Center for Primary Health Care Research, Lund University, Region Skåne, Malmö, Sweden.
Thromb Haemost. 2019 Jan;119(1):48-55. doi: 10.1055/s-0038-1676347. Epub 2018 Dec 31.
Studies on short-term prognosis of venous thromboembolism (VTE) that take family history of VTE and Charlson Comorbidity Index (CCI) into account are sparse. The aim was to investigate the importance of family history of VTE and CCI for short-term mortality after a first episode of VTE. Using Swedish medical databases, we conducted a 90-day nationwide cohort study of 41,700 Swedish born patients with a first-time VTE (July 2005-August 2012). Patients diagnosed with VTE and prescribed anticoagulant treatment were included. Mortality hazard ratios (HRs) with 95% confidence intervals (CIs) were determined with Cox regression. Patients with first-degree (sibling/parent) family history of VTE ( = 11,405, 27.4%) had significantly lower CCI than those without family history. Independent risk factors for 90-day mortality in the adjusted model were: female sex (HR = 1.19, 95% CI: 1.09-1.29), increasing age (HR = 1.02, 95% CI: 1.01-1.02 per year), pulmonary embolism (HR = 1.21, 95% CI: 1.11-1.32) or combined pulmonary embolism and deep venous thrombosis (HR = 1.60, 95% CI: 1.27-2.01) compared with deep venous thrombosis, CCI = 1 (HR = 2.93, 95% CI: 2.32-3.72), CCI = 2 (HR = 8.65, 95% CI: 7.16-10.46) or CCI = 3 (HR = 22.25, 95% CI: 18.73-26.44) compared with CCI = 0. Having one or two or more affected first-degree relatives with VTE was associated with lower mortality, HR = 0.83 (95% CI: 0.74-0.92) and HR = 0.65 (95% CI: 0.51-0.85), respectively. The mortality rate was 0.70% in patients with a CCI of zero. In receiver operating characteristic (ROC) analysis, the area under the ROC curve for CCI was 0.84 (0.83-0.95). Family history of VTE is associated with lower mortality while CCI is a strong predictor for short-term mortality in VTE. Co-morbidities are important for risk assessment of VTE.
考虑到静脉血栓栓塞症（VTE）家族史和 Charlson 合并症指数（CCI）的静脉血栓栓塞症短期预后研究较少。本研究旨在探讨 VTE 家族史和 CCI 对首次 VTE 后短期死亡率的重要性。我们使用瑞典医疗数据库，对 41700 名首次 VTE（2005 年 7 月至 2012 年 8 月）的瑞典出生患者进行了一项 90 天全国队列研究。纳入诊断为 VTE 并接受抗凝治疗的患者。使用 Cox 回归确定死亡率的风险比（HR）和 95%置信区间（CI）。具有一级（兄弟姐妹/父母）VTE 家族史的患者（ = 11405，27.4%）的 CCI 显著低于无家族史的患者。调整模型中 90 天死亡率的独立危险因素为：女性（HR = 1.19，95% CI：1.09-1.29）、年龄增加（HR = 1.02，95% CI：每年 1.01-1.02）、肺栓塞（HR = 1.21，95% CI：1.11-1.32）或肺栓塞和深静脉血栓形成的联合（HR = 1.60，95% CI：1.27-2.01）与深静脉血栓形成相比，CCI = 1（HR = 2.93，95% CI：2.32-3.72）、CCI = 2（HR = 8.65，95% CI：7.16-10.46）或 CCI = 3（HR = 22.25，95% CI：18.73-26.44）与 CCI = 0 相比。有一个或两个或更多一级亲属患有 VTE 与死亡率降低相关，HR = 0.83（95% CI：0.74-0.92）和 HR = 0.65（95% CI：0.51-0.85）。CCI 为零的患者死亡率为 0.70%。在接受者操作特征（ROC）分析中，CCI 的 ROC 曲线下面积为 0.84（0.83-0.95）。VTE 家族史与死亡率降低相关，而 CCI 是 VTE 短期死亡率的强预测因子。合并症对 VTE 的风险评估很重要。
