Liu Yang, Sun Hongze, Jiang Jianjun
Department of General Surgery, Vascular Surgery, Qilu Hospital of Shandong University, Jinan, People's Republic of China.
J Inflamm Res. 2023 Jan 14;16:225-234. doi: 10.2147/JIR.S399000. eCollection 2023.
In this study, we aimed to determine the mortality risk factors and whether placement of a vena cava filter improves the prognosis of acute upper extremity deep vein thrombosis (UEDVT).
Clinical data and follow-up results were retrospectively analyzed. Cox regression analysis was conducted to identify the risk factors associated with all-cause mortality in all patients and subgroups of patients. Results are expressed as hazard ratio (HR) with 95% confidence intervals (95% CI). Receiver operating characteristic curves (ROC) were used to determine the optimal cut-off value. Kaplan-Meier survival curves were constructed and compared by the Log rank test.
The study cohort comprised 109 patients of median age 56 years (47.5, 64.5). The median follow-up time was 25 months (8, 47): 39 patients (35.8%) had died by 12 months, 55 (50.5%) by 36 months, and 60 (55%) by the end of follow-up. Presence of malignancy (HR: 5.882, 95% CI: 2.128-16.667), D-dimer (HR: 1.56, 95% CI: 1.09-1.94), platelet/lymphocyte ratio (PLR; HR: 2.02, 95% CI: 1.15-3.54), and the systemic immune/inflammatory index (SII; HR: 1.471, 95% CI: 1.062-1.991) were identified as independent risk factors for mortality. Subgroup analysis of patients with malignancy determined gender (HR: 2.936, 95% CI: 1.599-5.393) and PLR (HR: 1.427,95% CI: 1.023-1.989) as independent risk factors. Kaplan-Meier analysis showed that the mortality rate was much higher in patients with malignancy, high D-dimer (≥ 0.92ug/mL), high PLR (≥ 291) and high SII (≥ 1487). However, there was no significant difference between patients with and without vena cava filters.
In this study, we identified PLR as an new independent predictor of mortality in patients with acute UEDVT. Emergency placement of a vena cava filter did not improve long-term prognosis.
在本研究中，我们旨在确定死亡率的危险因素，以及下腔静脉滤器的置入是否能改善急性上肢深静脉血栓形成（UEDVT）的预后。
对临床数据和随访结果进行回顾性分析。进行Cox回归分析以确定所有患者及患者亚组中与全因死亡率相关的危险因素。结果以风险比（HR）及95%置信区间（95%CI）表示。采用受试者工作特征曲线（ROC）确定最佳截断值。构建Kaplan-Meier生存曲线并通过对数秩检验进行比较。
研究队列包括109例患者，中位年龄56岁（47.5，64.5）。中位随访时间为25个月（8，47）：39例患者（35.8%）在12个月时死亡，55例（50.5%）在36个月时死亡，60例（55%）在随访结束时死亡。恶性肿瘤的存在（HR：5.882，95%CI：2.128 - 16.667）、D-二聚体（HR：1.56，95%CI：1.09 - 1.94）、血小板/淋巴细胞比值（PLR；HR：2.02，95%CI：1.15 - 3.54）以及全身免疫/炎症指数（SII；HR：1.471，95%CI：1.062 - 1.991）被确定为死亡的独立危险因素。对恶性肿瘤患者的亚组分析确定性别（HR：2.936，95%CI：1.599 - 5.393）和PLR（HR：1.427，95%CI：1.023 - 1.989）为独立危险因素。Kaplan-Meier分析显示，恶性肿瘤患者、高D-二聚体（≥0.92μg/mL）、高PLR（≥291）和高SII（≥1487）患者的死亡率要高得多。然而，置入和未置入下腔静脉滤器的患者之间没有显著差异。
在本研究中，我们确定PLR是急性UEDVT患者死亡率的一个新的独立预测因素。紧急置入下腔静脉滤器并不能改善长期预后。
