危组和高危组间无统计学差异。急性感染/风湿疾病和年龄满70岁,在低危组/高危组比例超过0.5。结论总体上,Padua评分用于识别非手术肺血栓栓塞症高危人群的价值有限。进一步研究活动性肿瘤、肥胖、急性感染/风湿疾病、年龄满70岁与PTE的关系,对提高Padua量表的预测准确性可能有一定价值。     

风险评估模型预测人工肝治疗肝衰竭患者发生静脉血栓栓塞症的价值分析

目的 探讨风险评估模型对人工肝治疗肝衰竭患者静脉血栓栓塞症(VTE)发生风险的预测价值。方法 回顾性选取2018年3月—2021年12月于南京大学医学院附属鼓楼医院行人工肝治疗的肝衰竭患者184例，其中并发VTE组患者41例，未并发VTE患者(对照组)143例。比较两组患者临床资料，并采用Caprini风险评估模型对两组患者进行评分及风险分级。计量资料两组间比较采用t检验；计数资料两组间比较采用χ²检验；等级资料两组间比较采用Mann-Whitney U秩和检验。采用Logistic回归分析人工肝治疗肝衰竭患者发生VTE的独立危险因素。采用受试者工作特征曲线(ROC曲线)分析Caprini量表评分、多因素预测模型及二者联合对VTE的预测价值。结果 并发VTE组患者Caprini量表评分为(4.39±1.10)分，明显高于对照组(3.12±1.04)分(t=6.805,P<0.001)。两组患者Caprini量表危险度分级存在明显差异(Z=-4.872,P<0.001),并发VTE的患者中，高危、极高危组占比更高。单因素分析结果显示，并发VTE组与对照组...     

四种常见风险评估模型对妇科恶性肿瘤患者术后静脉血栓栓塞症预测价值的对比研究

目的比较4种常见风险评估模型对妇科恶性肿瘤患者术后静脉血栓栓塞症(VTE)的预测价值。方法通过医院病案信息系统检索2009年3月—2017年10月首都医科大学附属北京妇产医院收治的术后2个月内发生VTE的妇科恶性肿瘤患者31例作为观察组,另按照1:2比例随机选取同期术后未发生VTE的妇科恶性肿瘤患者62例作为对照组。采用自行设计的一般资料登记表登记两组患者临床资料,分别采用Caprini、Wells、Padua、Autar风险评估模型对两组患者术前及术后情况进行VTE风险评分,并绘制受试者工作特征(ROC)曲线以评价4种常见风险评估模型对妇科恶性肿瘤患者术后VTE的预测价值。结果两组患者手术时间、术中出血量比较,差异无统计学意义(P0.05);两组患者年龄、体质指数(BMI)及肿瘤部位比较,差异有统计学意义(P0.05)。ROC曲线结果显示,术前Caprini、Wells、Padua、Autar风险评估模型评分预测妇科恶性肿瘤患者术后发生VTE的曲线下面积(AUC)分别为0.686、0.500、0.758、0.721;术后Caprini、Wells、Padua、Autar风险评估模型评分预测妇科恶性肿瘤患者术后发生VTE的AUC分别为0.788、0.839、0.690、0.721。结论术前采用Padua、Autar风险评估模型及术后采用Caprini、Wells、Autar风险评估模型对妇科恶性肿瘤患者术后发生VTE具有一定预测价值。     

