比较 Khorana 预测评分和 Caprini 风险评估模型在评估住院癌症患者静脉血栓栓塞风险中的应用：一项回顾性病例对照研究。
Comparison between the Khorana prediction score and Caprini risk assessment models for assessing the risk of venous thromboembolism in hospitalized patients with cancer: a retrospective case control study.
机构信息
Department of Respiratory and Critical Care Medicine, West China Hospital/West China School of Medicine, Sichuan University, Chengdu, China.
出版信息
Interact Cardiovasc Thorac Surg. 2020 Oct 1;31(4):454-460. doi: 10.1093/icvts/ivaa137.
OBJECTIVES
This study aimed to evaluate the optimal risk assessment model (RAM) to stratify the risk of venous thromboembolism (VTE) in hospitalized patients with cancer. We examined and compared the VTE predictive ability of the Khorana score (KS) and the Caprini RAM in hospitalized cancer patients.
METHODS
We performed a retrospective case-control study among hospitalized cancer patients admitted to a comprehensive hospital in China from January 2015 to December 2016. A total of 221 cases were confirmed to have VTE during hospitalization and 221 controls were selected randomly. The Caprini RAM and KS were implemented and the individual scores of each risk factor were summed to generate a cumulative risk score. Meanwhile, the sensitivity, specificity, areas under curve of the receiver operating characteristic curve and calibration of these 2 models were analysed.
RESULTS
Significant differences were observed in risk factors between VTE and non-VTE hospitalized cancer patients and the VTE risk increased significantly with an increase in the cumulative KS or Caprini RAM score. A classification of 'high risk' according to KS and Caprini RAM was associated with 2.272-fold and 3.825-fold increases in VTE risk, respectively. However, the Caprini RAM could identify 82.4% of the VTE cases that required preventive anticoagulant therapy according to American College of Chest Physicians guidelines, whereas the KS could only identify 35.3% of the VTE cases. In addition, the areas under curve of Caprini RAM were significantly higher than those of the KS (0.705 ± 0.024 vs 0.581 ± 0.025, P < 0.001), with a best cut-off value of 5 score, which happened to be the cut-off value for high risk of VTE in Caprini RAM. Both Caprini RAM and KS showed an excellent calibration curve (0.612 vs 0.141, P > 0.05), but the risk of VTE events predicted by Caprini seemed closer to the observed risk of VTE events.
CONCLUSIONS
The Caprini RAM was found to be more effective than the KS in identifying hospitalized patients with cancer at risk of VTE.
目的
本研究旨在评估最佳风险评估模型（RAM），以对住院癌症患者的静脉血栓栓塞（VTE）风险进行分层。我们检查并比较了 Khorana 评分（KS）和 Caprini RAM 在住院癌症患者中的 VTE 预测能力。
方法
我们在中国的一家综合医院进行了一项回顾性病例对照研究，纳入了 2015 年 1 月至 2016 年 12 月期间住院的癌症患者。共有 221 例患者在住院期间确诊为 VTE，随机选择 221 例对照。实施 Caprini RAM 和 KS，并将每个危险因素的个体评分相加以产生累积风险评分。同时，分析了这两种模型的敏感性、特异性、受试者工作特征曲线下面积和校准。
结果
VTE 和非 VTE 住院癌症患者的危险因素存在显著差异，随着 KS 或 Caprini RAM 评分的增加，VTE 风险显著增加。根据 KS 和 Caprini RAM 分类为“高危”与 VTE 风险增加 2.272 倍和 3.825 倍相关。然而，Caprini RAM 可根据美国胸科医师学会指南识别 82.4%需要预防性抗凝治疗的 VTE 病例，而 KS 只能识别 35.3%的 VTE 病例。此外，Caprini RAM 的曲线下面积显著高于 KS（0.705±0.024 比 0.581±0.025，P<0.001），最佳截断值为 5 分，恰好是 Caprini RAM 中 VTE 高危的截断值。Caprini RAM 和 KS 均显示出极好的校准曲线（0.612 比 0.141，P>0.05），但 Caprini 预测的 VTE 事件风险似乎更接近观察到的 VTE 事件风险。
结论
Caprini RAM 比 KS 更有效地识别有 VTE 风险的住院癌症患者。
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