Accuracy of diagnostic indicators for perioperative venous thromboembolism in orthopedic patients / 中华创伤杂志

ABSTRACT

Objective:To analyze the accuracy of diagnostic indicators for perioperative venous thromboembolism（VTE）in orthopedic patients.Methods:A retrospective case-control study was conducted to analyze the clinical data of 109 patients who underwent initial total hip arthroplasty（THA），total knee arthroplasty（TKA）or proximal femoral nail antirotation（PFNA）in Hechuan District People ’s Hospital of Chongqing from January 2015 to September 2019. There were 55 males and 54 females，with age range of 18-76 years［（46.3 ± 11.2）years］. Of all，54 patients underwent unilateral THA due to femoral head necrosis and femoral neck fracture，36 patients underwent unilateral TKA due to osteoarthritis and 19 patients underwent PFNA due to proximal femoral fracture. VTE was confirmed in 47 patients（VTE group），and did not occur in 62 patients（non-VTE group）. Venous blood was collected from all patients on admission and at postoperative 1，3，5，7 days to measure levels of plasma D-dimer，serum interleukin（IL）-18 and vascular endothelial growth factor（VEGF）. The accuracy of the above indicators in VTE diagnosis was analyzed by using receiver operating characteristic（ROC）curve. Results:In both groups，preoperative levels of D-dimer，IL-18 and VEGF were significantly lower than those postoperatively，and each indicator showed significant difference at each time points after operation（ P < 0.05 or 0.01）. Moreover，levels of D-dimer，IL-18 and VEGF in VTE group were significantly higher than those in non-VTE group at each time after operation（ P < 0.05 or 0.01）. Area under the ROC curve（AUC）for D-dimer was 0.839（95% CI 0.729-0.887），with the optimal cut-off of 5.5 μg/ml，sensitivity of 87.0%，specificity of 79.0% and Youden index of 0.67. AUC for IL-18 was 0.817（95% CI 0.719-0.857），with the optimal cut-off of 293.5 pg/ml，sensitivity of 67.0%，specificity of 87.1% and Youden index of 0.457. AUC for VEGF was 0.837（95% CI 0.784-0.918），with the optimal cut-off of 510.8 pg/ml，sensitivity of 81.0%，specificity of 79.0% and Youden index of 0.583. AUC for combined D-dimer，IL-18 and VEGF was 0.870（95% CI 0.747-0.992），with the sensitivity of 87.2%，specificity of 83.4% and Youden index of 0.606. Conclusions:For diagnosis of perioperative VTE in orthopedic patients，serum VEGF is relatively accurate，while serum IL-18 has a low accuracy. However，the diagnostic rate of VTE can be improved by combining indicators of D-dimer，IL-18 and VEGF.