CHA2DS2-VASc评分与非瓣膜性心房颤动并缺血性脑卒中患者预后的关系

目的:探讨非瓣膜病房颤卒中风险评分(CHA2DS2-VASc)与老年非瓣膜性心房颤动(NVAF)合并缺血性脑卒中(ICS)患者短期预后的关系。方法:入选我院2011年6月到2013年8月住院的206例老年NVAF合并ICS患者,应用CHA2DS2-VASc进行评分,分为低危组(24例,0分)、中危组(78例,1分)和高危组(104例,2~9分)。在发病后3个月时,采用改良Rankin量表(mRS)评定患者的预后,根据mRS得分将患者分为预后良好组(89例,0~2分)和预后不佳组(117例,3~6分)。分析患者3个月预后不佳的独立预测因素。结果:中危和高危组在年龄、高血压、糖尿病、心力衰竭、卒中、血管疾病史比例和美国国立卫生研究院卒中量表(NIHSS)评分显著高于低危组(P0.05或0.01)。与预后良好组比较,预后不佳组年龄[(72.81±7.68)岁比(81.56±8.03)岁]、高血压(58.4%比71.8%)、卒中史比例(9.0%比29.9%)、NIHSS评分[(2.97±1.42)分比(7.67±3.92)分]和CHA2DS2-VASc评分[(1.70±1.63)分比(4.03±2.53)分]显著升高,P0.05或0.01。多因素Logistic回归分析显示NIHSS评分(高危:OR=1.78,95%CI:1.27~2.56,P=0.001)、CHA2DS2-VASc评分(高危:OR=3.24,95%CI:1.32~6.98,P=0.001)和年龄(高危:OR=1.23,95%CI:1.07~1.54,P=0.01)是老年NVAF合并ICS患者3个月预后不佳的独立预测因素。结论:CHA2DS2-VASc评分与NVAF合并ICS早期病情改善有关,年龄、NIHSS评分和CHA2DS2-VASc评分是短期预后不佳的独立预测因素。     

Caprini风险评估模型对重症患者静脉血栓栓塞症的预测价值研究

目的回顾性验证Caprini风险评估模型在评估重症患者静脉血栓栓塞症(VTE)发病风险的有效性。方法采用病例对照研究设计,收集2012年10月至2017年10月于华北理工大学附属医院ICU中被确诊患有VTE的72例重症患者作为病例组,按照与病例组2:1的比例随机选择同时期的144例未患VTE的重症患者作为对照组,回顾性收集患者的一般情况、既往病史、治疗方式等临床资料,依据Caprini评估模型对患者进行评分及危险度分级,探讨不同危险度分级与患者VTE发病风险的关系,采用多因素Logistic回归分析重症患者发生VTE的主要风险因素。结果病例组Caprini评分(10.50±2.91)高于对照组(6.64±2.51),差异有统计学意义(P0.05)。病例组与对照组Caprini危险度分级的构成之间差异有统计学意义(P0.05),极高危患者发生VTE的风险为非极高危患者的17倍。回归分析显示下肢肿胀、恶性肿瘤(既往或现患)、需要卧床(3 d)、卒中(1个月)以及髋、骨盆或下肢骨折等5个因素是重症患者发生VTE的主要危险因素。结论 Caprini风险评估模型对重症患者VTE发病风险具有较好的预测性,值得在临床上推广应用。     

改良强制性诱导运动疗法对脑卒中偏瘫患者康复的疗效

目的:探讨改良强制性诱导运动疗法对脑卒中偏瘫患者康复的疗效。方法:选择136例脑卒中偏瘫患者,分为改良康复组和常规康复组,12周后比较两组上下肢运动功能评定量表Fugl-Meyer评分(FMA)、改良Barthel指数评分(MBI),Berg平衡量表评分(BBS)和6min步行距离(6MWD),并比较两组患者的心理状态和生活质量。结果:12周后两组FMA、MBI、BBS、6MWD均明显增加,焦虑自评量表(SAS)和抑郁自评量表(SDS)评分明显降低(P均0.05);与常规康复组比较,改良康复组FMA[(53.23±5.13)分比(60.67±5.67)分]、MBI[(57.83±6.11)分比(69.93±6.74)分]、BBS[(41.45±4.12)分比(50.53±4.56)分]、6MWD[(179.46±24.62)m比(211.34±26.71)m]增加更显著,SAS[(50.75±2.56)分比(41.11±1.53)分]和SDS[(51.34±3.35)分比(40.78±2.11)分]得分降低更显著(P均0.05);生活质量上,两组治疗后在生理、心理、社会、环境四个维度积分上均较康复前明显提高,且改良康复组提高更显著(P均0.05)。结论:改良强制性诱导运动疗法能显著改善脑卒中偏瘫患者的运动、平衡功能,改善患者抑郁和焦虑等情绪和日常生活能力。     

Venous thromboembolism prophylaxis-prescribing patterns among elderly medical patients in a Saudi tertiary care center: success or failure?

