Mitrovic Mirjana, Pantic Nikola, Bukumiric Zoran, Sabljic Nikica, Virijevic Marijana, Pravdic Zlatko, Cvetkovic Mirjana, Ilic Nikola, Rajic Jovan, Todorovic-Balint Milena, Vidovic Ana, Suvajdzic-Vukovic Nada, Thachil Jecko, Antic Darko
Clinic of Hematology, University Clinical Center of Serbia, Belgrade, Serbia.
Faculty of Medicine, University of Belgrade, Belgrade, Serbia.
Thromb J. 2024 Apr 17;22(1):37. doi: 10.1186/s12959-024-00607-6.
Patients with acute myeloid leukemia (AML) are at increased risk of venous thromboembolic events (VTE). However, thromboprophylaxis is largely underused.
This study aimed to determine possible VTE development risk factors and to develop a novel predictive model.
We conducted a retrospective cohort study of adult patients with newly diagnosed AML. We used univariate and multivariable logistic regression to estimate binary outcomes and identify potential predictors. Based on our final model, a dynamic nomogram was constructed with the goal of facilitating VTE probability calculation.
Out of 626 eligible patients with AML, 72 (11.5%) developed VTE during 6 months of follow-up. Six parameters were independent predictors: male sex (odds ratio [OR] 1.82, 95% confidence interval [CI]: 1.077-2.065), prior history of thrombotic events (OR 2.27, 95% CI: 1.4-4.96), international normalized ratio (OR 0.21, 95% CI: 0.05-0.95), Eastern Cooperative Oncology Group performance status (OR 0.71, 95% CI: 0.53-0.94), and intensive therapy (OR 2.05, 95% CI: 1.07-3.91). The C statistics for the model was 0.68. The model was adequately calibrated and internally validated. The decision-curve analysis suggested the use of thromboprophylaxis in patients with VTE risks between 8 and 20%.
We developed a novel and convenient tool that may assist clinicians in identifying patients whose VTE risk is high enough to warrant thromboprophylaxis.
急性髓系白血病（AML）患者发生静脉血栓栓塞事件（VTE）的风险增加。然而，血栓预防措施在很大程度上未得到充分应用。
本研究旨在确定VTE发生的可能危险因素，并开发一种新型预测模型。
我们对新诊断的成年AML患者进行了一项回顾性队列研究。我们使用单变量和多变量逻辑回归来估计二元结局并识别潜在预测因素。基于我们的最终模型，构建了一个动态列线图，目的是便于计算VTE概率。
在626例符合条件的AML患者中，72例（11.5%）在随访6个月期间发生了VTE。六个参数是独立预测因素：男性（比值比[OR]1.82，95%置信区间[CI]：1.077 - 2.065）、既往血栓形成事件史（OR 2.27，95% CI：1.4 - 4.96）、国际标准化比值（OR 0.21，95% CI：0.05 - 0.95）、东部肿瘤协作组体能状态（OR 0.71，95% CI：0.53 - 0.94）和强化治疗（OR 2.05，95% CI：1.07 - 3.91）。该模型的C统计量为0.68。该模型经过了充分校准和内部验证。决策曲线分析表明，对于VTE风险在8%至20%之间的患者应使用血栓预防措施。
我们开发了一种新型且便捷的工具，可帮助临床医生识别VTE风险高到足以进行血栓预防的患者。
