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Objective:To assess the risk of venous thromboembolism (VTE) and anticoagulation-related bleeding of acute critical emergency patients staying in the emergency department at least 72 h, so as to improve the ability of emergency physicians to identify risk factors of VTE and their awareness of safety prevention in these patients.Methods:Multicenter emergency internal medicine patients meeting the inclusion criteria at the same time were collected. Padua and Caprini scores were used to evaluate the risk of VTE and the HAS-BLED score was used to assess the risk of anticoagulation-related bleeding.Results:A total of 930 emergency patients from 7 medical centers were enrolled in our study from January 15, 2021 to March 15, 2021. The proportion of high-risk population with VTE was 50.22% with Padua score and 78.49% with Caprini score, respectively. The proportion of high-risk bleeding (HAS-BLED score) was 40.43%.Conclusions:More than half of the acute critical ill patients who stay in emergency department for more than 72 h are at high risk of VTE. This group of patients have a relatively low risk of anticoagulation-related bleeding.
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Objective:To explore the characteristics of the changes in risk score for intensive care unit (ICU) patients during hospitalization by the intelligent calculation method, and to provide evidence for the risk prevention.Methods:In this retrospective study, ICU patients of the Fifth Central Hospital in Tianjin from November 3, 2021 to March 28, 2022 were enrolled and divided into ≥ 14 days group, 10-13 days group, 7-9 days group, and 3-6 days group according to the ICU length of stay. Risk scores assessed by the intelligent calculation method of the ICU patients were collected, including nutritional risk screening 2002 (NRS 2002), Caprini score and Padua score. NRS 2002 score for all patients, Caprini score for surgical patients and Padua score for internal medicine patients were selected. Trends in change of each score were compared between patients admitted to ICU 1, 3, 7 (if necessary), 10 (if necessary), and 14 days (if necessary).Results:A total of 138 patients were involved, including 79 males and 59 females, with an average age of (61.71±18.86) years and an average hospital stay of [6.00 (4.00, 9.25)] days. ① in the group with ICU length of stay ≥ 14 days (21 cases): there was no significant change in the NRS 2002 scores of the patients within 10 days, but the NRS 2002 score was significantly decreased in 14 days as compared with 1 day [3.00 (2.50, 3.50) vs. 4.00 (3.00, 5.00), P < 0.05]; both Caprini and Padua score were increased with prolonged hospital stay and compared with 1 day, the scores at the other time points were significantly increased, especially at 14 days [Caprini score: 5.00 (3.25, 7.00) vs. 2.50 (1.25, 5.50), Padua score: 6.00 (6.00, 7.00) vs. 3.00 (1.00, 3.00), both P < 0.05].② in the group with ICU length of stay from 10-13 days (15 cases): with the prolonged hospital stay, there was no significant change in NRS 2002 score, but both Caprini and Padua score were increased at 3, 7, 10 days, especially at 10 days [Caprini score: 3.00 (2.00, 4.75) vs. 2.00 (0.25, 2.75), Padua score: 5.00 (3.50, 6.00) vs. 2.00 (0.50, 4.00), both P < 0.05].③ in the group with ICU length of stay from 7-9 days (23 cases): compared with 1 day, the NRS 2002 score at 3 days and7 days were decreased, but the Caprini and Padua score were increased, especially at 7 days [NRS 2002 score: 2.00 (1.00, 4.00) vs. 2.00 (2.00, 4.00), Caprini score: 3.00 (2.00, 5.50) vs. 2.00 (0.25, 3.00), Padua score: 5.00 (4.00, 6.00) vs. 2.00 (0, 2.00), all P < 0.05]. ④ in the group with ICU length of stay from 3-6 days (79 cases): compared with 1 day, the NRS 2002 score at 3 days was decreased [NRS 2002 score: 2.00 (1.00, 3.00) vs. 2.00 (1.00, 3.00), P < 0.05], Caprini and Padua score were significantly increased [Caprini score: 3.00 (2.00, 4.00) vs. 2.00 (1.00, 3.00), Padua score: 5.00 (4.00, 5.00) vs. 2.00 (1.00, 3.00), both P < 0.05]. Conclusion:Based on dynamic assessment of intelligent calculation methods, the risk of thrombosis in ICU patients increased with hospital length of stay, and the nutritional risk was generally flat or reducing in different hospitalization periods.
