Shao X, Si C Z, Zhen K Y, Zhang Z, Wang J, Wang D Y, Lei J P, Wan J, Xie W M, Zhai Z G, Wang C
China-Japan Friendship Clinical Medical College, Beijing University of Chinese Medicine, Beijing 100029, China.
Information Center, China-Japan Friendship Hospital, Beijing 100029, China.
Zhonghua Yi Xue Za Zhi. 2020 May 26;100(20):1539-1543. doi: 10.3760/cma.j.cn112137-20200223-00407.
To investigate the clinical features and risk factors of hospital-associated venous thromboembolism (VTE). The study enrolled acute VTE patients admitted into China-Japan Friendship Hospital from January 1, 2017 to December 31, 2017. The hospital-associated VTE (HA-VTE) group and the community-associated VTE (CA-VTE) group were classified according to whether the VTE occurred during hospitalization or within a 90-day period of admission to hospital (including inpatient with at least two days of hospital stay or a surgical procedure under general or regional anaesthesia). Differences in clinical features, risk factors, and mortality rate were compared between the two groups. A total of 437 patients with acute VTE were analyzed in the study. Among them, 266 patients were HA-VTE, 171 patients were CA-VTE. Patients in the CA-VTE group were more likely to have varicose veins, sedentary, long-distance travel, and patients in the HA-VTE group were more complicated with recent surgery (<1 month), bed rest, active malignant tumor, acute infections, acute cerebral infarction, fracture, central venous catheter (0.05). The CA-VTE group had more clinical symptoms such as lower extremity pain, dyspnea, chest pain and chest tightness (0.05). HA-VTE patients had less clinical symptoms but were more severe than the CA-VTE patients, with more sudden deaths (0 vs 3.4%, 0.035). Among HA-VTE patients, 92.8% experienced VTE during hospitalization or within 1 month of the preceding hospital encounter, with a 13-day median time to VTE. The all-cause mortality rate was higher for HA-VTE group than CA-VTE group (8.3% vs 1.2%, 0.001), and the in-hospital VTE was more common compared to VTE diagnosed post-discharge (12.2% vs 3.4%, 0.001). More than half events of VTE are related to recent hospitalizations. HA-VTE has different risk factors from CA-VTE, combined with fewer clinical symptoms but higher all-cause mortality rate. More attention about VTE should be paid to hospitalized patients to reduce the incidence of HA-VTE events.
探讨医院相关性静脉血栓栓塞症（VTE）的临床特征及危险因素。本研究纳入了2017年1月1日至2017年12月31日期间入住中日友好医院的急性VTE患者。根据VTE是在住院期间还是在入院后90天内发生（包括住院至少两天的住院患者或接受全身或区域麻醉的手术患者），将患者分为医院相关性VTE（HA-VTE）组和社区相关性VTE（CA-VTE）组。比较两组患者的临床特征、危险因素及死亡率。本研究共分析了437例急性VTE患者。其中，266例为HA-VTE患者，171例为CA-VTE患者。CA-VTE组患者更易出现静脉曲张、久坐、长途旅行，而HA-VTE组患者近期手术（<1个月）、卧床休息、活动性恶性肿瘤、急性感染、急性脑梗死、骨折、中心静脉置管更为常见（P<0.05）。CA-VTE组有更多的临床症状，如下肢疼痛、呼吸困难、胸痛和胸闷（P<0.05）。HA-VTE患者临床症状较少，但比CA-VTE患者病情更严重，猝死更多（0 vs 3.4%，P=0.035）。在HA-VTE患者中，92.8%在住院期间或上次住院后1个月内发生VTE，VTE的中位时间为13天。HA-VTE组的全因死亡率高于CA-VTE组（8.3% vs 1.2%，P=0.001），与出院后诊断的VTE相比，院内VTE更常见（12.2% vs 3.4%，P=0.001）。超过一半的VTE事件与近期住院有关。HA-VTE与CA-VTE的危险因素不同，临床症状较少但全因死亡率较高。应更加关注住院患者VTE，以降低HA-VTE事件的发生率。
