Jiang Jiabao, Xing Fei, Luo Rong, Chen Zhao, Liu Hao, Xiang Zhou, Duan Xin
Department of Orthopedic Surgery, Orthopedic Research Institute, West China Hospital, Sichuan University, Chengdu, Sichuan, China.
Department of Orthopedics Surgery, West China Sanya Hospital, Sichuan University, Sanya, Hainan, China.
Front Med (Lausanne). 2023 Sep 1;10:1236451. doi: 10.3389/fmed.2023.1236451. eCollection 2023.
Calf muscular vein thrombosis (CMVT) is a common complication in geriatric hip fracture patients. Despite its high incidence, prior research on the topic is limited. The occurrence of CMVT in patients will prolong the preoperative waiting time and even lead to serious thromboembolic events, which can be detrimental to the patient's prognosis. Therefore, this study aimed to identify the risk factors for preoperative CMVT in geriatric hip fracture patients and construct a nomogram model to predict the risk of preoperative CMVT in patients.
Geriatric hip fracture patients who underwent surgery between January 2019 and January 2022 were included. The patients were categorized into two groups depending on whether they had preoperative CMVT, confirmed through Color Doppler ultrasound or venography examination. Univariate and multivariate logistic regression analyses were used to analyze demographic characteristics, medical history, comorbidities, and laboratory tests. A nomogram was constructed to predict preoperative CMVT in geriatric hip fracture patients based on the results of the multivariate logistic regression.
Three hundred and eighty-eight geriatric hip fracture patients, including one hundred and thirty-four patients with CMVT and two hundred and fifty-four patients without CMVT, were ultimately included in our study. After multivariable logistic regression analysis, the time from injury to admission, smoking history, serum albumin levels, and D-dimer levels was identified as independent risk factors and was entered into a nomogram model. The nomogram showed robust discrimination, with an area under the receiver operating characteristic curve of 0.805. The calibration curve showed strong agreement between the CMVT probabilities predicted by the nomogram and the actual probabilities. The decision curve analysis illustrates the excellent clinical utility of the model.
We have constructed a new nomogram prediction model that can effectively predict the risk of preoperative CMVT in geriatric hip fracture patients based on their medical history and blood test results. This model can help clinicians make individualized predictions of CMVT that are tailored to each patient's unique circumstances.
小腿肌肉静脉血栓形成（CMVT）是老年髋部骨折患者常见的并发症。尽管其发病率很高，但此前关于该主题的研究有限。患者发生CMVT会延长术前等待时间，甚至导致严重的血栓栓塞事件，这对患者的预后可能不利。因此，本研究旨在确定老年髋部骨折患者术前CMVT的危险因素，并构建列线图模型以预测患者术前CMVT的风险。
纳入2019年1月至2022年1月期间接受手术的老年髋部骨折患者。根据经彩色多普勒超声或静脉造影检查确诊是否存在术前CMVT，将患者分为两组。采用单因素和多因素逻辑回归分析来分析人口统计学特征、病史、合并症和实验室检查结果。根据多因素逻辑回归结果构建列线图，以预测老年髋部骨折患者术前CMVT的发生情况。
最终纳入388例老年髋部骨折患者，其中134例患有CMVT，254例未患有CMVT。经过多因素逻辑回归分析，受伤至入院时间、吸烟史、血清白蛋白水平和D-二聚体水平被确定为独立危险因素，并纳入列线图模型。该列线图显示出较强的区分能力，受试者工作特征曲线下面积为0.805。校准曲线显示列线图预测的CMVT概率与实际概率之间具有高度一致性。决策曲线分析表明该模型具有出色的临床实用性。
我们构建了一种新的列线图预测模型，该模型可以根据老年髋部骨折患者的病史和血液检查结果有效预测其术前CMVT的风险。该模型有助于临床医生针对每位患者的独特情况进行个性化的CMVT预测。
