Al-Dorzi Hasan M, Arishi Hatim, Al-Hameed Fahad M, Burns Karen E A, Mehta Sangeeta, Jose Jesna, Alsolamy Sami J, Abdukahil Sheryl Ann I, Afesh Lara Y, Alshahrani Mohammed S, Mandourah Yasser, Almekhlafi Ghaleb A, Almaani Mohammed, Al Bshabshe Ali, Finfer Simon, Arshad Zia, Khalid Imran, Mehta Yatin, Gaur Atul, Hawa Hassan, Buscher Hergen, Lababidi Hani, Al Aithan Abdulsalam, Al-Dawood Abdulaziz, Arabi Yaseen M
Intensive Care Department, Ministry of National Guard Health Affairs, Riyadh, Kingdom of Saudi Arabia; King Abdullah International Medical Research Center, Riyadh, Kingdom of Saudi Arabia; King Saud Bin Abdulaziz University for Health Sciences, Riyadh, Kingdom of Saudi Arabia.
Intensive Care Department, Ministry of National Guard Health Affairs, Jeddah, Kingdom of Saudi Arabia; King Saud Bin Abdulaziz University for Health Sciences, Jeddah, Kingdom of Saudi Arabia; King Abdullah International Medical Research Center, Jeddah, Kingdom of Saudi Arabia.
Chest. 2025 Feb;167(2):598-610. doi: 10.1016/j.chest.2024.07.182. Epub 2024 Sep 2.
The diagnostic performance of the available risk assessment models for VTE in patients who are critically ill receiving pharmacologic thromboprophylaxis is unclear.
For patients who are critically ill receiving pharmacologic thromboprophylaxis, do risk assessment models predict who would develop VTE or who could benefit from adjunctive pneumatic compression for thromboprophylaxis?
In this post hoc analysis of the Pneumatic Compression for Preventing VTE (PREVENT) trial, different risk assessment models for VTE (ICU-VTE, Kucher, Intermountain, Caprini, Padua, and International Medical Prevention Registry on VTE [IMPROVE] models) were evaluated. Receiver-operating characteristic curves were constructed, and the sensitivity, specificity, positive and negative predictive values, and positive and negative likelihood ratios were calculated. In addition, subgroup analyses were performed evaluating the effect of adjunctive pneumatic compression vs none on the study primary outcome.
Among 2,003 patients receiving pharmacologic thromboprophylaxis, 198 (9.9%) developed VTE. With multivariable logistic regression analysis, the independent predictors of VTE were Acute Physiology and Chronic Health Evaluation II score, prior immobilization, femoral central venous catheter, and invasive mechanical ventilation. All risk assessment models had areas under the curve < 0.60 except for the Caprini model (0.64; 95% CI, 0.60-0.68). The Caprini, Padua, and Intermountain models had high sensitivities (> 85%) but low specificities (< 20%) for predicting VTE, whereas the ICU-VTE, Kucher, and IMPROVE models had low sensitivities (< 15%) but high specificities (> 85%). The positive predictive values were low (< 20%) for all studied cutoff scores, whereas the negative predictive values were mostly > 90%. Using the risk assessment models to stratify patients into high- vs low-risk subgroups, the effect of adjunctive pneumatic compression vs pharmacologic prophylaxis alone did not differ across the subgroups (P > .05).
The risk assessment models for VTE performed poorly in patients who are critically ill receiving pharmacologic thromboprophylaxis. None of the models identified a subgroup of patients who might benefit from adjunctive pneumatic compression.
ClinicalTrials.gov, No.: NCT02040103, URL: www.
gov. ISRCTN44653506; International Standard Randomised Controlled Trial No.: ISRCTN44653506, URL: https://www.isrctn.com.
对于接受药物性血栓预防的重症患者，现有静脉血栓栓塞症（VTE）风险评估模型的诊断性能尚不清楚。
对于接受药物性血栓预防的重症患者，风险评估模型能否预测谁会发生VTE或谁能从辅助气压式压迫预防血栓形成中获益？
在这项针对预防VTE的气压式压迫（PREVENT）试验的事后分析中，评估了不同的VTE风险评估模型（ICU-VTE、库彻尔、山间医疗、卡普里尼、帕多瓦和国际VTE医学预防注册研究[IMPROVE]模型）。构建了受试者工作特征曲线，并计算了敏感性、特异性、阳性和阴性预测值以及阳性和阴性似然比。此外，进行了亚组分析，评估辅助气压式压迫与不使用辅助气压式压迫对研究主要结局的影响。
在2003例接受药物性血栓预防的患者中，198例（9.9%）发生了VTE。通过多变量逻辑回归分析，VTE的独立预测因素为急性生理与慢性健康状况评估II评分、既往制动、股静脉中心静脉导管和有创机械通气。除卡普里尼模型（曲线下面积为0.64；95%置信区间，0.60 - 0.68）外，所有风险评估模型的曲线下面积均<0.60。卡普里尼、帕多瓦和山间医疗模型预测VTE的敏感性较高（>85%）但特异性较低（<20%），而ICU-VTE、库彻尔和IMPROVE模型的敏感性较低（<15%）但特异性较高（>85%）。所有研究的截断分数的阳性预测值均较低（<20%），而阴性预测值大多>90%。使用风险评估模型将患者分为高风险和低风险亚组，辅助气压式压迫与单纯药物预防的效果在各亚组间无差异（P>.05）。
VTE风险评估模型在接受药物性血栓预防的重症患者中表现不佳。没有一个模型能识别出可能从辅助气压式压迫中获益的患者亚组。
ClinicalTrials.gov，编号：NCT02040103，网址：www. ClinicalTrials.gov。ISRCTN44653506；国际标准随机对照试验编号：ISRCTN44653506，网址：https://www.isrctn.com。
