Hayssen Hilary, Sahoo Shalini, Nguyen Phuong, Mayorga-Carlin Minerva, Siddiqui Tariq, Englum Brian, Slejko Julia F, Mullins C Daniel, Yesha Yelena, Sorkin John D, Lal Brajesh K
medRxiv. 2023 Mar 21:2023.03.20.23287506. doi: 10.1101/2023.03.20.23287506.
Venous thromboembolism (VTE) is a preventable complication of hospitalization. Risk-stratification is the cornerstone of prevention. The Caprini and Padua are the most commonly used risk-assessment models to quantify VTE risk. Both models perform well in select, high-risk cohorts. While VTE risk-stratification is recommended for all hospital admissions, few studies have evaluated the models in a large, unselected cohort of patients.
We analyzed consecutive first hospital admissions of 1,252,460 unique surgical and non-surgical patients to 1,298 VA facilities nationwide between January 2016 and December 2021. Caprini and Padua scores were generated using the VA's national data repository. We first assessed the ability of the two RAMs to predict VTE within 90 days of admission. In secondary analyses, we evaluated prediction at 30 and 60 days, in surgical versus non-surgical patients, after excluding patients with upper extremity DVT, in patients hospitalized ≥72 hours, after including all-cause mortality in the composite outcome, and after accounting for prophylaxis in the predictive model. We used area under the receiver-operating characteristic curves (AUC) as the metric of prediction.
A total of 330,388 (26.4%) surgical and 922,072 (73.6%) non-surgical consecutively hospitalized patients (total n=1,252,460) were analyzed. Caprini scores ranged from 0-28 (median, interquartile range: 4, 3-6); Padua scores ranged from 0-13 (1, 1-3). The RAMs showed good calibration and higher scores were associated with higher VTE rates. VTE developed in 35,557 patients (2.8%) within 90 days of admission. The ability of both models to predict 90-day VTE was low (AUCs: Caprini 0.56 [95% CI 0.56-0.56], Padua 0.59 [0.58-0.59]). Prediction remained low for surgical (Caprini 0.54 [0.53-0.54], Padua 0.56 [0.56-0.57]) and non-surgical patients (Caprini 0.59 [0.58-0.59], Padua 0.59 [0.59-0.60]). There was no clinically meaningful change in predictive performance in patients admitted for ≥72 hours, after excluding upper extremity DVT from the outcome, after including all-cause mortality in the outcome, or after accounting for ongoing VTE prophylaxis.
Caprini and Padua risk-assessment model scores have low ability to predict VTE events in a cohort of unselected consecutive hospitalizations. Improved VTE risk-assessment models must be developed before they can be applied to a general hospital population.
静脉血栓栓塞症（VTE）是一种可预防的住院并发症。风险分层是预防的基石。Caprini和Padua是最常用的用于量化VTE风险的风险评估模型。这两种模型在特定的高危队列中表现良好。虽然建议对所有住院患者进行VTE风险分层，但很少有研究在未经选择的大型患者队列中评估这些模型。
我们分析了2016年1月至2021年12月期间全国1298家退伍军人事务部（VA）医疗机构中1,252,460名独特的外科和非外科患者的连续首次住院情况。使用VA的国家数据存储库生成Caprini和Padua评分。我们首先评估这两种风险评估模型（RAMs）在入院后90天内预测VTE的能力。在二次分析中，我们评估了30天和60天时的预测情况，比较了外科与非外科患者，排除上肢深静脉血栓形成（DVT）患者后，住院≥72小时的患者，将全因死亡率纳入复合结局后，以及在预测模型中考虑预防措施后的预测情况。我们使用受试者操作特征曲线下面积（AUC）作为预测指标。
共分析了330,388名（26.4%）外科和922,072名（73.6%）非外科连续住院患者（总计n = 1,252,460）。Caprini评分范围为0 - 28（中位数，四分位间距：4，3 - 6）；Padua评分范围为0 - 13（1，1 - 3）。这些RAMs显示出良好的校准，较高的评分与较高的VTE发生率相关。35,557名患者（2.8%）在入院后90天内发生VTE。两种模型预测90天VTE的能力较低（AUC：Caprini为0.56 [95%置信区间0.56 - 0.56]，Padua为0.59 [0.58 - 0.59]）。外科患者（Caprini为0.54 [0.53 - 0.54]，Padua为0.56 [0.56 - 0.57]）和非外科患者（Caprini为0.59 [0.58 - 0.59]，Padua为0.59 [0.59 - 0.60]）的预测能力仍然较低。在住院≥72小时的患者中，从结局中排除上肢DVT后，将全因死亡率纳入结局后，或在考虑正在进行的VTE预防措施后，预测性能没有临床上有意义的变化。
Caprini和Padua风险评估模型评分在未经选择的连续住院患者队列中预测VTE事件的能力较低。在将改进的VTE风险评估模型应用于普通医院人群之前，必须先开发出来。
