慢性阻塞性肺疾病急性加重住院患者 D-二聚体对 Padua 评分预测静脉血栓栓塞症的优越价值：一项多中心队列研究。
Superior Predictive Value of D-Dimer to the Padua Prediction Score for Venous Thromboembolism in Inpatients with AECOPD: A Multicenter Cohort Study.
机构信息
West China School of Medicine, West China Hospital, Sichuan University, Chengdu, Sichuan Province, People's Republic of China.
State Key Laboratory of Respiratory Disease, Guangzhou Medical University, Guangzhou, Guangdong Province, People's Republic of China.
出版信息
Int J Chron Obstruct Pulmon Dis. 2022 Oct 21;17:2711-2722. doi: 10.2147/COPD.S380418. eCollection 2022.
BACKGROUND
The optimal tool for risk prediction of venous thromboembolism (VTE) in inpatients with acute exacerbation of chronic obstructive pulmonary disease (AECOPD) is still unknown. This study aimed to evaluate whether D-dimer could predict the risk of VTE in inpatients with AECOPD compared to the Padua Prediction Score (PPS).
METHODS
Inpatients with AECOPD were prospectively enrolled from seven medical centers in China between December 2018 and June 2020. On admission, D-dimer was detected, PPS was calculated for each patient, and the incidence of 2-month VTE was investigated. The receiver operating characteristic (ROC) curve was used to evaluate the predictive value of D-dimer and PPS on VTE development, and the best cut-off value for both methods was evaluated through the Youden index.
RESULTS
Among the 4468 eligible patients with AECOPD, 90 patients (2.01%) developed VTE within 2 months after admission. The area under the receiver operating characteristic curves (AUCs) of D-dimer for predicting VTE were significantly higher than those of the PPS both in the overall cohort (0.724, 95% CI 0.672-0.776 vs 0.620, 95% CI 0.562-0.679; P<0.05) and the subgroup of patients without thromboprophylaxis (0.747, 95% CI 0.695-0.799 vs 0.640, 95% CI 0.582-0.698; P<0.05). By calculating the Youden Index, the best cut-off value of D-dimer was determined to be 0.96 mg/L with an AUC of 0.689, which was also significantly better than that of the PPS with the best cut-off value of 2 (AUC 0.581, P=0.007). After the combination of D-dimer with PPS, the AUC (0.621) failed to surpass D-dimer alone (P=0.104).
CONCLUSION
D-dimer has a superior predictive value for VTE over PPS in inpatients with AECOPD, which might be a better choice to guide thromboprophylaxis in inpatients with AECOPD due to its effectiveness and convenience.
CLINICAL TRIAL REGISTRATION
Chinese Clinical Trail Registry NO. ChiCTR2100044625; URL: http://www.chictr.org.cn/showproj.aspx?proj=121626.
背景
用于预测慢性阻塞性肺疾病急性加重（AECOPD）住院患者静脉血栓栓塞症（VTE）风险的最佳工具仍不清楚。本研究旨在评估 D-二聚体与 Padua 预测评分（PPS）相比，是否可以预测 AECOPD 住院患者的 VTE 风险。
方法
2018 年 12 月至 2020 年 6 月，中国 7 家医疗中心前瞻性纳入 AECOPD 住院患者。入院时检测 D-二聚体，计算每位患者的 PPS，并调查 2 个月内 VTE 的发生率。受试者工作特征（ROC）曲线用于评估 D-二聚体和 PPS 对 VTE 发展的预测价值，并通过约登指数评估两种方法的最佳截断值。
结果
在 4468 名符合条件的 AECOPD 患者中，90 名（2.01%）在入院后 2 个月内发生 VTE。D-二聚体预测 VTE 的 ROC 曲线下面积（AUC）明显高于 PPS 在整个队列中的 AUC（0.724，95%CI 0.672-0.776 比 0.620，95%CI 0.562-0.679；P<0.05）和未接受血栓预防治疗的患者亚组的 AUC（0.747，95%CI 0.695-0.799 比 0.640，95%CI 0.582-0.698；P<0.05）。通过计算约登指数，确定 D-二聚体的最佳截断值为 0.96mg/L，AUC 为 0.689，也明显优于最佳截断值为 2 的 PPS（AUC 为 0.581，P=0.007）。D-二聚体与 PPS 联合后，AUC（0.621）并未超过单独使用 D-二聚体（P=0.104）。
结论
D-二聚体对 AECOPD 住院患者的 VTE 预测价值优于 PPS，由于其有效性和便利性，D-二聚体可能是指导 AECOPD 住院患者血栓预防的更好选择。
临床试验注册
中国临床试验注册中心编号 ChiCTR2100044625；网址：http://www.chictr.org.cn/showproj.aspx?proj=121626。
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