Guo Xiaoqian, Tao Haiying, Li Di, Li Yan
Clin Lab. 2021 Apr 1;67(4). doi: 10.7754/Clin.Lab.2020.200856.
Venous thromboembolism (VTE) is a common complication in orthopedic trauma patients. Accurate prediction of individual thrombosis risk is important in determining whether prophylactic treatment with anticoagulants is necessary. In this study, we screened for biomarkers that could be used as predictors of VTE risk and evaluated their efficacy and benefit in treating orthopedic traumatic patients.
A total of 683 patients with orthopedic trauma were consecutively enrolled between January 2017 and June 2018 at Renmin Hospital of Wuhan University. Demographic and clinical information was collected, and VTE risk was assessed using the Caprini risk assessment score. The concentrations of PIC, coagulation parameters and other routine biochemical markers were quantified. The Mann-Whitney U test was used to identify potential biomarkers which were significantly different between patients who developed VTE and those who did not. Correlation between individual parameters was assessed using Pearson's correlation. A nomogram model was constructed to predict VTE risk using a combination of biomarkers, and a decision curve analysis was performed to assess the net benefit of using each biomarker.
Patients with VTE had significantly higher levels of PIC (p = 0.037) and DD (p = 0.042) than those without, even after adjusting for confounding factors. PIC and DD levels increased in a stepwise fashion with increasing VTE risk and were the markers most strongly associated with Caprini score (PIC, r = 0.408; DD, r = 0.474; p < 0.001). In decision curve analysis, PIC levels provided greater net benefit than the Caprini score or DD level across patients with various bleeding risks.
Plasma PIC levels are a useful biomarker of VTE risk and can be used to determine whether pharmaco-prophylaxis is needed in orthopedic trauma patients.
静脉血栓栓塞症（VTE）是骨科创伤患者常见的并发症。准确预测个体血栓形成风险对于确定是否需要使用抗凝剂进行预防性治疗至关重要。在本研究中，我们筛选了可作为VTE风险预测指标的生物标志物，并评估了它们在治疗骨科创伤患者中的疗效和益处。
2017年1月至2018年6月期间，武汉大学人民医院连续纳入了683例骨科创伤患者。收集了人口统计学和临床信息，并使用Caprini风险评估评分评估VTE风险。对PIC、凝血参数和其他常规生化标志物的浓度进行了定量分析。采用Mann-Whitney U检验来识别在发生VTE的患者和未发生VTE的患者之间有显著差异的潜在生物标志物。使用Pearson相关性分析评估个体参数之间的相关性。构建了一个列线图模型，使用生物标志物组合来预测VTE风险，并进行决策曲线分析以评估使用每种生物标志物的净效益。
即使在调整混杂因素后，发生VTE的患者的PIC（p = 0.037）和DD（p = 0.042）水平仍显著高于未发生VTE的患者。PIC和DD水平随着VTE风险的增加而逐步升高，并且是与Caprini评分相关性最强的标志物（PIC，r = 0.408；DD，r = 0.474；p < 0.001）。在决策曲线分析中，对于具有不同出血风险的患者，PIC水平比Caprini评分或DD水平提供了更大的净效益。
血浆PIC水平是VTE风险的有用生物标志物，可用于确定骨科创伤患者是否需要药物预防。
