Harvey Philip R, Coupland Benjamin, Mytton Jemma, De Silva Shanika, Trudgill Nigel J
Department of Gastroenterology, Royal Wolverhampton NHS Trust, Wolverhampton, UK.
Department of Health Informatics, University Hospital Birmingham NHS Foundation Trust, Birmingham, UK.
J Crohns Colitis. 2023 Jan 27;17(1):103-110. doi: 10.1093/ecco-jcc/jjac112.
Patients admitted to hospital with inflammatory bowel disease[IBD] are at increased risk of venous thromboembolism[VTE]. This study aims to identify IBD patients at increased VTE risk on hospital discharge and to develop a risk scoring system to recognise them.
Hospital episode statistics data were used to identify all patients admitted with IBD as an emergency or electively for surgery. All patients with VTE within 90 days of hospital discharge were identified. A multilevel logistic regression model was used to identify patient- and admission-level factors associated with VTE. A scoring system to identify patients at higher risk for VTE was constructed.
A total of 201 779 admissions in 101 966 patients were included. The rate of VTE within 90 days was 17.2 per 1000 patient-years at risk and was highest in patients admitted as an emergency who underwent surgery[36.9]. VTE was associated with: female sex (odds ratio 0.65 [95% confidence interval 0.53-0.80], p <0.001); increasing age [49-60 years] (4.67 [3.36-6.49], p <0.001); increasing length of hospital stay [>10 days] (3.80 [2.80-5.15], p <0.001); more than two hospital admissions in previous 3 months (2.23 [1.60-3.10], p <0.001); ulcerative colitis (1.48 [1.21-1.82], p <0.001); and emergency admission including surgery (1.59 [1.12-2.27], p = 0.010); or emergency admission not including surgery (1.59 [1.08-2.35], p = 0.019) compared with elective surgery. A score >12 in the VTE scoring system gave a positive predictive value [PPV] of VTE of 1%. The area under the curve [AUC] was 0.714 [95% CI 0.70-0.73].
IBD patients admitted to hospital with a prolonged length of stay, increasing age, male sex, or as an emergency were at increased risk of VTE following discharge. Higher-risk patients were identifiable by a VTE risk scoring system.
因炎症性肠病（IBD）入院的患者发生静脉血栓栓塞症（VTE）的风险增加。本研究旨在确定出院时VTE风险增加的IBD患者，并开发一种风险评分系统以识别这些患者。
利用医院病历统计数据确定所有因急诊或择期手术而入院的IBD患者。确定所有在出院后90天内发生VTE的患者。采用多水平逻辑回归模型确定与VTE相关的患者和入院水平因素。构建一个用于识别VTE高风险患者的评分系统。
共纳入101966例患者的201779次入院记录。90天内VTE发生率为每1000患者年17.2例，在接受手术的急诊入院患者中最高（36.9例）。VTE与以下因素相关：女性（比值比0.65 [95%置信区间0.53 - 0.80]，p <0.001）；年龄增加[49 - 60岁]（4.67 [3.36 - 6.49]，p <0.001）；住院时间延长[>10天]（3.80 [2.80 - 5.15]，p <0.001）；前3个月内超过2次住院（2.23 [1.60 - 3.10]，p <0.001）；溃疡性结肠炎（1.48 [1.21 - 1.82]，p <0.001）；包括手术的急诊入院（1.59 [1.12 - 2.27]，p = 0.010）；或与择期手术相比不包括手术的急诊入院（1.59 [1.08 - 2.35]，p = 0.019）。VTE评分系统中得分>12时，VTE的阳性预测值（PPV）为1%。曲线下面积（AUC）为0.714 [95%CI 0.70 - 0.73]。
住院时间延长、年龄增加、男性或急诊入院的IBD患者出院后发生VTE的风险增加。通过VTE风险评分系统可识别高风险患者。
