Xu Jia-Xuan, Dong Jun, Ren Hong, Chen Xiao-Jie, Yang Yong, Chen Ren-Xiong, Wang Guo-Dong, Wang Hong-Zhi
Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Department of Critical Care Medicine, Peking University Cancer Hospital and Institute, Beijing, China.
J BUON. 2018 Jan-Feb;23(1):500-506.
Cancer patients undergoing surgery are at high risk of venous thromboembolism (VTE). The occurrence of VTE in Chinese cancer patients admitted to intensive care unit (ICU) for postoperative care is poorly characterized. This study was designed to investigate the incidence of VTE in this population and to evaluate the utility of the Caprini score in risk stratification.
2127 consecutive adult patients admitted to a 10-bed surgical ICU (SICU) in a tertiary care academic hospital during a 4-year period (January 1, 2013 - December 31, 2016) were enrolled. Demographic and VTE data were collected. Data for the Caprini risk assessment model (RAM) was used to stratify patients on their risk of VTE.
Of the 2127 patients admitted to ICU after cancer surgery, 66 (3.1%) developed symptomatic VTE. There were a total of 32 patients with pulmonary embolism (PE), 51 patients with deep vein thrombosis (DVT) and 17 patients with both conditions. Based on the original Caprini RAM, 99.5% of the patients scored in the "highest risk" category (score ≥5), all patients with VTE were in the "highest risk" category. Further substratification in the "highest risk" category showed the risk of developing VTE events was significantly higher among patients with Caprini score greater than 10, as compared with patients with Caprini score of 5 to 6 (OR 5.63;95%CI 1.27-24.94), 7 to 8 (OR 2.36;95%CI 1.23-4.52 ) or 9 to 10 (OR 2.28;95%CI 1.17-4.44). The percentage of patients receiving double prophylaxis was 16.8% (358/2127), 20 of the 66 VTE patients (30.3%) received double prophylaxis before VTE was diagnosed. Patients with higher Caprini score were more likely to receive double thromboprophylaxis than patients with lower Caprini score (23.4% of patients with Caprini score>10 vs 10.8% with Caprini score 5-6).
Though accompanied with the subutilizing of chemoprophylaxis, the overall incidence of VTE was relatively low in Chinese cancer patients admitted to ICU for postoperative care. In contrast, the Caprini score was high in this population. The original Caprini RAM was limited to stratify this population, but further substratification of "highest risk" category demonstrated the risk of developing VTE events was significantly higher in patients with Caprini score greater than 10. Future research with high quality evidence should be performed targeting on the accurate risk stratification and optimizing VTE prophylaxis for this population.
接受手术的癌症患者发生静脉血栓栓塞症（VTE）的风险很高。入住重症监护病房（ICU）接受术后护理的中国癌症患者VTE的发生情况特征描述不足。本研究旨在调查该人群中VTE的发生率，并评估Caprini评分在风险分层中的效用。
纳入在一家三级医疗学术医院的10张床位的外科ICU（SICU）连续收治的2127例成年患者，时间跨度为4年（2013年1月1日至2016年12月31日）。收集人口统计学和VTE数据。使用Caprini风险评估模型（RAM）的数据对患者的VTE风险进行分层。
在2127例癌症手术后入住ICU的患者中，66例（3.1%）发生了有症状的VTE。共有32例肺栓塞（PE）患者，51例深静脉血栓形成（DVT）患者，17例同时患有这两种疾病。根据原始的Caprini RAM，99.5%的患者评分为“最高风险”类别（评分≥5），所有VTE患者均在“最高风险”类别中。在“最高风险”类别中进一步分层显示，与Caprini评分为5至6分（OR 5.63；95%CI 1.27 - 24.94）、7至8分（OR 2.36；95%CI 1.23 - 4.52）或9至10分（OR 2.28；95%CI 1.17 - 4.44）的患者相比，Caprini评分大于10分的患者发生VTE事件的风险显著更高。接受双重预防的患者比例为16.8%（358/2127），66例VTE患者中有20例（30.3%）在VTE被诊断之前接受了双重预防。Caprini评分较高的患者比Caprini评分较低的患者更有可能接受双重血栓预防（Caprini评分>10分的患者中有23.4%，而Caprini评分为5 - 6分的患者中有10.8%）。
尽管化学预防措施未得到充分利用，但入住ICU接受术后护理的中国癌症患者VTE的总体发生率相对较低。相比之下，该人群的Caprini评分较高。原始的Caprini RAM在对该人群进行分层方面存在局限性，但“最高风险”类别的进一步分层表明，Caprini评分大于10分的患者发生VTE事件的风险显著更高。未来应针对该人群进行高质量证据的研究，以实现准确的风险分层并优化VTE预防。
