Department of Orthopedics, Drum Tower Hospital Clinical College of Nanjing University, Nanjing, China,
Clin Interv Aging. 2018 Sep 11;13:1669-1674. doi: 10.2147/CIA.S174691. eCollection 2018.
Preoperative deep vein thrombosis (DVT) is a common complication in patients with hip fractures. Chronic kidney disease (CKD) as a frequent comorbidity in middle-aged and elderly patients with hip fractures is known to promote a proinflammatory and prothrombotic state. We aimed to identify whether CKD can increase the risk of DVT in middle-aged and elderly patients with hip fractures, as well as identify other risk factors.
We retrospectively studied 248 middle-aged and elderly patients with hip fractures who were admitted to our hospital from January 2016 to June 2017, meeting all the inclusion criteria. Doppler ultrasonography was used to diagnose DVT. Patients with CKD were classified into five stages according to the Kidney Diseases Outcomes Quality Initiative. We identified whether CKD could increase the occurrence of preoperative DVT in middle-aged and elderly patients with hip fractures and further investigated other independent risk factors for preoperative DVT by using univariate and multivariate analyses.
The mean estimated glomerular filtration rate was 125.7±41.4 mL/min/1.73 m. Briefly, 82.3% (n=204) had been diagnosed with normal kidney function, 11.7% (n=29) with mildly decreased kidney function, and 6.0% (n=15) with stage 3 and 4 CKD. In addition, of the 248 patients, 11.7% (n=29) developed DVT before surgery. Independent predictors of preoperative DVT identified by multivariate analyses were age, prolonged bedridden time, increased levels of fibrinogen, and lower estimated glomerular filtration rate.
CKD can increase the risk rate of preoperative DVT in middle-aged and elderly patients with hip fractures. Additionally, age, prolonged bedridden time, and increased levels of fibrinogen were also independent risk factors for preoperative DVT in these patients. We should take preventive measures for these patients with risk factors in order to reduce the incidence of preoperative DVT.
术前深静脉血栓（DVT）是髋部骨折患者的常见并发症。慢性肾脏病（CKD）作为中老年髋部骨折患者的常见合并症，已知会促进促炎和促血栓形成状态。我们旨在确定 CKD 是否会增加中老年髋部骨折患者发生 DVT 的风险，并确定其他危险因素。
我们回顾性研究了 2016 年 1 月至 2017 年 6 月期间我院收治的 248 例符合所有纳入标准的中老年髋部骨折患者。采用多普勒超声诊断 DVT。根据肾脏病预后质量倡议（Kidney Diseases Outcomes Quality Initiative）将 CKD 患者分为五个阶段。我们确定 CKD 是否会增加中老年髋部骨折患者术前 DVT 的发生，并通过单因素和多因素分析进一步研究术前 DVT 的其他独立危险因素。
估计肾小球滤过率平均值为 125.7±41.4mL/min/1.73m。简要来说，82.3%（n=204）患者被诊断为肾功能正常，11.7%（n=29）患者为轻度肾功能减退，6.0%（n=15）患者为 3 期和 4 期 CKD。此外，在 248 例患者中，有 11.7%（n=29）在术前发生 DVT。多因素分析确定的术前 DVT 的独立预测因子为年龄、卧床时间延长、纤维蛋白原水平升高和估计肾小球滤过率降低。
CKD 可增加中老年髋部骨折患者术前 DVT 的风险率。此外，年龄、卧床时间延长和纤维蛋白原水平升高也是这些患者术前 DVT 的独立危险因素。我们应为这些有危险因素的患者采取预防措施，以降低术前 DVT 的发生率。