BackgroundHospitalized elderly patients are at high risk of venous thromboembolism (VTE), and the appropriate use of thromboprophylaxis can significantly reduce the incidence of VTE in high-risk patients. We investigated the pattern of VTE prophylaxis administration among elderly medical patients and assessed its appropriateness based on the American College of Chest Physicians (ACCP) recommendations.MethodsA cross-sectional single-center study was conducted between October 2019 and March 2020, including hospitalized (> 48 h), elderly (≥ 60 years), medical patients, and excluding patients receiving anticoagulant for other reason, having contraindication to thromboprophylaxis, or had VTE diagnosed within 48 h. The Padua prediction score was used to determine the patients'' risk for VTE, and thromboprophylaxis use was assessed against the ACCP recommendations.ResultsThe study included 396 patients with an average age of 75.0 ± 9.01 years, and most patients (71.7%) were classified as high risk for VTE development (Padua score ≥ 4 points). Thromboprophylaxis use was inappropriate in 27.3% of patients, of whom 85.2% were ineligible but still received thromboprophylaxis. Patients who were classified as low risk of VTE were more likely to receive inappropriate thromboprophylaxis (AOR = 76.5, 95% CI: 16.1-363.2), whereas patients with acute infection or rheumatologic disorder were less likely to receive inappropriate thromboprophylaxis (AOR = 0.46, 95% CI: 0.22-0.96).ConclusionsAlthough the use of thromboprophylaxis among high-risk elderly patients was reasonably adequate, a large proportion of low-risk patients were exposed to unnecessary risk through inappropriate overutilization of thromboprophylaxis. Thus, healthcare providers should accurately assess patients'' risk before prescribing thromboprophylaxis to ensure patient safety.     

Colectomy is a risk factor for venous thromboembolism in ulcerative colitis

AIM: To compare venous thromboembolism(VTE) in hospitalized ulcerative colitis(UC) patients who respond to medical management to patients requiring colectomy. METHODS: Population-based surveillance from 1997 to 2009 was used to identify all adults admitted to hospital for a flare of UC and those patients who underwent colectomy. All medical charts were reviewed to confirm the diagnosis and extract clinically relevant information. UC patients were stratified by:(1) responsive to inpatient medical therapy(n = 382);(2) medically refractory requiring emergent colectomy(n = 309); and(3) elective colectomy(n = 329). The primary outcome was the development of VTE during hospitalization or within 6 mo of discharge. Heparin prophylaxis to prevent VTE was assessed. Logistic regression analysis determined the effect of disease course(i.e., responsive to medical therapy, medically refractory, and elective colectomy) on VTE after adjusting for confounders including age, sex, smoking, disease activity, comorbidities, extent of disease, and IBD medications(i.e., corticosteroids, mesalamine, azathioprine, and infliximab). Point estimates were presented as odds ratios(OR) with 95%CI.RESULTS: The prevalence of VTE among patients with UC who responded to medical therapy was 1.3% and only 16% of these patients received heparinprophylaxis. In contrast, VTE was higher among patients who underwent an emergent(8.7%) and elective(4.9%) colectomy, despite greater than 90% of patients receiving postoperative heparin prophylaxis. The most common site of VTE was intra-abdominal(45.8%) followed by lower extremity(19.6%). VTE was diagnosed after discharge from hospital in 16.7% of cases. Elective(adjusted OR = 3.69; 95%CI: 1.30-10.44) and emergent colectomy(adjusted OR = 5.28; 95%CI: 1.93-14.45) were significant risk factors for VTE as compared to medically responsive UC patients. Furthermore, the odds of a VTE significantly increased across time(adjusted OR = 1.10; 95%CI: 1.01-1.20). Age, sex, comorbidities, disease extent, disease activity, smoking, corticosteroids, mesalamine, azathioprine, and infliximab were not independently associated with the development of VTE. CONCLUSION: VTE was associated with colectomy, particularly, among UC patients who failed medical management. VTE prophylaxis may not be sufficient to prevent VTE in patients undergoing colectomy.     

