Pirogov Russian National Research Medical University, Moscow, Russian Federation; Clinical Hospital No. 1 (Volynskaya) of the President's Administration of the Russian Federation, Moscow, Russian Federation.
Clinical Hospital No. 1 (Volynskaya) of the President's Administration of the Russian Federation, Moscow, Russian Federation.
J Vasc Surg Venous Lymphat Disord. 2021 Nov;9(6):1371-1381.e4. doi: 10.1016/j.jvsv.2021.02.018. Epub 2021 Mar 17.
The study aimed to validate the original Caprini score and its modifications considering coronavirus disease (COVID-19) as a severe prothrombotic condition in patients admitted to the hospital.
The relevant data were extracted from the electronic medical records with an implemented Caprini score and were retrospectively evaluated. The score was calculated twice: by the physician on admission and by the investigator at discharge (death). The final assessment considered additional risk factors that occurred during inpatient treatment. Besides the original Caprini score (a version of 2005), the modified version added the elevation of D-dimer and specific scores for COVID-19 as follows: two points for asymptomatic, three points for symptomatic, and five points for symptomatic infection with positive D-dimer. Cases were evaluated retrospectively. The primary end point was symptomatic venous thromboembolism (VTE) detected during inpatient treatment and confirmed by appropriate imaging testing or autopsy. The secondary end points included those observed during hospitalization (admission to the intensive care unit, a requirement for invasive mechanical ventilation, death, bleeding), and those assessed at 6-month follow-up (symptomatic VTE, bleeding, death). The association of eight different versions of the Caprini score with VTE events was evaluated.
A total of 168 patients (83 males and 85 females at the age of 58.3 ± 12.7 years) were admitted to the hospital between April 30 and May 29, 2020, and were discharged or died to the time of data analysis. The original Caprini score varied between 2 and 12 (5.4 ± 1.8) at the admission and between 2 and 15 (5.9 ± 2.5) at discharge or death. The maximal score was observed with modification including specific COVID-19 points of 5 to 20 (10.0 ± 3.0). Patients received prophylactic (enoxaparin 40 mg once daily: 2.4%), intermediate (enoxaparin 80 mg once daily: 76.8%), or therapeutic (enoxaparin 1 mg/kg twice daily: 20.8%) anticoagulation. Despite this, symptomatic VTE was detected in 11 (6.5%) inpatients. Of the 168 individuals, 28 (16.7%) admitted to the intensive care unit, 8 (4.8%) required invasive mechanical ventilation, and 8 (4.8%) died. Clinically relevant nonmajor bleeding was detected in two (1.2%) cases. The Caprini score of all eight versions demonstrated a significant association with inpatient VTE frequency. The highest predictability was observed for the original scale when assessed at discharge (death). Only symptomatic VTE was reported after discharge with a cumulative incidence of 7.1%. This did not affect the predictability of the Caprini score. Extended antithrombotic treatment was prescribed to 49 (29%) patients with a cumulative incidence of bleeding of 1.8% at 6 months.
The study identified a significant correlation between the Caprini score and the risk of VTE in patients with COVID-19. All models including specific COVID-19 scores showed equally high predictability, and use of the original Caprini score is appropriate for patients with COVID-19.
本研究旨在验证原始 Caprini 评分及其在因冠状病毒病（COVID-19）而成为严重促血栓形成情况下对住院患者的修正版，以评估其对 COVID-19 患者静脉血栓栓塞症（VTE）的预测能力。
从电子病历中提取相关数据，实施 Caprini 评分并进行回顾性评估。该评分由医生在入院时和研究者在出院（死亡）时两次计算。最终评估考虑了住院期间发生的其他额外危险因素。除了原始 Caprini 评分（2005 年版）外，改良版增加了 D-二聚体升高和 COVID-19 的特定评分：无症状患者为 2 分，有症状患者为 3 分，有症状感染且 D-二聚体阳性患者为 5 分。病例进行回顾性评估。主要终点为住院期间检测到并经适当影像学检查或尸检证实的有症状 VTE。次要终点包括住院期间（入住重症监护病房、需要有创机械通气、死亡、出血）和 6 个月随访期间（有症状 VTE、出血、死亡）观察到的终点。评估了 8 种不同版本的 Caprini 评分与 VTE 事件的相关性。
共有 168 名患者（83 名男性和 85 名女性，年龄 58.3±12.7 岁）于 2020 年 4 月 30 日至 5 月 29 日住院，至数据分析时出院或死亡。入院时原始 Caprini 评分为 2 至 12 分（5.4±1.8），出院或死亡时为 2 至 15 分（5.9±2.5）。最大评分为包括特定 COVID-19 评分的 5 至 20 分（10.0±3.0）。患者接受预防（依诺肝素 40mg 每日 1 次：2.4%）、中程（依诺肝素 80mg 每日 1 次：76.8%）或治疗（依诺肝素 1mg/kg 每日 2 次：20.8%）抗凝治疗。尽管如此，仍有 11 名（6.5%）住院患者出现有症状 VTE。在 168 名患者中，28 名（16.7%）入住重症监护病房，8 名（4.8%）需要有创机械通气，8 名（4.8%）死亡。有 2 例（1.2%）患者出现临床相关非大出血。所有 8 种版本的 Caprini 评分均与住院 VTE 发生率显著相关。当在出院（死亡）时评估时，原始量表的预测能力最高。仅在出院后报告有症状 VTE，累积发生率为 7.1%。这并未影响 Caprini 评分的预测能力。对 49 名（29%）患者进行了扩展抗血栓治疗，6 个月时出血的累积发生率为 1.8%。
本研究确定了 COVID-19 患者的 Caprini 评分与 VTE 风险之间存在显著相关性。所有包括特定 COVID-19 评分的模型均显示出同等的高预测能力，因此对于 COVID-19 患者，使用原始 Caprini 评分是合适的。
