Department of General Surgery, Xiangya Hospital of Central South University, Changsha, Hunan Province, China.
Hunan Key Laboratory of Precise Diagnosis and Treatment of Gastrointestinal Tumor, Xiangya Hospital of Central South University, Changsha, Hunan Province, China.
World J Surg Oncol. 2023 Sep 21;21(1):299. doi: 10.1186/s12957-023-03183-7.
To explore the diagnostic value of Caprini risk assessment model (2005) combined with D-dimer for deep vein thrombosis, and to exclude patients with low incidence of thrombosis who might not need anticoagulation after surgery.
A total of 171 colorectal cancer patients who underwent surgery from January 2022 to August 2022 were enrolled in this study. Caprini risk assessment model was used to evaluate patients the day before surgery, and full-length venous ultrasonography of lower extremity was used to assess whether patients had thrombosis one day before surgery and the sixth day after surgery. The value of D-dimer was measured by enzyme-linked immunosorbent assays on the first day after surgery, and clinical data of patients were collected during hospitalization.
A total of 171 patients were divided into IPC Group and IPC + LMWH Group according to whether low molecular weight heparin (LMWH) were used to prevent thrombus after surgery. Eventually, 17.6% (15/85) patients in IPC Group and 7% (6/86) patients in IPC + LMWH Group developed DVT. Through separate analysis of IPC Group, it is found that Caprini score and D-dimer were independent risk factors for DVT (Caprini OR 3.39 [95% CI 1.38-8.32]; P = 0.008, D-Dimer OR 6.142 [95% CI 1.209-31.187]; P = 0.029). The area under ROC curve of Caprini risk assessment model is 0.792 (95% CI 0.69-0.945, P < 0.01), the cut-off value is 9.5, and the area under ROC curve of D-dimer is 0.738 (95%CI 0.555-0.921, P < 0.01), the cut-off value is 0.835 μg/mL, and the area under the ROC curve was 0.865 (95% CI 0.754-0.976, P < 0.01) when both of them were combined. Based on decision curve analysis, it is found that Caprini risk assessment model combined with D-dimer can benefit patients more. All patients are divided into four groups. When Caprini score < 10 and D-dimer < 0.835 μg/mL, only 1.23% (1/81) of patients have thrombosis and LMWH has little significance. When Caprini score > 10 and D-dimer > 0.835 μg/mL, the incidence of DVT is 38.7% (12/31) and LMWH should be considered.
The Caprini risk assessment model and D-dimer can provide more accurate risk stratification for patients after laparoscopic radical resection of colorectal cancer.
探讨卡普里尼风险评估模型（2005 年）联合 D-二聚体对深静脉血栓形成的诊断价值，排除术后发生血栓风险低、可能不需要抗凝治疗的患者。
选取 2022 年 1 月至 2022 年 8 月接受手术的 171 例结直肠癌患者，术前 1 天采用卡普里尼风险评估模型进行评估，术前及术后第 6 天行下肢全长静脉超声检查，术后第 1 天采用酶联免疫吸附法测定 D-二聚体，收集患者住院期间的临床资料。
根据术后是否使用低分子肝素（LMWH）预防血栓形成，将 171 例患者分为 IPC 组和 IPC+LMWH 组。最终，IPC 组 15/85（17.6%）例患者和 IPC+LMWH 组 6/86（7%）例患者发生 DVT。对 IPC 组进行单独分析，发现卡普里尼评分和 D-二聚体是 DVT 的独立危险因素（卡普里尼 OR 3.39[95%CI 1.38-8.32]；P=0.008，D-二聚体 OR 6.142[95%CI 1.209-31.187]；P=0.029）。卡普里尼风险评估模型的 ROC 曲线下面积为 0.792（95%CI 0.69-0.945，P<0.01），截断值为 9.5，D-二聚体的 ROC 曲线下面积为 0.738（95%CI 0.555-0.921，P<0.01），截断值为 0.835μg/mL，两者联合时 ROC 曲线下面积为 0.865（95%CI 0.754-0.976，P<0.01）。基于决策曲线分析，发现卡普里尼风险评估模型联合 D-二聚体能为患者带来更多获益。将所有患者分为四组，当卡普里尼评分<10 且 D-二聚体<0.835μg/mL 时，仅 1.23%（1/81）例患者发生血栓，LMWH 意义不大；当卡普里尼评分>10 且 D-二聚体>0.835μg/mL 时，DVT 发生率为 38.7%（12/31），应考虑使用 LMWH。
卡普里尼风险评估模型和 D-二聚体可对腹腔镜结直肠癌根治术后患者进行更准确的风险分层。
