Ye Yun, Li Xiang, Zhu Li, Yang Cong, Tan You-Wen
Department of Hepatology, The Third Hospital of Zhenjiang Affiliated Jiangsu University, Zhenjiang 212000, Jiangsu Province, China.
World J Clin Cases. 2021 Nov 6;9(31):9406-9416. doi: 10.12998/wjcc.v9.i31.9406.
The artificial liver support system (ALSS) is an effective treatment method for liver failure, but it requires deep venous intubation and long-term indwelling catheterization. However, the coagulation mechanism disorder of basic liver failure diseases, and deep venous thrombosis (DVT) often occur.
To evaluate the risk factors for DVT following use of an ALSS and establish a risk assessment score.
This study was divided into three stages. In the first stage, the risk factors for DVT were screened and the patient data were collected, including ALSS treatment information; biochemical indices; coagulation and hematology indices; complications; procoagulant use therapy status; and a total of 24 indicators. In the second stage, a risk assessment score for DVT after ALSS treatment was developed. In the third stage, the DVT risk assessment score was validated.
A total of 232 patients with liver failure treated with ALSS were enrolled in the first stage, including 12 with lower limb DVT. Logistic regression analysis showed that age [odds ratio (OR), 1.734; = 0.01], successful catheterization time (OR, 1.667; = 0.005), activity status (strict bed rest) (OR, 3.049; = 0.005), and D-dimer level (≥ 500 ng/mL) (OR, 5.532; < 0.001) were independent risk factors for DVT. We then established a scoring system for risk factors. In the validation group, a total of 213 patients with liver failure were treated with ALSS, including 14 with lower limb DVT. When the cutoff value of risk assessment was 3, the specificity and sensitivity of the risk assessment score were 88.9% and 85.7%, respectively.
A simple risk assessment scoring system was established for DVT patients with liver failure treated with ALSS and was verified to have good sensitivity and specificity.
人工肝支持系统（ALSS）是治疗肝衰竭的一种有效方法，但需要进行深静脉插管及长期留置导管。然而，基础肝衰竭疾病本身存在凝血机制紊乱，深静脉血栓形成（DVT）常随之发生。
评估使用ALSS后发生DVT的危险因素并建立风险评估评分。
本研究分为三个阶段。第一阶段，筛查DVT的危险因素并收集患者数据，包括ALSS治疗信息、生化指标、凝血和血液学指标、并发症、促凝剂使用治疗情况等，共24项指标。第二阶段，制定ALSS治疗后DVT的风险评估评分。第三阶段，对DVT风险评估评分进行验证。
第一阶段共纳入232例接受ALSS治疗的肝衰竭患者，其中12例发生下肢DVT。Logistic回归分析显示，年龄[比值比（OR），1.734；P = 0.01]、置管成功时间（OR，1.667；P = 0.005）、活动状态（严格卧床休息）（OR，3.049；P = 0.005）及D - 二聚体水平（≥500 ng/mL）（OR，5.532；P < 0.001）是DVT的独立危险因素。随后我们建立了危险因素评分系统。在验证组中，共213例肝衰竭患者接受ALSS治疗，其中14例发生下肢DVT。当风险评估的截断值为3时，风险评估评分的特异性和敏感性分别为88.9%和85.7%。
为接受ALSS治疗的肝衰竭DVT患者建立了一个简单的风险评估评分系统，经验证具有良好的敏感性和特异性。