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Objective:To seek indicators or models for predicting the risk of deep vein thrombosis (DVT) after traumatic lower extremity fractures.Methods:A nested case-control study was conducted on 424 patients with traumatic lower extremity fractures in Beijing Jishuitan Hospital from May 2019 to December 2019. Patients with traumatic lower extremity fractures of the hip, femoral shaft, distal femoral, patella, tibial plateau, tibiofibular shaft, ankle or foot were 18 or older. Trauma patients were examined by venogram before surgery. 56 of 424 patients with traumatic lower limb fractures were diagnosed with preoperative DVT. Then, those with no evidence of DVT were paired by age, gender and fracture sites to those with DVT. Laboratory parameters included conventional coagulation tests and thrombotic biomarkers, such as D-dimer, plasmin-ɑ2-plasmin inhibitor complex (PIC), tissue plasminogen activator-plasminogen activator inhibitor complex (tPAIC), and Caprini score was calculated. Univariate analysis was used to distinguish statistically significant variables between trauma patients with and without DVT. Then logistic regression analysis was applied to identify independent risk factors for post-traumatic DVT. The receiver-operating characteristic (ROC) curve analysis was employed to assess the efficacy of indicators in predicting the risk of DVT after traumatic lower extremity fractures.Results:The levels of tPAIC and Caprini score in patients with DVT after traumatic lower limb fractures were significantly higher than those in non-DVT patients ( P values of 0.036 and 0.016, respectively). D-dimer, PIC, and Caprini score were independent risk factors for preoperative DVT after traumatic lower limb fractures. Thus, we defined the Predicting Index as 0.098×D-dimer (mg/L FEU)+(-0.564) ×PIC (μg/ml)+0.233×Caprini score, and found that the area under the ROC curve for the Predicting Index was 0.721. Conclusions:Predicting Index, calculated by D-dimer, PIC and Caprini score, can comprehensively encompass the changes of risk factors between patients with and without DVT after traumatic lower limb fractures, and can well predict the risk of DVT after traumatic lower extremity fractures.
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BACKGROUND@#The previous study has indicated that the incidence of venous thromboembolism (VTE) after thoracic surgery is high. The purpose of this study was to analyze the incidence and risk factors of postoperative VTE in thymic malignancy patients.@*METHODS@#This was a single-center study. Patients undergoing resection for thymic malignancy between December 2017 and February 2021 in Department of Thoracic Surgery, Beijing Tongren Hospital Affiliated to Capital Medical University were enrolled in this study. In addition to the routine examination, all patients were screened for deep venous thrombosis (DVT) by using noninvasive duplex lower extremity ultrasound before and after surgery. Patients did not receive any prophylactic anticoagulant therapy before and after surgery. All patients received modified caprini risk assessment. According to whether VTE occurred after operation, patients were divided into VTE group and control group. The clinical data of the two groups were compared. The occurrence time and possible high risk factors of VTE after operation were analyzed.@*RESULTS@#A total of 169 patients with thymic malignant tumor were enrolled, including 94 males and 75 females, aging from 22 to 76 years. A total of 95 patients underwent thoracoscopic surgery and 74 patients underwent median sternotomy. The total incidence of VTE was 12.4%. The median time for diagnosis of VTE was 4 days (2 days-15 days) after operation. According to the modified caprini score, the incidence of VTE in low risk patients (Caprini score≤4 points), moderate risk patients (Caprini score 5 to 8 points) and high risk patients (Caprini score≥9 points) were 0% (0/7), 7.0% (8/115) and 27.7% (13/47), respectively (Z=1.670, P=0.008). Univariate analysis showed that there were significant differences between VTE group and control group in age, operation method, operation time, indwelling central venous catheter, postoperative bed rest time more than 72 hours (P<0.05). Multivariate analysis showed that over 60 years old, operation method and operation time were independent risk factors for VTE after resection for thymic malignancies.@*CONCLUSIONS@#Over 60 years old, operation method and operation time are independent risk factors for VTE. Modified caprini assessment can effectively screen high-risk patients.
