Zeng Huimin, Gao Meng, Chen Jinbo, Cui Yu, Huang Fang, Zeng Feng, Yang Zhongqing, Li Yang, Chen Zhiyong, Zhu Zewu, Chen Hequn
Department of Urology, Xiangya Hospital, Central South University, Changsha, 410008, China.
World J Urol. 2021 Sep;39(9):3571-3577. doi: 10.1007/s00345-021-03658-w. Epub 2021 Mar 16.
To determine the incidence and risk factors of the venous thromboembolism (VTE) in patients undergoing percutaneous nephrolithotomy (PCNL).
We retrospectively reviewed the records of 896 consecutive cases receiving PCNL between July 2018 and August 2020 in our institution. Univariate analysis was performed to identify the risk factors of VTE, and multivariate logistic regression analysis was further performed to determine the independent risk factors. Furthermore, the corresponding nomogram was conducted to establish a predicted model for VTE.
The overall incidence of VTE was 2.8%. The multivariate logistic regression analysis showed that discontinued anticoagulant or antiplatelet therapies (OR 4.505, 95% CI 1.410-14.401), increased postoperative 12-h D-dimer (OR 11.162, 95% CI 2.370-52.574), hydronephrosis (OR 3.303, 95% CI 1.303-8.375), higher Caprini risk assessment model (RAM) score (OR 3.233, 95% CI 1.207-8.659) and postoperative sepsis or septic shock (OR 3.784, 95% CI 1.163-12.306) were independent risk factors of VTE following PCNL. Moreover, the area under the curve of postoperative 12-h D-dimer, hydronephrosis and Caprini RAM score was 0.826, 0.621 and 0.660, respectively. Based on the identified independent risk factors, the well-calibrated nomogram showed a moderate discriminative ability with concordance index 0.731.
2.8% of patients developed VTE following PCNL. Regarding those patients who have independent risk factors in this study, due attention should be paid to the effective thromboprophylaxis and the early detection of VTE.
确定经皮肾镜取石术（PCNL）患者静脉血栓栓塞症（VTE）的发生率及危险因素。
我们回顾性分析了2018年7月至2020年8月在我院连续接受PCNL的896例患者的记录。进行单因素分析以确定VTE的危险因素，并进一步进行多因素逻辑回归分析以确定独立危险因素。此外，绘制相应的列线图以建立VTE预测模型。
VTE的总体发生率为2.8%。多因素逻辑回归分析显示，停用抗凝或抗血小板治疗（比值比[OR]4.505，95%置信区间[CI]1.410 - 14.401）、术后12小时D - 二聚体升高（OR 11.162，95% CI 2.370 - 52.574）、肾积水（OR 3.303，95% CI 1.303 - 8.375）、较高的卡普里尼风险评估模型（RAM）评分（OR 3.233，95% CI 1.207 - 8.659）以及术后脓毒症或感染性休克（OR 3.784，95% CI 1.163 - 12.306）是PCNL术后VTE的独立危险因素。此外，术后12小时D - 二聚体、肾积水和卡普里尼RAM评分的曲线下面积分别为0.826、0.621和0.660。基于确定的独立危险因素，校准良好的列线图显示出中等判别能力，一致性指数为0.731。
2.8%的患者在PCNL术后发生VTE。对于本研究中有独立危险因素的患者，应重视有效的血栓预防及VTE的早期检测。
