Yale University School of Medicine, New Haven, Conn.
Section of Pulmonary, Critical Care and Sleep Medicine, Department of Internal Medicine, Yale University School of Medicine, New Haven, Conn.
J Vasc Surg Venous Lymphat Disord. 2018 Jan;6(1):7-12. doi: 10.1016/j.jvsv.2017.08.015. Epub 2017 Oct 23.
The Caprini model estimates patients' risk for venous thromboembolism by 30 different factors. Hemodynamically significant pulmonary embolism (PE), defined as high-risk (massive) or intermediate-risk (submassive) PE, has high morbidity and mortality rates. This study tests whether the Caprini model and deep venous thrombosis (DVT) characteristics correlate with the prevalence of PE and hemodynamically significant PE in patients with DVT.
A retrospective review of patients diagnosed with DVT between January 2013 and August 2014 in a tertiary care center was performed. Multivariable analysis was used to determine predictors of PE and hemodynamically significant PE.
Of 838 consecutive patients with DVT, 217 (25.9%) had concomitant PE at presentation, of whom 135 had hemodynamically significant PE (101 submassive PE, 34 massive PE). The mean age was 65 years, and 51.0% were women. There was no significant relation between age or gender and the occurrence of PE or hemodynamically significant PE. Patients with PE were less likely to have undergone recent surgery (18.4% vs 30.3%; P = .001), to have sepsis (4.6% vs 11.8%; P = .002), and to have higher Caprini scores (6.1 vs 6.5; P = .047). Patients with DVT were less likely to have hemodynamically significant PE after recent surgery (13.3% vs 27.2%; P = .011) but more likely to have hemodynamically significant PE with proximal DVT (80.7% vs 64.2%). There was no association between Caprini score and hemodynamically significant PE (6.3 vs 5.7; P = .171).
The Caprini model has a poor association with PE or hemodynamically significant PE in patients with DVT. Among all patients with DVT, a concomitant diagnosis of PE or hemodynamically significant PE is less common in those with sepsis or undergoing recent surgery but more common in those with proximal DVT.
卡普里尼模型通过 30 个不同因素来评估患者发生静脉血栓栓塞的风险。血流动力学显著的肺栓塞（PE），定义为高危（大面积）或中危（次大面积）PE，具有较高的发病率和死亡率。本研究旨在检测卡普里尼模型和深静脉血栓形成（DVT）特征是否与伴有 DVT 的患者中 PE 和血流动力学显著 PE 的患病率相关。
对 2013 年 1 月至 2014 年 8 月在一家三级保健中心诊断为 DVT 的连续患者进行回顾性分析。采用多变量分析来确定 PE 和血流动力学显著 PE 的预测因子。
在 838 例连续患有 DVT 的患者中，217 例（25.9%）在就诊时伴有同时性 PE，其中 135 例为血流动力学显著 PE（101 例次大面积 PE，34 例大面积 PE）。患者的平均年龄为 65 岁，51.0%为女性。年龄或性别与 PE 或血流动力学显著 PE 的发生之间无显著关系。患有 PE 的患者近期手术的可能性较小（18.4%比 30.3%；P=0.001），患有败血症的可能性较小（4.6%比 11.8%；P=0.002），且卡普里尼评分较高（6.1 比 6.5；P=0.047）。近期手术的 DVT 患者发生血流动力学显著 PE 的可能性较小（13.3%比 27.2%；P=0.011），但近端 DVT 更易发生血流动力学显著 PE（80.7%比 64.2%）。卡普里尼评分与血流动力学显著 PE 之间无关联（6.3 比 5.7；P=0.171）。
卡普里尼模型与伴有 DVT 的患者的 PE 或血流动力学显著 PE 关联度较差。在所有患有 DVT 的患者中，伴有败血症或近期手术的患者中，PE 或血流动力学显著 PE 的同时诊断较少，但近端 DVT 患者中更常见。