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Objective To investigate the changes of Caprini score, plasma D-D and FIB levels in patients with post-fracture DVT and its diagnostic significance.Methods Sixty patients with post-fracture DVT (DVT group) and 120 patients without DVT after fracture were selected (control group).The Caprini score, plasma D-D and FIB levels were compared between the two groups.The relationship between Caprini score and plasma D-D and FIB in the DVT group was analyzed.Results The Caprini score, D-D and FIB levels in the DVT group[7.26±1.88, (3.31±1.52) mg/L, (4.48±0.72) g/L] were significantly higher than those in the control group[3.39±0.80, (0.46±0.11) mg/L, (3.60±0.68) g/L], and the difference was statistically significant (P＜0.05).There was a significant positive correlation between Caprini score and D-D and FIB levels in patients with DVT (P＜0.05).There was a positive correlation between Caprini score and level of D-D and FIB (r=0.748、r=0.662, P＜0.05).The sensitivity of Caprini score combined with D-D and FIB levels in the diagnosis of DVT in fracture patients was 97.83％, specificity was 92.00％, missed diagnosis rate was 2.17％, misdiagnosis rate was 8.00, and area under ROC curve was 0.947 (P＜0.05).Conclusion Caprini score, D-D and FIB levels in patients with lower limb fracture have certain clinical value for the diagnosis of DVT.
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Objective@#To assess the value of D-dimer for monitoring venous thromboembolism risk in hospitalized non-surgical cancer patients within 15 days. @*Methods@#A total of 397 non-surgical cancer patients from January 2018 to December 2018 were enrolled, including 236 males and 161 females in the age of (56±18) years. According to Caprini Thrombosis Risk Scale, the patients were divided into 2 groups: the intermediate-risk group (171 patients, 3 to 4 points) and the high-risk group (226 patients, ≥5 points). The plasma levels of D-dimer were determined by using the Biomerieux Mini Vidas Automated Immunoassay Analyzer and VADIS D-Dimer Exclusion. The enrolled patients were followed up for 15 days with the endpoint event of VTE. The experimental data were expressed by M (P 25 , P 75 ). The Mann-Whitney U test was used to compare the data between the two groups. The Kaplan-Meier curve was used to implement the survival analysis. P＜0.05 was considered as statistically significance. Receiver operating characteristic curve (ROC) was used to evaluate the diagnostic performance of D-dimer. @*Results@#The plasma level of D-dimer in the high-risk group were significantly higher than that in the intermediate risk group (U=13 306, P＜0.001). There was no significant difference for the incidence of VTE between the two groups (χ 2 =1.85, P＞0.05). When the cut-off point value of D-dimer was defined as 1 579 ng/mL, the sensitivity of VTE risk prediction in cancer patients within 15 days was 69.0%, the specificity was 57.1% and the area under the ROC curve was 0.694 (95% CI: 0.613-0.774). There were significant differences in Caprini scores between the patients with D-dimer ≤1 579 ng/mL and D-dimer＞1 579 ng/mL (U=16 104，P=0.002). There was no statistical difference for the incidence of VTE between the two groups (χ 2 =7.36, P＞0.05). Among all of the patients, the patients with D-dimer＞1 579 ng/mL showed significantly higher cumulative probability of VTE within 15 days, compared with patients with D-dimer≤1 579 ng/mL (Log-rank χ 2 =7.729, P=0.005). In the intermediate-risk group, the cumulative probability of VTE of the patients whose D-dimer plasma level above the cut-off point value within 15 days was significantly higher than that of the patients with D-dimer plasma level below the cut-off point value (Log-rank χ 2 =7.156，P=0.007). In the high-risk group, there was no significant difference in the cumulative probability of VTE between the patients with D-dimer plasma level above the cut-off point value and the patients below the cut-off point value (Log-rank χ 2 =2.009，P=0.156). @*Conclusion@#According to the Caprini rating scale or D-dimer cut-off point value (1 579 ng/mL), cancer patients could be divided into two groups: VTE intermediate-risk and VTE high-risk. There were no significant differences in the two groups for the incidence of VTE within 15 days. However, the cumulative probability of VTE was significantly increased in total patients of both groups monitored by D-dimer, and the VTE cumulative probability in intermediate-risk group patients was increased.