Malatino Lorenzo, Cardella Antonella M, Puccia Giuseppe, Cilia Chiara, Terranova Valentina, Cataudella Emanuela, Buonacera Agata, Tripepi Giovanni, Di Marca Salvatore, Mastrosimone Gianluca, Pisano Marcella, Giordano Mauro, Stancanelli Benedetta
Department of Clinical and Experimental Medicine, Unit of Internal Medicine, c/o Ospedale Cannizzaro, Catania, Italy
Department of Clinical and Experimental Medicine, Unit of Internal Medicine, c/o Ospedale Cannizzaro, Catania, Italy.
Angiology. 2016 Mar;67(3):245-51. doi: 10.1177/0003319715586289. Epub 2015 May 19.
Shifting the context from the emergency department to the department of medicine, we compared different scores to diagnose deep vein thrombosis (DVT) in patients with several comorbidities, hospitalized in a department of internal medicine. We prospectively recruited 178 consecutive hospitalized patients in whom clinical suspicion of DVT was assessed by Wells modified score for DVT, Hamilton, Kahn, and St Andrè Hospital scores. Deep vein thrombosis was confirmed in 85 (48%) patients by both echocolor Doppler and angiocomputed tomography scan. The use of risk scores based on symptoms and clinical signs was weakly useful (area under the curve [AUC]: 0.69, positive predictive value: 59%, and negative predictive value: 74%). Patients with DVT had significantly (P < .0001) lower serum albumin and protein S levels compared to those without DVT. Moreover, serum protein S (AUC: 0.82) and albumin in percentage (AUC: 0.80) showed a better accuracy than clinical scores (P < .001) in assessing the diagnosis of DVT. Therefore, serum albumin and protein S improved the accuracy of clinical scores for the diagnosis of incident DVT in patients hospitalized in a department of medicine.
将背景从急诊科转移到内科，我们比较了不同评分在诊断内科住院的合并多种疾病患者深静脉血栓形成（DVT）中的作用。我们前瞻性地招募了178例连续住院患者，通过Wells DVT改良评分、汉密尔顿评分、卡恩评分和圣安德烈医院评分对其DVT临床疑似情况进行评估。85例（48%）患者经彩色多普勒超声和计算机断层血管造影扫描确诊为深静脉血栓形成。基于症状和临床体征的风险评分作用微弱（曲线下面积[AUC]：0.69，阳性预测值：59%，阴性预测值：74%）。与无DVT的患者相比，DVT患者的血清白蛋白和蛋白S水平显著更低（P <.0001）。此外，血清蛋白S（AUC：0.82）和白蛋白百分比（AUC：0.80）在评估DVT诊断时比临床评分具有更高的准确性（P <.001）。因此，血清白蛋白和蛋白S提高了内科住院患者新发DVT诊断临床评分的准确性。