Venous thromboembolism risk stratification in medically-ill hospitalized cancer patients. A comprehensive cancer center experience

Cancer and its treatment are recognized risk factors for VTE. Compliance rate with published VTE prophylaxis guidelines is low. Decision on when to offer prophylaxis for hospitalized cancer patients is difficult to make. This paper describes current clinical practice in offering VTE prophylaxis to hospitalized cancer patients. Prophylaxis rate and rate of VTE will be correlated with the risk level. We prospectively followed all consecutive adult cancer patients admitted to medical units over a 5-month period. Caprini risk assessment model, with some modifications, was utilized to determine risk of VTE. Six hundred and six patients (51% males, median age 52 years, range 18–91) were included. Reasons for admission included infections (25%), chemotherapy (22%) and palliative care (10%). In addition to cancer, the most frequently encountered risk factors for VTE were: Immobilization (35%), age > 60 years (31%) and body mass index > 30 in (20%). Patients were grouped according to their total risk score: low (9%), moderate (44%) and high risk (47%). VTE prophylaxis rate was 55.1% for the whole study group. Following discharge, patients were followed for 60 days. The incidence of VTE was 3.4% in the moderate and 4.2% in the high risk groups, while none in the low risk group developed VTE. Many additional risk factors for VTE are usually encountered in hospitalized cancer patients. Cancer alone may not be an enough reason for VTE prophylaxis. Risk assessment model able to stratify patients into different risk categories will simplify decision making and enhance VTE prophylaxis rate.     

An evaluation of venous thromboembolic risk in acutely ill medical patients immobilized at home: the AT-HOME Study.

Many risk factors for venous thromboembolism (VTE) in hospitalized medical patients are also present in medical outpatients. VTE prevention represents an important challenge for physicians treating patients at home. The AT-HOME study was a prospective cross-sectional observational study designed to assess awareness of the risk of VTE in immobilized acutely ill medical outpatients among German physicians, many of whom were participating in a national Continuing Medical Education (CME) program designed to raise awareness of VTE. The study involved 1210 medical patients who were acutely confined to bed at home. Physicians performed a subjective assessment of VTE risk, which was rated on a 10-point scale (1 = very low risk; 10 = very high risk). The risk of VTE was also assessed retrospectively by using a scorecard developed for use in hospitalized medical patients. Of the 1210 patients, 198 (16%) had risk scores of 0-4, 319 (26%) had scores of 5 or 6, and 693 (57%) had scores > or =7. Overall, 966 patients (80%) received thromboprophylaxis. The proportion of patients receiving thromboprophylaxis was 0% to 47% in risk score groups 0-4, 76% to 85% in groups 5 and 6, and 90% to 100% in risk score groups 7-10. In the retrospective assessment of VTE risk, 74% of patients were at high risk, 15% were at intermediate risk, and 11% were at low risk. The proportions of patients receiving thromboprophylaxis in these groups were 87%, 61%, and 55%, respectively. The involvement of physicians in educational activities focusing on VTE awareness appeared to create awareness of the risks of VTE in acutely ill medical outpatients.     

Risk assessment model for venothromboembolism in post-hospitalized patients.

