Liu Hongmei, Li Lamei, Zhao Zhe
Department of Gynaecology, the First Affiliated Hospital of Shihezi University, Shihezi, 832000, People's Republic of China.
Department of Gynaecology and Obstetrics, Shihezi University School of Medicine, Shihezi, 832000, People's Republic of China.
Int J Womens Health. 2024 Jan 12;16:47-53. doi: 10.2147/IJWH.S443245. eCollection 2024.
To evaluate the predictive value of the combination of the Caprini risk assessment model (RAM) and D-dimer for venous thromboembolism (VTE) during puerperium.
This was a retrospective case-control study. Thirty-one puerperium patients with VTE were included as cases, and 279 puerperium women without VTE were matched to cases according to age, number of fetuses, birth day and delivery mode at the ratio of 9:1. Demographic data, clinical data and laboratory parameters within postpartum 24 h were collected. Multivariate analysis, employing the forward stepwise model, was conducted to identify independent factors associated with VTE during puerperium. The predictive values of Caprini RAM, D-dimer and their combination were evaluated using receiver operating characteristic (ROC) curve, and the area under curve (AUC) was compared using test.
Univariate analysis demonstrated that there were significant differences in D-dimer levels, Caprini score, scarred uterus, adherent placenta, postpartum hemorrhage and intrauterine infection between cases and controls (<0.05). Multivariate analysis demonstrated that D-dimer levels (: 1.754, 95% : 1.237-3.182), Caprini score (: 1.209, 95% : 1.058-2.280), scarred uterus (: 1.978, 95% : 1.258-3.794), postpartum hemorrhage (: 2.276, 95% : 1.334-4.347) and intrauterine infection (: 2.575, 95% : 1.463-4.618) were independently associated with VTE during puerperium with adjustment for adherent placenta and fetal birth weight. The AUCs of D-dimer levels, Caprini score and their combination were 0.748 (: 0.030, 95% : 0.688-0.807), 0.647 (: 0.035, 95% : 0.578-0.716) and 0.840 (: 0.025, 95% : 0.791-0.888). Combination prediction had a higher AUC compared with that of independent prediction (0.840 0.748, =2.356, 0.009; 0.840 vs 0.647, =4.487, <0.001) with a sensitivity of 83.9% and specificity of 80.3%.
The combination of the Caprini RAM and D-dimer could significantly elevate the predictive value for VTE during puerperium, and this new tool had the potential in the prediction of VTE during puerperium.
评估Caprini风险评估模型（RAM）与D - 二聚体联合检测对产褥期静脉血栓栓塞症（VTE）的预测价值。
这是一项回顾性病例对照研究。纳入31例产褥期VTE患者作为病例组，按照年龄、胎儿数、分娩日期和分娩方式以9:1的比例匹配279例无VTE的产褥期妇女作为对照组。收集产后24小时内的人口统计学数据、临床资料和实验室参数。采用向前逐步模型进行多因素分析，以确定与产褥期VTE相关的独立因素。使用受试者工作特征（ROC）曲线评估Caprini RAM、D - 二聚体及其联合检测的预测价值，并使用检验比较曲线下面积（AUC）。
单因素分析显示，病例组与对照组在D - 二聚体水平、Caprini评分、瘢痕子宫、胎盘粘连、产后出血和宫内感染方面存在显著差异（<0.05）。多因素分析显示，校正胎盘粘连和胎儿出生体重后，D - 二聚体水平（: 1.754，95% : 1.237 - 3.182）、Caprini评分（: 1.209，95% : 1.058 - 2.280）、瘢痕子宫（: 1.978，95% : 1.258 - 3.794）、产后出血（: 2.276，95% : 1.334 - 4.347）和宫内感染（: 2.575，95% : 1.463 - 4.618）与产褥期VTE独立相关。D - 二聚体水平、Caprini评分及其联合检测的AUC分别为0.748（: 0.030，95% : 0.688 - 0.807）、0.647（: 0.035，95% : 0.578 - 0.716）和0.840（: 0.025，95% : 0.791 - 0.888）。联合预测的AUC高于单独预测（0.840 0.748，=2.356，0.009；0.840 vs 0.647，=4.487，<0.001），敏感性为83.9%，特异性为80.3%。
Caprini RAM与D - 二聚体联合检测可显著提高产褥期VTE的预测价值，这一新工具在产褥期VTE预测方面具有潜力。
