Frere Corinne, Crichi Benjamin, Wahl Clémentine, Lesteven Elodie, Connault Jérôme, Durant Cécile, Rueda-Camino Jose Antonio, Yannoutos Alexandra, Bensaoula Okba, Le Maignan Christine, Marjanovic Zora, Farge Dominique
INSERM UMRS-1166, Institute of Cardiometabolism and Nutrition, GRC 27 GRECO, Sorbonne Université, F-75013 Paris, France.
Internal Medicine Unit (UF 04): CRMR MATHEC, Maladies Auto-Immunes et Thérapie Cellulaire, Saint-Louis Hospital, Assistance Publique-Hôpitaux de Paris, F-75010 Paris, France.
J Clin Med. 2022 Jun 28;11(13):3729. doi: 10.3390/jcm11133729.
The Ottawa score (OS) for predicting the risk of recurrent venous thromboembolism (VTE) in cancer patients with VTE may help to guide anticoagulant treatment decisions that will optimize benefit-risk ratios. However, data on its reliability are conflicting. We applied the OS to all cancer patients with VTE enrolled in the prospective multicenter TROPIQUE study who received low-molecular-weight heparin over a 6-month period. Of 409 patients, 171 (41.8%) had a high-risk OS. The 6-month cumulative incidence of recurrent VTE was 7.8% (95%CI 4.2-14.8) in the high-risk OS group versus 4.8% (95%CI 2.6-8.9) in the low-risk OS group (SHR 1.47; 95%CI 0.24-8.55). The Area Under the Receiver Operating Characteristic curve (AUROC) of the OS in identifying patients who developed recurrent VTE was 0.53 (95%CI 0.38-0.65), and its accuracy was 57.9%. Among individual variables included in the OS, only prior VTE was significantly associated with the 6-month risk of recurrent VTE (SHR 4.39; 95% CI 1.13-17.04). When pooling data from all studies evaluating this score for predicting VTE recurrence in cancer patients (7 studies, 3413 patients), the OS estimated pooled AUROC was 0.59 (95%CI 0.56-0.62), and its accuracy was 55.7%. The present findings do not support the use of the OS to assess the risk of recurrent VTE in cancer patients.
渥太华评分（OS）用于预测静脉血栓栓塞症（VTE）复发风险，这对于癌症合并VTE患者而言，可能有助于指导抗凝治疗决策，从而优化获益风险比。然而，关于其可靠性的数据存在矛盾。我们将OS应用于前瞻性多中心TROPIQUE研究中所有接受低分子量肝素治疗6个月的癌症合并VTE患者。在409例患者中，171例（41.8%）的OS为高危。高危OS组6个月复发性VTE的累积发生率为7.8%（95%CI 4.2 - 14.8），而低危OS组为4.8%（95%CI 2.6 - 8.9）（风险比1.47；95%CI 0.24 - 8.55）。OS用于识别发生复发性VTE患者的受试者工作特征曲线下面积（AUROC）为0.53（95%CI 0.38 - 0.65），其准确性为57.9%。在OS所包含的个体变量中，只有既往VTE与6个月复发性VTE风险显著相关（风险比4.39；95%CI 1.13 - 17.04）。当汇总所有评估该评分用于预测癌症患者VTE复发的研究数据（7项研究，3413例患者）时，OS估计的汇总AUROC为0.59（95%CI 0.56 - 0.62），其准确性为55.7%。目前的研究结果不支持使用OS来评估癌症患者复发性VTE的风险。
