Department of Neurosurgery, The Second Affiliated Hospital of Fujian Medical University, Quanzhou, China.
Department of Neurosurgery, The Second Affiliated Clinical Medical College of Fujian Medical University, Quanzhou, China.
Eur J Med Res. 2024 Jun 6;29(1):311. doi: 10.1186/s40001-024-01842-3.
Our study aimed to determine whether there exists an association between low-grade systemic inflammation, as measured by serum C-reactive protein (CRP), and the risk of lower-extremity deep venous thrombosis (LEDVT) in patients with primary intracerebral hemorrhage (ICH).
This observational study was retrospectively conducted on patients with primary ICH who were presented to two tertiary medical centers between January 2021 and August 2022. The primary outcome was detecting LEDVT occurrence within 14 days from the onset of the acute ICH episode. Weighted logistic regression and restricted cubic spline models were employed to estimate the association between CRP and LEDVT following 1:1 propensity score matching (PSM).
Of the 538 patients with primary ICH who met the inclusion criteria, 76 (14.13%) experienced LEDVT. Based on the cut-off levels of CRP measured upon admission from the receiver operating characteristic (ROC) curve, patients with primary ICH were categorized into two groups: (i) CRP < 1.59 mg/L and (ii) CRP ≥ 1.59 mg/L. After 1:1 PSM, the LEDVT events occurred in 24.6% of patients with CRP ≥ 1.59 mg/L and 4.1% of patients with CRP < 1.59 mg/L (P < 0.001). ROC curve revealed the area under the ROC curve of 0.717 [95% confidence interval (CI) 0.669-0.761, P < 0.001] for CRP to predict LEDVT with a sensitivity of 85.71% and specificity of 56.29%. After adjusting for all confounding variables, the occurrence of LEDVT in ICH patients with higher CRP levels (≥ 1.59 mg/L) was 10.8 times higher compared to those with lower CRP levels (95% CI 4.5-25.8, P < 0.001). A nonlinear association was observed between CRP and an increased risk of LEDVT in the fully adjusted model (P for overall < 0.001, P for nonlinear = 0.001). The subgroup results indicated a consistent positive link between CRP and LEDVT events following primary ICH.
Higher initial CRP levels (CRP as a dichotomized variable) in patients with primary ICH are significantly associated with an increased risk of LEDVT and may help identify high-risk patients with LEDVT. Clinicians should be vigilant to enable early and effective intervention in patients at high risk of LEDVT.
本研究旨在探讨血清 C 反应蛋白（CRP）水平较低的全身性低度炎症与原发性脑出血（ICH）患者下肢深静脉血栓（LEDVT）风险之间是否存在关联。
本回顾性观察性研究纳入了 2021 年 1 月至 2022 年 8 月期间在两家三级医疗中心就诊的原发性 ICH 患者。主要结局为在急性 ICH 发作后 14 天内检测到 LEDVT 的发生。采用加权逻辑回归和限制性立方样条模型对 CRP 与 1：1 倾向评分匹配（PSM）后 LEDVT 的相关性进行估计。
在符合纳入标准的 538 例原发性 ICH 患者中，有 76 例（14.13%）发生了 LEDVT。根据接受者操作特征（ROC）曲线测量的入院时 CRP 的截断水平，将原发性 ICH 患者分为两组：（i）CRP＜1.59mg/L；（ii）CRP≥1.59mg/L。1：1 PSM 后，CRP≥1.59mg/L 组患者中 LEDVT 事件的发生率为 24.6%，而 CRP＜1.59mg/L 组患者中 LEDVT 事件的发生率为 4.1%（P＜0.001）。ROC 曲线显示，CRP 预测 LEDVT 的 ROC 曲线下面积为 0.717[95%置信区间（CI）0.669-0.761，P＜0.001]，敏感性为 85.71%，特异性为 56.29%。在调整所有混杂变量后，CRP 水平较高（≥1.59mg/L）的 ICH 患者发生 LEDVT 的风险是 CRP 水平较低（＜1.59mg/L）患者的 10.8 倍（95%CI 4.5-25.8，P＜0.001）。在完全调整模型中，CRP 与 LEDVT 风险增加之间存在非线性关联（总体 P＜0.001，非线性 P=0.001）。亚组结果表明，原发性 ICH 后 CRP 与 LEDVT 事件之间存在一致的正相关关系。
原发性 ICH 患者初始 CRP 水平较高（CRP 为二分类变量）与 LEDVT 风险增加显著相关，可能有助于识别 LEDVT 高危患者。临床医生应保持警惕，以便对 LEDVT 高危患者进行早期和有效的干预。
