West China School of Medicine, West China Hospital, Sichuan University, Chengdu, Sichuan Province, China.
Department of Respiratory and Critical Care Medicine, West China Hospital, Sichuan University, Chengdu, Sichuan Province, China.
Thromb Haemost. 2022 Jul;122(7):1177-1185. doi: 10.1055/a-1693-0063. Epub 2021 Nov 10.
Inpatients with acute exacerbation of chronic obstructive pulmonary disease (AECOPD) are at increased risk for venous thromboembolism (VTE); however, the prophylaxis for VTE is largely underused in China. Identifying high-risk patients requiring thromboprophylaxis is critical to reduce the mortality and morbidity associated with VTE. This study aimed to evaluate and compare the validities of the Padua Prediction Score and Caprini risk assessment model (RAM) in predicting the risk of VTE in inpatients with AECOPD in China.
The inpatients with AECOPD were prospectively enrolled from seven medical centers of China between September 2017 and January 2020. Caprini and Padua scores were calculated on admission, and the incidence of 3-month VTE was investigated.
Among the 3,277 eligible patients with AECOPD, 128 patients (3.9%) developed VTE within 3 months after admission. The distribution of the study population by the Caprini risk level was as follows: high, 53.6%; moderate, 43.0%; and low, 3.5%. The incidence of VTE increased by risk level as high, 6.1%; moderate, 1.5%; and low, 0%. According to the Padua RAM, only 10.9% of the study population was classified as high risk and 89.1% as low risk, with the corresponding incidence of VTE of 7.9 and 3.4%, respectively. The Caprini RAM had higher area under curve compared with the Padua RAM (0.713 ± 0.021 vs. 0.644 ± 0.023, = 0.029).
The Caprini RAM was superior to the Padua RAM in predicting the risk of VTE in inpatients with AECOPD and might better guide thromboprophylaxis in these patients.
慢性阻塞性肺疾病急性加重（AECOPD）住院患者发生静脉血栓栓塞症（VTE）的风险增加；然而，VTE 的预防措施在中国仍未得到广泛应用。识别需要血栓预防的高危患者对于降低与 VTE 相关的死亡率和发病率至关重要。本研究旨在评估和比较 Padua 预测评分和 Caprini 风险评估模型（RAM）在中国 AECOPD 住院患者中预测 VTE 风险的有效性。
2017 年 9 月至 2020 年 1 月，前瞻性纳入来自中国 7 家医疗中心的 AECOPD 住院患者。入院时计算 Caprini 和 Padua 评分，并调查 3 个月内 VTE 的发生率。
在 3277 例符合条件的 AECOPD 患者中，128 例（3.9%）在入院后 3 个月内发生 VTE。根据 Caprini 风险水平，研究人群的分布如下：高，53.6%；中，43.0%；低，3.5%。VTE 的发生率随风险水平的增加而升高，高风险组为 6.1%，中风险组为 1.5%，低风险组为 0%。根据 Padua RAM，只有 10.9%的研究人群被归类为高风险，89.1%为低风险，相应的 VTE 发生率分别为 7.9%和 3.4%。Caprini RAM 的曲线下面积高于 Padua RAM（0.713±0.021 与 0.644±0.023，=0.029）。
Caprini RAM 预测 AECOPD 住院患者 VTE 风险优于 Padua RAM，可能更好地指导这些患者的血栓预防。
