Gong Maofeng, Kong Jie, Shi Yadong, Zhao Boxiang, Liu Zhengli, He Xu, Gu Jianping
Department of Interventional and Vascular Radiology, Nanjing First Hospital, Nanjing Medical University, Nanjing, Jiangsu, China.
Front Cardiovasc Med. 2023 Jan 11;9:1083152. doi: 10.3389/fcvm.2022.1083152. eCollection 2022.
Nonfilter-associated inferior vena cava thrombosis (IVCT) is an under-recognized but severe state of venous thromboembolism. The aims of this study were to investigate risk factors and develop a prediction model based on clinical data and imaging findings to evaluate the probability of IVCT in patients with lower extremity deep vein thrombosis (LEDVT).
A single-center retrospective cohort study was conducted. We analyzed the clinical data and multimodal imaging findings of consecutive patients with confirmed LEDVT between February 2016 and January 2022. The demographics, presentation of LEDVT, laboratory examination, thrombus characteristics, comorbidities and risk factors for LEDVT, and imaging findings were analyzed using an independent -test, test, exact test, and regression analysis to determine the univariable and multivariable associations and to establish a predictive model to assess the probability of IVCT.
A total of 267 eligible patients were included, of whom 40 were in the IVCT group and 227 were in the non-IVCT group. The incidence of nonfilter-associated IVCT was 15.0% (40/267). Age < 63.5 years [odds ratio (OR) 2.54; 95% confidence interval (CI), 1.10-5.85, = 0.029], male sex (OR 2.82; 95% CI, 1.19-6.72, = 0.019), proximal DVT (OR 8.21; 95% CI, 1.01-66.76, = 0.049), bilateral DVT (OR 7.30; 95% CI, 3.28-16.21, < 0.001), and D-dimer >4.72 μg/ml (OR 4.64; 95% CI, 1.80-11.72, = 0.001) were risk factors for IVCT's occurrence. Then, we established a prediction model based on these risk factors. The diagnostic efficiency [area under the curve (AUC) of receiver operating characteristic (ROC) curve was 0.858] for predicting IVCT was superior to that of isolated risk factors, including age < 63.5 years (AUC of ROC curve was 0.624) or D-dimer >4.72 μg/ml (AUC of ROC curve was 0.656).
Age < 63.5 years, male sex, proximal LEDVT, bilateral LEDVT and D-dimer >4.72 μg/ml were risk factors. The diagnostic efficiency of the predictive model for predicting IVCT was superior to that of a single risk factor alone. It may be used for predicting the probability of nonfilter-associated IVCT in patients with LEDVT.
非滤器相关的下腔静脉血栓形成（IVCT）是一种未得到充分认识但严重的静脉血栓栓塞状态。本研究的目的是调查危险因素，并基于临床数据和影像学表现开发一种预测模型，以评估下肢深静脉血栓形成（LEDVT）患者发生IVCT的概率。
进行了一项单中心回顾性队列研究。我们分析了2016年2月至2022年1月期间确诊为LEDVT的连续患者的临床数据和多模态影像学表现。使用独立样本t检验、卡方检验、确切概率检验和回归分析对LEDVT的人口统计学、表现、实验室检查、血栓特征、合并症和危险因素以及影像学表现进行分析，以确定单变量和多变量关联，并建立一个预测模型来评估IVCT的概率。
共纳入267例符合条件的患者，其中40例在IVCT组，227例在非IVCT组。非滤器相关IVCT的发生率为15.0%（40/267）。年龄<63.5岁[比值比（OR）2.54；95%置信区间（CI），1.10 - 5.85，P = 0.029]、男性（OR 2.82；95%CI，1.19 - 6.72，P = 0.019）、近端DVT（OR 8.21；95%CI，1.01 - 66.76，P = 0.049）、双侧DVT（OR 7.30；95%CI，3.28 - 16.21，P < 0.001）和D - 二聚体>4.72μg/ml（OR 4.64；95%CI，1.80 - 11.72，P = 0.001）是IVCT发生的危险因素。然后，我们基于这些危险因素建立了一个预测模型。预测IVCT的诊断效率[受试者操作特征（ROC）曲线下面积（AUC）为0.858]优于单独的危险因素，包括年龄<63.5岁（ROC曲线AUC为0.624）或D - 二聚体>4.72μg/ml（ROC曲线AUC为0.656）。
年龄<63.5岁、男性、近端LEDVT、双侧LEDVT和D - 二聚体>4.72μg/ml是危险因素。预测模型预测IVCT的诊断效率优于单一危险因素。它可用于预测LEDVT患者非滤器相关IVCT的概率。
