Department of Respiratory and Critical Care Medicine, Beijing Shijitan Hospital, Capital Medical University, Beijing, China.
Department of Hepatobiliary and Pancreatic Surgery, The People Hospital of Pu'er, Pu'er, China.
Clin Appl Thromb Hemost. 2024 Jan-Dec;30:10760296241247205. doi: 10.1177/10760296241247205.
To external validate the risk assessment model (RAM) of venous thromboembolism (VTE) in multicenter internal medicine inpatients. We prospectively collected 595 internal medical patients (310 with VTE patients, 285 non-VTE patients) were from Beijing Shijitan Hospital, Beijing Chaoyang Hospital, and the respiratory department of Beijing Tsinghua Changgeng Hospital from January 2022 to December 2022 for multicenter external validation. The prediction ability of Caprini RAM, Padua RAM, The International Medical Prevention Registry on Venous Thromboembolism (IMPROVE) RAM, and Shijitan (SJT) RAM were compared. This study included a total of 595 internal medicine inpatients, including 242 (40.67%) in the respiratory department, 17 (2.86%) in the respiratory intensive care unit, 49 (8.24%) in the neurology department, 34 (5.71%) in the intensive care unit, 26 (4.37%) in the geriatric department, 22 (3.70%) in the emergency department, 71 (11.93%) in the nephrology department, 63 (10.59%) in the cardiology department, 24 (4.03%) in the hematology department, 6 (1.01%) in the traditional Chinese medicine department, 9 (1.51%) cases in the rheumatology department, 7 (1.18%) in the endocrinology department, 14 (2.35%) in the oncology department, and 11 (1.85%) in the gastroenterology department. Multivariate logistic regression analysis showed that among internal medicine inpatients, age > 60 years old, heart failure, nephrotic syndrome, tumors, history of VTE, and elevated D-dimer were significantly correlated with the occurrence of VTE ( < .05). The incidence of VTE increases with the increase of D-dimer. It was found that the effectiveness of SJT RAM (AUC = 0.80 ± 0.03) was better than Caprini RAM (AUC = 0.74 ± 0.03), Padua RAM (AUC = 0.72 ± 0.03) and IMPROVE RAM (AUC = 0.52 ± 0.03) ( < .05). The sensitivity and Yoden index of SJT RAM were higher than those of Caprini RAM, Pauda RAM, and IMPROVE RAM ( < .05), but specificity was not significantly different between the 4 models ( > .05). The SJT RAM derived from general hospitalized Chinese patients has effective and better predictive ability for internal medicine inpatients at risk of VTE.
为了对外验证多中心内科住院患者静脉血栓栓塞症(VTE)风险评估模型(RAM)。我们前瞻性收集了 2022 年 1 月至 12 月来自北京世纪坛医院、北京朝阳医院和北京清华长庚医院呼吸科的 595 名内科住院患者(310 例 VTE 患者,285 例非 VTE 患者)进行多中心外部验证。比较了 Caprini RAM、Padua RAM、国际静脉血栓栓塞预防注册研究(IMPROVE)RAM 和 Shijitan(SJT)RAM 的预测能力。本研究共纳入 595 例内科住院患者,其中呼吸科 242 例(40.67%),呼吸重症监护病房 17 例(2.86%),神经科 49 例(8.24%),重症监护病房 34 例(5.71%),老年科 26 例(4.37%),急诊 22 例(3.70%),肾病科 71 例(11.93%),心内科 63 例(10.59%),血液科 24 例(4.03%),中医科 6 例(1.01%),风湿科 9 例(1.51%),内分泌科 7 例(1.18%),肿瘤科 14 例(2.35%),消化科 11 例(1.85%)。多因素 logistic 回归分析显示,内科住院患者中年龄>60 岁、心力衰竭、肾病综合征、肿瘤、VTE 史和 D-二聚体升高与 VTE 的发生显著相关( < .05)。D-二聚体水平升高,VTE 发生率增加。发现 SJT RAM(AUC=0.80±0.03)的有效性优于 Caprini RAM(AUC=0.74±0.03)、Padua RAM(AUC=0.72±0.03)和 IMPROVE RAM(AUC=0.52±0.03)( < .05)。SJT RAM 的灵敏度和 Yoden 指数均高于 Caprini RAM、Padua RAM 和 IMPROVE RAM( < .05),但 4 种模型的特异性无显著差异( > .05)。源自中国普通住院患者的 SJT RAM 对 VTE 风险的内科住院患者具有有效且更好的预测能力。