ABSTRACT
Objective:To analyze the risk factors associated with hemorrhagic complications at the puncture site after femoral artery access cerebrovascular interventions and construct a bleeding risk scale.Methods:Two hundred and fifteen patients who underwent femoral artery puncture interventions in the neurointerventional department ward of the First Affiliated Hospital of Zhengzhou University from April to October 2020 were selected for the study, including 60 cases in the complication group and 155 cases in the control group. The patients′ general data, interventional procedure-related data and laboratory tests were analyzed univariately and then incorporated into a binary multi-factor logistic regression analysis to determine independent risk factors, and a bleeding risk scale was constructed according to the regression model.Results:Compared with the control group, there was a statistically significant increase in the incidence of women, diabetes mellitus, use of glucose-lowering drugs, proportion of (anticoagulant/antiplatelet drugs) use and irritability in the complication group ( χ2 values were 4.94-15.81, all P<0.05); age, BMI, HbA1c, prothrombin time activity, and sheath size and operative time were higher than those of the control group, and prothrombin time and creatinine values were lower than those of the control group, with statistically significant differences ( t values of -6.25 to 2.80, respectively, all P<0.05). Multifactorial logistic regression analysis showed that gender ( OR=0.09, 95% CI 0.025-0.302), BMI ( OR=1.736, 95% CI 1.462-2.115), HbA1c ( OR=1.775, 95% CI 1.107-2.845), and use of anticoagulant/antiplatelet drugs ( OR= 0.082, 95% CI 0.015- 0.448) and time to surgery ( OR=1.031, 95% CI 1.012-1.052) were independent risk factors for bleeding complications. In the risk scale: the total score was -3 to 13, and risk existed for a score ≥5. The sensitivity of this scale was 83.3%, the specificity was 92.3%, and the area under the ROC curve was 0.878 ( P<0.001, 95% CI 0.818 to 0.938). Conclusions:Female, high BMI, high HbA1c, anticoagulant/antiplatelet drug use, and long procedure time can increase the risk of bleeding complications at the femoral artery puncture. The predictive model has good predictive performance and can be extended for use.
ABSTRACT
Objective We aimed to assess effectiveness of Risk Score Scale (RSS) for aortic Dissection (AD) in early triage stage.Methods A total of 251 patients with acute chest or back pain complaints were allocated by triage nurses according to the pre-established RSS from 2011 to 2013.87 cases were assessed to have 5 points or more,and 80 cases were assessed to have 6 points or more from 95 patients diagnosed as aortic dissection (the diagnosed group) by CT angiography and magnetic resonance imaging while excluded 156 cases of control after discharge (control group).The general conditions,distribution of aortic dissection risk factors,aortic dissection risk score,sensitivity and specificity of RSS between two groups were compared.The misdiagnosis rate,missed diagnosis rate,RSS triage sensitivity and specificity and OR value were compared between RSS ≥5 points and RSS ≥6 points.Results There was significant differences in abrupt onset of severe pain intensity,ripping or tearing pain,pulse deficit or systolic blood pressure differential between extremities [upper extremity≥20 mmHg (1 mmHg=0.133 kPa) or lower extremity≥ 10 mmHg],x2 value was 62.6,94.2 and 20.2.RSS≥5 points had high sensitivity and specificity,lower missed diagnosis rate and high OR value for triage application.Conclusion RSS≥5 points could serve as a reliable evidence for early triage of aortic dissection.