Sharif-Kashani Babak, Azimi Mojdeh, Tabarsi Payam, Sadr Makan, Shirzadi Shahriar
Chronic Respiratory Diseases Research Center, National Research Institute of Tuberculosis and Lung Diseases, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
Clinical Tuberculosis and Epidemiology Research Center, National Research Institute of Tuberculosis and Lung Diseases, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
Int J Mycobacteriol. 2022 Jan-Mar;11(1):83-87. doi: 10.4103/ijmy.ijmy_252_21.
Tuberculosis (TB) remains an infectious disease with a high prevalence worldwide and represents a major public health concern. It is known that TB causes a hyper-coagulable state due to its infective nature. Thus, patients are prone to higher incidence rates of venous thromboembolism (VTE) in comparison with the general population. Although there are many risk assessment models (RAMs) that estimate the risk of VTE incidence in the general population, none have been proven to show significant prognostic value in early and accurate VTE prediction among TB patients. This study aims to investigate the accuracy of general RAMs in prediction of VTE incidence in the population of TB-positive patients.
The following survey is a retrospective study among patients afflicted with TB, in whom VTE had occurred either during or at the onset of admission. A total number of 865 smear-positive TB cases were recorded in hospital in a 7-year timespan, among which a total sum of 37 patients (67.6% males, age: 56.19 ± 20 years) experienced at least one episode of thromboembolic incidence. We nominated Padua and Geneva RAMs and calculated the scores with regard to their inpatient hospital records.
Of 865 adult hospitalized smear-positive TB patients, 37 patients happened to develop VTE in the course of infection, after excluding the unacceptable data. The incidence of VTE was calculated at 4.27%. Of all VTEs, 73% turned out to be deep venous thromboembolism (DVT), 18.9% were pulmonary thromboembolism (PTE), and 8.1% of patients developed both DVT and PTE during the course of disease. Among all cases, 32.4% revealed Geneva score equivalent or >3. It conveys the meaning that these patients were at greater risk for VTE development and were indicated to receive prophylactic medication. Similarly, Padua model was capable of predicting 29.7% cases scoring >4, which is alarming for elevated VTE probability. 21.6% of TB patients, who had developed VTE during the course of their disease eventually passed away.
Our statistics show minimal positive predictive value for Padua and Geneva RAMs, which are seemingly in sharp contrast with the excellent validation of these models verified by numerous surveys in general population. This fact could be attributable to failing to consider TB, or in general chronic infections, as independent indicators of VTE incidence. These findings indicate the need for revising the presenting RAMs or establishing a separate RAM for VTE prediction in TB patients, resembling the VTE risk assessment model for cancer patients.
结核病在全球范围内仍然是一种高流行率的传染病，是主要的公共卫生问题。众所周知，结核病因其感染性会导致高凝状态。因此，与普通人群相比，结核病患者发生静脉血栓栓塞（VTE）的发病率更高。虽然有许多风险评估模型（RAMs）可估计普通人群中VTE发生的风险，但尚无模型被证明在结核病患者早期准确预测VTE方面具有显著的预后价值。本研究旨在调查普通RAMs对结核病阳性患者人群中VTE发生率预测的准确性。
以下调查是对患有结核病且在住院期间或入院时发生VTE的患者进行的回顾性研究。在7年时间跨度内，医院共记录了865例涂片阳性结核病病例，其中37例患者（男性占67.6%，年龄：56.19±20岁）经历了至少一次血栓栓塞事件。我们选用了帕多瓦和日内瓦RAMs，并根据他们的住院记录计算得分。
在865例成年住院涂片阳性结核病患者中，排除不可接受的数据后，有37例患者在感染过程中发生了VTE。VTE的发生率计算为4.27%。在所有VTE中，73%为深静脉血栓栓塞（DVT），18.9%为肺血栓栓塞（PTE），8.1%的患者在病程中同时发生了DVT和PTE。在所有病例中，32.4%的患者日内瓦评分等于或>3。这意味着这些患者发生VTE的风险更高，应接受预防性药物治疗。同样，帕多瓦模型能够预测29.7%评分>4的病例，这表明VTE概率升高令人担忧。21.6%在病程中发生VTE的结核病患者最终死亡。
我们的统计显示帕多瓦和日内瓦RAMs的阳性预测值极低，这似乎与这些模型在普通人群中经大量调查验证的良好效果形成鲜明对比。这一事实可能归因于未将结核病或一般慢性感染视为VTE发生率的独立指标。这些发现表明需要修订现有的RAMs或为结核病患者建立单独的VTE预测RAMs，类似于癌症患者的VTE风险评估模型。
