Peng Lu, Bao Qiang, Hong Xiaoli, Li Weichao, Zheng Yukai, Zou Zijun, Liao Wenhua, Huang Canxia
Department of Intensive Care Unit, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China.
Ann Transl Med. 2022 Jul;10(14):763. doi: 10.21037/atm-22-2453.
The incidence of deep venous thrombosis (DVT) is higher in surgical patients, but there have been few studies on the risk factors of DVT in intensive care unit (ICU) patients after oral cancer surgery, particularly in relation to the inflammatory and nutritional scores, and intervene with these risk factors early may decrease the occurrence of DVT.
We performed a retrospective study of adult patients who were admitted to ICU after undergoing radical resection of oral cancer and performed ultrasound detection for DVT within 1 week after surgery from April 2019 to July 2021. DVT was diagnosed by venous ultrasonography of the lower extremities. Preoperative inflammatory and nutritional scores, including neutrophil to lymphocyte ratio (NLR), plate to lymphocyte ratio (PLR), prognostic nutritional index (PNI) were retrospectively calculated according to test results before surgery. Clinical characteristics, including the Acute Physiology and Chronic Health Evaluation II (APACHE II) score, Caprini Risk Score (CRS), Charlson comorbidity index, anticoagulation therapy, and mechanical ventilation time (MVT) after admitted to ICU were obtained. The risk factors affecting DVT occurrence were analyzed by logistic regression, and the receiver operating characteristic (ROC) curve was used to analyze the value of the relevant indicators in evaluating DVT.
Among the 128 patients, 43 patients (33.6%) developed DVT. Compared with the non-DVT group, the preoperative glucose (GLU), postoperative D-dimer (P<0.05), and postoperative NLR (P<0.001) were higher in the DVT group than in the non-DVT group. In multivariate logistic analysis, NLR (P=0.001), postoperative D-dimer >5.57 µg/mL (P=0.002), GLU >5.15 mmol/L (P=0.025) was associated with DVT, and the areas under the curve (AUCs) of NLR in predicting DVT was 0.729. We also found that the DVT group had longer MVT and length of stay (LOS) than the non-DVT group, and correlation analysis indicated that NLR level was positively related with MVT (r=0.36; P<0.0001) and LOS (r=0.452; P<0.0001).
A high level of NLR, indicative of a poor immunity and nutrition status, increases the risk of DVT in patients after oral cancer surgery, and improvement of immunity and nutrition status may help decrease the occurrence of postoperative DVT.
外科手术患者深静脉血栓形成（DVT）的发生率较高，但关于口腔癌手术后重症监护病房（ICU）患者DVT危险因素的研究较少，尤其是与炎症和营养评分相关的因素，早期干预这些危险因素可能会降低DVT的发生率。
我们对2019年4月至2021年7月期间接受口腔癌根治性切除术后入住ICU的成年患者进行了一项回顾性研究，并在术后1周内对DVT进行超声检测。通过下肢静脉超声检查诊断DVT。根据术前检查结果回顾性计算术前炎症和营养评分，包括中性粒细胞与淋巴细胞比值（NLR）、血小板与淋巴细胞比值（PLR）、预后营养指数（PNI）。获取临床特征，包括急性生理与慢性健康状况评分系统II（APACHE II）评分、Caprini风险评分（CRS）、Charlson合并症指数、抗凝治疗以及入住ICU后的机械通气时间（MVT）。通过逻辑回归分析影响DVT发生风险的因素，并使用受试者工作特征（ROC）曲线分析相关指标在评估DVT中的价值。
128例患者中，43例（33.6%）发生DVT。与非DVT组相比，DVT组术前血糖（GLU）、术后D-二聚体（P<0.05）和术后NLR（P<0.001）高于非DVT组。在多因素逻辑分析中，NLR（P=0.001）、术后D-二聚体>5.57µg/mL（P=0.002）、GLU>5.15mmol/L（P=0.025）与DVT相关，NLR预测DVT的曲线下面积（AUC）为0.729。我们还发现DVT组的MVT和住院时间（LOS）比非DVT组长，相关性分析表明NLR水平与MVT（r=0.36；P<0.0001）和LOS（r=0.452；P<0.0001）呈正相关。
高水平的NLR表明免疫和营养状况较差，增加了口腔癌手术后患者发生DVT的风险，改善免疫和营养状况可能有助于降低术后DVT的发生率。