AIM: Venothromboembolism (VTE) is an important condition in hospitalized patients accounting for significant morbidity and mortality, and the risk of VTE often continues post-hospitalization. Although risk assessment models have been developed to predict the risk of deep venous thrombosis (DVT) in hospitalized patients, no models have been developed that determine the risk of DVT during the post-hospitalization period. The objective of this study was to create a risk profile using risk factor assessment that could be used to predict which patients are at highest risk of developing DVT within 60 days following hospital discharge. METHODS: The computerized medical records of 380 patients (190 with DVT and 190 without DVT) who received care from 1995-2002 and were subsequently re-hospitalized within 60 days of discharge were retrospectively reviewed. Univariate and multivariate logistic regression analyses were conducted to identify risk variables related to VTE. A novel risk assessment model was created using risk factors from the logistic regression analyses. RESULTS: The prevalence of VTE was found to be 93.2% (69/74) in the high-risk category, 52.9% (109/206) in the moderate-risk category, and 12% (12/100) in the low-risk category. CONCLUSIONS: Once validated, this risk assessment model may be applied to identify patients who may be at increased risk of developing VTE post-hospitalization. Those at high risk should be considered for anticoagulation therapy during the post-hospitalization period. Availability of a risk profile using risk factor assessment to guide decisions related to anticoagulation therapy will have important ramifications relative to patient outcomes including morbidity, mortality, and reductions in VTE-associated cost.     

Derivation and validation of a simple model to identify venous thromboembolism risk in medical patients

Background

Fewer than half of eligible hospitalized medical patients receive appropriate venous thromboembolism (VTE) prophylaxis. One reason for this low rate is the complexity of existing risk assessment models. A simple set of easily identifiable risk factors that are highly predictive of VTE among hospitalized medical patients may enhance appropriate thromboprophylaxis.

Methods

Electronic medical record interrogation was performed to identify medical admissions from January 1, 2000-December 31, 2007 (n = 143,000), and those patients with objectively confirmed VTE during hospitalization or within 90 days following discharge. Putative risk factors most predictive of VTE were identified, and a risk assessment model (RAM) was derived; 46,000 medicine admissions from January 1, 2008-December 31, 2009 served as a validation cohort to test the predictive ability of the RAM. The newly derived RAM was compared with a published VTE assessment tool (Kucher Score).

Results

Four risk factors: previous VTE; an order for bed rest; peripherally inserted central venous catheterization line; and a cancer diagnosis, were the minimal set most predictive of hospital-associated VTE (area under the receiver operating characteristic curve [AUC] = 0.874; 95% confidence interval [CI], 0.869-0.880). These risk factors upon validation in a separate population (validation cohort) retained an AUC = 0.843; 95% CI, 0.833-0.852. The ability of the 4-element RAM to identify patients at risk of developing VTE within 90 days was superior to the Kucher Score.

Conclusions

The 4-element RAM identified in this study may be used to identify patients at risk for VTE and improve rates of thromboprophylaxis. This simple and accurate RAM is an alternative to more complicated published VTE risk assessment tools that currently exist.     

Risk assessment of venous thromboembolism and bleeding in COVID‐19 patients

BackgroundThe coronavirus disease 2019 (COVID‐19) is a newly recognized illness that has spread rapidly all over the world. More and more reports highlight the risk of venous thromboembolism (VTE) in COVID‐19. Our study aims to identify in‐hospital VTE risk and bleeding risk in COVID‐19 patients.MethodsWe retrospectively studied 138 consecutively enrolled patients with COVID‐19 and identified in‐hospital VTE and bleeding risk by Padua Prediction Score and Improve bleed risk assessment model. The clinical data and features were analyzed in VTE patients.ResultsOur findings identified that 23 (16.7%) patients with COVID‐19 were at high risk for VTE according to Padua prediction score and 9 (6.5%) patients were at high risk of bleeding for VTE prophylaxis according to Improve prediction score. Fifteen critically ill patients faced double high risk from thrombosis (Padua score more than 4 points in all 15 [100%] patients) and hemorrhage (Improve score more than 7 points in 9 [60.0%] patients). Thrombotic events were identified in four patients (2.9%) of all COVID‐19 patients. All of them were diagnosed with deep vein thrombosis by ultrasound 3 to 18 days after admission. Three (75.0%) were critically ill patients, which means that the incidence of VTE among critically ill patients was 20%. One major hemorrhage happened in critically ill patients during VTE treatment.ConclusionCritically ill patients with COVID‐19 suffered both a high risk of thrombosis and bleeding risks. More effective VTE prevention strategies based on an individual assessment of bleeding risks were necessary for critically ill patients with COVID‐19.     

