Zhao Ming-Xian, Li Guo-Jie
Department of Vascular Surgery, Qinghai Province Cardiovascular and Cerebrovascular Disease Specialist Hospital, Xining 810000, Qinghai Province, China.
World J Clin Cases. 2024 Aug 6;12(22):4881-4889. doi: 10.12998/wjcc.v12.i22.4881.
Patients with deep venous thrombosis (DVT) residing at high altitudes can only rely on anticoagulation therapy, missing the optimal window for surgery or thrombolysis. Concurrently, under these conditions, patient outcomes can be easily complicated by high-altitude polycythemia (HAPC), which increases the difficulty of treatment and the risk of recurrent thrombosis. To prevent reaching this point, effective screening and targeted interventions are crucial. Thus, this study analyzes and provides a reference for the clinical prediction of thrombosis recurrence in patients with lower-extremity DVT combined with HAPC.
To apply the nomogram model in the evaluation of complications in patients with HAPC and DVT who underwent anticoagulation therapy.
A total of 123 patients with HAPC complicated by lower-extremity DVT were followed up for 6-12 months and divided into recurrence and non-recurrence groups according to whether they experienced recurrence of lower-extremity DVT. Clinical data and laboratory indices were compared between the groups to determine the influencing factors of thrombosis recurrence in patients with lower-extremity DVT and HAPC. This study aimed to establish and verify the value of a nomogram model for predicting the risk of thrombus recurrence.
Logistic regression analysis showed that age, immobilization during follow-up, medication compliance, compliance with wearing elastic stockings, and peripheral blood D-dimer and fibrin degradation product levels were indepen-dent risk factors for thrombosis recurrence in patients with HAPC complicated by DVT. A Hosmer-Lemeshow goodness-of-fit test demonstrated that the nomogram model established based on the results of multivariate logistic regression analysis was effective in predicting the risk of thrombosis recurrence in patients with lower-extremity DVT complicated by HAPC ( = 0.873; > 0.05). The consistency index of the model was 0.802 (95%CI: 0.799-0.997), indicating its good accuracy and discrimination.
The column chart model for the personalized prediction of thrombotic recurrence risk has good application value in predicting thrombotic recurrence in patients with lower-limb DVT combined with HAPC after discharge.
居住在高海拔地区的深静脉血栓形成（DVT）患者只能依靠抗凝治疗，错过了手术或溶栓的最佳时机。同时，在这些情况下，患者的预后很容易因高原红细胞增多症（HAPC）而复杂化，这增加了治疗难度和血栓复发风险。为防止出现这种情况，有效的筛查和针对性干预至关重要。因此，本研究分析并为下肢DVT合并HAPC患者血栓复发的临床预测提供参考。
将列线图模型应用于接受抗凝治疗的HAPC和DVT患者并发症的评估。
对123例合并下肢DVT的HAPC患者进行6至12个月的随访，根据下肢DVT是否复发分为复发组和未复发组。比较两组的临床资料和实验室指标，以确定下肢DVT和HAPC患者血栓复发的影响因素。本研究旨在建立并验证列线图模型预测血栓复发风险的价值。
Logistic回归分析显示，年龄、随访期间的制动情况、用药依从性、穿弹力袜的依从性以及外周血D-二聚体和纤维蛋白降解产物水平是合并DVT的HAPC患者血栓复发的独立危险因素。Hosmer-Lemeshow拟合优度检验表明，基于多因素Logistic回归分析结果建立的列线图模型可有效预测合并HAPC的下肢DVT患者的血栓复发风险（=0.873；>0.05）。该模型的一致性指数为0.802（95%CI：0.799-0.997），表明其具有良好的准确性和区分度。
个性化预测血栓复发风险的列线图模型在预测下肢DVT合并HAPC患者出院后血栓复发方面具有良好的应用价值。
