Takahashi Paul Y, Chandra Anupam, Cha Stephen S, Crane Sarah J
Mayo Clinic College of Medicine, Rochester, Minnesota 55905, USA.
Ostomy Wound Manage. 2010 Apr 1;56(4):60-6.
Although venous leg ulcers (VLU) are a common health concern for many older adults, knowledge about common risk factors and optimal screening methods remains limited. To determine risk factors and develop a predictive model for future venous ulceration, a retrospective cohort study of clinical outpatients >60 years old in a primary care panel in Olmsted County, MN (N = 12,650) was conducted. The primary outcome was a new diagnosis of VLU within 2 years of the study date (January 1, 2005). Risk factors included demographic and comorbid health risk factors. The average age of study participants was 72.7 years (SD 8.9) and the incidence of VLU was 1.7% - 8.6 cases per 1,000 patient-years. The most significant risk factor was a history of venous ulceration (OR 19.4; 95% CI 14.5-25.9). In the final multivariate logistic regression model, a history of venous ulceration (OR 18.66; CI 13.96-24.96, P < .0001), renal insufficiency (OR 2.24; 95% CI 1.60-3.15, P <.0001), cataracts (OR 1.64; CI 1.16-2.33, P = 0.01), blindness (OR 2.53; 95% CI 1.05-6.11, P = 0.04), and pressure ulceration (OR 2.36; 95% CI 1.26-4.45, P = 0.01) remained significant as risk factors for VLU. Using the odds ratios from the predictors in the final multivariable mode, a scoring model for the entire cohort was created and a scoring model for each subject was run for the final model. The area under the receiver operator curve was 0.797 with a cutoff score of 3. Prior venous ulceration remains the most important risk factor for future venous ulceration. Further study and application of the risk assessment model to substantiate its clinical value are warranted.
尽管下肢静脉溃疡（VLU）是许多老年人常见的健康问题，但关于常见风险因素和最佳筛查方法的知识仍然有限。为了确定风险因素并建立未来静脉溃疡的预测模型，对明尼苏达州奥尔姆斯特德县初级保健小组中年龄大于60岁的临床门诊患者进行了一项回顾性队列研究（N = 12,650）。主要结局是在研究日期（2005年1月1日）后2年内新诊断的VLU。风险因素包括人口统计学和合并症健康风险因素。研究参与者的平均年龄为72.7岁（标准差8.9），VLU的发病率为每1000患者年1.7% - 8.6例。最显著的风险因素是静脉溃疡病史（比值比19.4；95%置信区间14.5 - 25.9）。在最终的多变量逻辑回归模型中，静脉溃疡病史（比值比18.66；置信区间13.96 - 24.96，P <.0001）、肾功能不全（比值比2.24；95%置信区间1.60 - 3.15，P <.0001）、白内障（比值比1.64；置信区间1.16 - 2.33，P = 0.01）、失明（比值比2.53；95%置信区间1.05 - 6.11，P = 0.04）和压疮（比值比2.36；95%置信区间1.26 - 4.45，P = 0.01）作为VLU的风险因素仍然显著。使用最终多变量模型中预测因子的比值比，为整个队列创建了一个评分模型，并为每个受试者运行最终模型的评分模型。受试者操作曲线下面积为0.797，临界评分为3分。既往静脉溃疡仍然是未来静脉溃疡最重要的风险因素。有必要进一步研究和应用风险评估模型以证实其临床价值。