External validation of the IMPROVE-DD risk assessment model for venous thromboembolism among inpatients with COVID-19

There is a need to discriminate which COVID-19 inpatients are at higher risk for venous thromboembolism (VTE) to inform prophylaxis strategies. The IMPROVE-DD VTE risk assessment model (RAM) has previously demonstrated good discrimination in non-COVID populations. We aimed to externally validate the IMPROVE-DD VTE RAM in medical patients hospitalized with COVID-19. This retrospective cohort study evaluated the IMPROVE-DD VTE RAM in adult patients with COVID-19 admitted to one of thirteen Northwell Health hospitals in the New York metropolitan area between March 1, 2020 and April 27, 2020. VTE was defined as new-onset symptomatic deep venous thrombosis or pulmonary embolism. To assess the predictive value of the RAM, the receiver operating characteristic (ROC) curve was plotted and the area under the curve (AUC) was calculated. Sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) were calculated. Of 9407 patients who met study criteria, 274 patients developed VTE with a prevalence of 2.91%. The VTE rate was 0.41% for IMPROVE-DD score 0–1 (low risk), 1.21% for score 2–3 (moderate risk), and 5.30% for score?≥?4 (high risk). Approximately 45.7% of patients were classified as high VTE risk, 33.3% moderate risk, and 21.0% low risk. Discrimination of low versus moderate-high VTE risk demonstrated sensitivity 0.971, specificity 0.215, PPV 0.036, and NPV 0.996. ROC AUC was 0.703. In this external validation study, the IMPROVE-DD VTE RAM demonstrated very good discrimination to identify hospitalized COVID-19 patients at low, moderate, and high VTE risk.

     

Inverse relationship of serum albumin to the risk of venous thromboembolism among acutely ill hospitalized patients: Analysis from the APEX trial

Hypoalbuminemia is a common finding and independent predictor for unfavorable prognosis. The prognostic value of albumin measurement for short-term VTE prediction in hospitalized patients remains unclear. In the APEX trial ( ClinicalTrials.gov identifier: NCT01583218), medical inpatients were randomized to receive either extended-duration betrixaban or shorter-duration enoxaparin and followed for 77 days. Baseline albumin concentrations were obtained in 7266 subjects with evaluable VTE endpoints. The association of baseline albumin to VTE was assessed, with adjustment for patient characteristics, thromboprophylaxis, and biomarkers for fibrinolysis and inflammation (ie, D-dimer and C-reactive protein [CRP]). VTE risk refinement was evaluated by incorporation of albumin to well-validated risk assessment models. A stepwise increase in the risk of VTE (P < .0001) was observed with lower levels of albumin. Patients at the bottom albumin quartile (<35 g/L) had a two-fold greater odds for developing VTE compared with the top quartile (≥42 g/L) (OR = 2.119 [95% CI, 1.592-2.820]; adjusted OR = 2.079 [1.485-2.911]). The odds for VTE increased by 1.368 (95% CI, 1.240-1.509) times per SD decrement of albumin (5.24 g/L). Compared with the propensity score-matched pairs of patients with albumin ≥35 g/L, patients with albumin <35 g/L had a greater risk of VTE (OR = 1.623 [1.260-2.090]; adjusted OR = 1.658 [1.209-2.272]). Albumin measurement also refined VTE risk discrimination and reclassification after inclusion in the risk assessment models. In conclusion, acutely ill hospitalized patients with low serum albumin had an increased VTE risk through 77 days. VTE risk assessment models for medical inpatients should consider incorporation of baseline albumin measurement.