性别有影响吗？对筛查创伤患者静脉血栓栓塞风险的影响
Does sex matter? Effects on venous thromboembolism risk in screened trauma patients.
作者信息
Berndtson Allison E, Costantini Todd W, Smith Alan M, Kobayashi Leslie, Coimbra Raul
机构信息
From the University of California, San Diego, Division of Trauma, Surgical Critical Care, Burns and Acute Care Surgery (A.E.B., T.W.C., A.M.S., L.K., R.C.).
出版信息
J Trauma Acute Care Surg. 2016 Sep;81(3):493-9. doi: 10.1097/TA.0000000000001157.
BACKGROUND
Sex is associated with disparate risk of venous thromboembolism (VTE) in nontrauma patients, with increased risk seen during pregnancy and in women on hormone-containing medications. Sex effects on VTE after trauma are unclear. Some studies have demonstrated no effect whereas others have instead shown a higher incidence of VTE among men. We hypothesized that male sex would increase the risk of VTE across all age groups in trauma patients undergoing standardized duplex screening.
METHODS
All admissions to a Level I academic trauma center 2000 to 2014 were reviewed. We excluded patients for age <18 years, pregnancy, pre-admission anticoagulant use, and hospital length of stay (LOS) <72 hours. A strict venous duplex screening protocol was followed. Female patients were subcategorized into pre- and post-menopausal groups based on age (18-44 vs. ≥ 55 years). Bivariate analysis and logistic regression were used to identify variables correlating with VTE risk.
RESULTS
A total of 8,726 patients met inclusion criteria. The overall VTE rate was 5.3%. Bivariate analysis did not find a difference in VTE risk by sex (5.1% women vs. 5.4% men, p = 0.565), or between women and men within age-defined menopausal categories (pre-menopausal women 3.9% vs. men 4.7%, p = 0.293; post-menopausal women 5.9% vs. men 7.0%, p = 0.22). Logistic regression (see figure) did identify other risk factors for VTE including age ≥55 (adjusted odds ratio [AOR] 2.0), increasing ISS (AOR 1.5-2.1), penetrating mechanism of injury (AOR 2.2), lower extremity injury (AOR 1.7), need for mechanical ventilation (AOR 2.1), and increasing hospital length of stay (LOS 7-28 days, AOR 3.8; LOS > 28 days, AOR 9.1).
CONCLUSION
There was no difference in VTE rates based on patient sex, even after controlling for menopausal status. Aggressive VTE screening of over 8,700 patients did identify several other patient populations at increased risk of developing VTE. More intensive VTE prophylaxis may be appropriate in these patients.
LEVEL OF EVIDENCE
Epidemiologic study, level III; therapeutic study, level V.
背景
在非创伤患者中，性别与静脉血栓栓塞症（VTE）的不同风险相关，在怀孕期间以及使用含激素药物的女性中风险增加。创伤后性别对VTE的影响尚不清楚。一些研究表明没有影响，而另一些研究则显示男性VTE的发病率更高。我们假设在接受标准化双功超声筛查的创伤患者中，男性会增加所有年龄组VTE的风险。
方法
回顾了2000年至2014年一家一级学术创伤中心的所有入院患者。我们排除了年龄<18岁、怀孕、入院前使用抗凝剂以及住院时间（LOS）<72小时的患者。遵循严格的静脉双功超声筛查方案。根据年龄（18 - 44岁与≥55岁）将女性患者分为绝经前和绝经后组。采用双变量分析和逻辑回归来确定与VTE风险相关的变量。
结果
共有8726名患者符合纳入标准。总体VTE发生率为5.3%。双变量分析未发现VTE风险在性别上存在差异（女性为5.1%，男性为5.4%，p = 0.565），也未发现在按年龄定义的绝经类别中女性和男性之间存在差异（绝经前女性为3.9%，男性为4.7%，p = 0.293；绝经后女性为5.9%，男性为7.0% p = 0.22）。逻辑回归（见图）确实确定了VTE的其他风险因素，包括年龄≥55岁（调整优势比[AOR] 2.0）、损伤严重度评分（ISS）增加（AOR 为1.5 - 2.1）、穿透性损伤机制（AOR 2.2）、下肢损伤（AOR 1.7）、需要机械通气（AOR 2.1）以及住院时间增加（住院7 - 28天，AOR 3.8；住院>28天，AOR 9.1）。
结论
即使在控制绝经状态后，基于患者性别的VTE发生率也没有差异。对超过8700名患者进行积极VTE筛查确实发现了其他几个发生VTE风险增加的患者群体。在这些患者中可能需要更强化的VTE预防措施。
证据级别
流行病学研究，III级；治疗性研究，V级。
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