Patell Rushad, Rybicki Lisa, McCrae Keith R, Khorana Alok A
Internal Medicine, Cleveland Clinic Foundation, Cleveland, Ohio, USA.
Quantitative Health Sciences, Cleveland Clinic Foundation, Cleveland, Ohio, USA.
Am J Hematol. 2017 Jun;92(6):501-507. doi: 10.1002/ajh.24700. Epub 2017 May 2.
Inpatient venous thromboembolism (VTE) is a priority preventable illness; risk in cancer varies and prophylaxis is inconsistently used. A previously validated tool (Khorana Score, [KS]) identifies VTE risk in cancer outpatients with 5 easily available variables but has not been studied in the inpatient setting. We evaluated the validity of KS in predicting VTE risk in hospitalized cancer patients. We conducted a retrospective cohort study of consecutive oncology inpatients at the Cleveland Clinic from 11/2012 to 12/2014 (n = 3531). Patients were excluded for VTE on admission (n = 304), incomplete KS data (n = 439) or other reasons (n = 8). Data collected included demographics, cancer type, length of stay (LOS), anticoagulant use, and laboratory values. Multivariate risk factors were identified with stepwise logistic regression, confirmed with bootstrap analysis. Of 2780 patients included, 106 (3.8%) developed VTE during hospitalization. Median age was 62 (range, 19-98) years and 56% were male. Median LOS was 5 (range, 0-152) days. High risk KS (≥ 3) was significantly associated with VTE in uni- and multivariate analyses (OR 2.5, 95% [confidence interval] CI 1.3-4.9). Other significant variables included male gender (OR 1.67, 1.1-2.53), older age (OR 0.86, 0.75-0.99) and use of anticoagulants (OR 0.57, 0.39-0.85). Recursive partitioning analysis suggested optimal cut point for KS is 2 (OR 1.82, 1.23-2.69). This is the first report validating KS as a risk tool to predict VTE in hospitalized cancer patients. Using this tool could lead to more consistent and successful application of inpatient thromboprophylaxis.
住院患者静脉血栓栓塞症（VTE）是一种重点可预防疾病；癌症患者的风险各不相同，预防措施的使用也不一致。一种先前经验证的工具（科纳纳评分，[KS]）可通过5个易于获取的变量识别癌症门诊患者的VTE风险，但尚未在住院患者中进行研究。我们评估了KS在预测住院癌症患者VTE风险方面的有效性。我们对2012年11月至2014年12月在克利夫兰诊所连续就诊的肿瘤住院患者进行了一项回顾性队列研究（n = 3531）。因入院时存在VTE（n = 304）、KS数据不完整（n = 439）或其他原因（n = 8）而被排除的患者。收集的数据包括人口统计学资料、癌症类型、住院时间（LOS）、抗凝剂使用情况和实验室检查值。通过逐步逻辑回归确定多变量风险因素，并通过自助法分析进行确认。在纳入的2780例患者中，106例（3.8%）在住院期间发生了VTE。中位年龄为62岁（范围19 - 98岁），56%为男性。中位住院时间为5天（范围0 - 152天）。在单变量和多变量分析中，高风险KS（≥3）与VTE显著相关（OR 2.5，95%[置信区间]CI 1.3 - 4.9）。其他显著变量包括男性（OR 1.67，1.1 - 2.53）、年龄较大（OR 0.86，0.75 - 0.99）和使用抗凝剂（OR 0.57，0.39 - 0.85）。递归划分分析表明，KS的最佳切点为2（OR 1.82，1.
