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前瞻性近端深静脉血栓形成患者队列中血栓后综合征的临床预测模型的建立。

Development of a clinical prediction model for the postthrombotic syndrome in a prospective cohort of patients with proximal deep vein thrombosis.

机构信息

Thrombosis and Hemostasis Unit, Hematology Institute, Soroka University Medical Center, Faculty of Health Sciences, Ben Gurion University of the Negev, Beer Sheva, Israel.

URCA-CHU Sainte-Justine, Université de Montréal, Montréal, Quebec, Canada.

出版信息

J Thromb Haemost. 2018 Feb;16(2):262-270. doi: 10.1111/jth.13909. Epub 2017 Dec 29.

Abstract

UNLABELLED

Essentials We developed a prediction model for postthrombotic syndrome (PTS) after deep vein thrombosis (DVT). High risk predictors were iliac vein DVT, BMI>35 and moderate-severe Villalta category. Patients with a score ≥4 had an odds ratio of 5.9 (95% CI 2.1-16.6) for PTS. SOX-PTS score may select DVT patients for close monitoring or aggressive strategies to treat DVT.

SUMMARY

Background Postthrombotic syndrome (PTS) is a chronic complication that develops in 20-50% of patients after deep vein thrombosis (DVT). Although individual risk factors for PTS have been characterized, the ability to predict which DVT patients are likely to develop PTS remains limited. Objective To develop a clinical prediction score for PTS in patients with DVT. Methods The derivation cohort consisted of participants in the SOX Trial, a randomized double-blind placebo-controlled trial of elastic compression stockings versus placebo stockings worn for 2 years after DVT to prevent PTS in patients with a first proximal DVT, enrolled in 24 community and tertiary-care hospitals from 2004 to 2010. Multivariable logistic regression analysis of baseline characteristics was performed. The outcome was the occurrence of PTS, diagnosed starting from 6 months or later according to Ginsberg's criteria. Results Seven hundred and sixty-two patients were included in the analysis. The median follow-up was 728 days. The model includes three independent predictors, and has a range of possible scores from 0 to 5. High-risk predictors were: index DVT in the iliac vein; body mass index of ≥ 35 kg m ; and moderate-severe Villalta severity category at DVT diagnosis. As compared with patients with a score of 0, those with a score of ≥ 4 had an odds ratio of 5.9 (95% confidence interval 2.1-16.6) for developing PTS. Conclusions To our knowledge, this is the first clinical prediction score for PTS. We identified three independent predictors that, when combined, predicted PTS risk after a first proximal DVT. The SOX-PTS score requires external validation before it can be considered for clinical use.

摘要

背景

深静脉血栓形成(DVT)后,20-50%的患者会出现血栓后综合征(PTS),这是一种慢性并发症。尽管已经确定了 PTS 的个体危险因素,但预测哪些 DVT 患者可能会发生 PTS 的能力仍然有限。目的:为 DVT 患者 PTS 开发一种临床预测评分。

方法

该推导队列包括 SOX 试验的参与者,这是一项随机、双盲、安慰剂对照试验,研究了弹性压缩袜与安慰剂袜在 DVT 后 2 年内的应用,以预防首次近端 DVT 后 PTS 的发生,该试验于 2004 年至 2010 年在 24 家社区和三级医疗机构进行。对基线特征进行多变量逻辑回归分析。结果是 PTS 的发生,根据 Ginsberg 的标准,从 6 个月或之后开始诊断。

结果

762 例患者纳入分析。中位随访时间为 728 天。该模型包含三个独立的预测因子,其得分范围为 0 至 5。高危预测因子包括:DVT 位于髂静脉;BMI≥35kg/m2;DVT 诊断时的 Villalta 严重程度为中度至重度。与得分 0 的患者相比,得分≥4 的患者发生 PTS 的比值比为 5.9(95%置信区间 2.1-16.6)。

结论

据我们所知,这是第一个 PTS 临床预测评分。我们确定了三个独立的预测因子,它们结合起来可以预测首次近端 DVT 后 PTS 的风险。SOX-PTS 评分需要进一步的外部验证,才能考虑用于临床使用。

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