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基于血清同型半胱氨酸水平和 Wells 评分的慢性阻塞性肺疾病急性加重期患者静脉血栓栓塞预测模型的建立:一项回顾性队列研究。

Establishment of a prediction model for venous thromboembolism in patients with acute exacerbation of chronic obstructive pulmonary disease based on serum homocysteine levels and Wells scores: a retrospective cohort study.

机构信息

Department of Emergency, Shenzhen New Frontier United Family Hospital, Shenzhen, Guangdong Province, 518048, China.

Department of Gynaecology, Shenzhen Nanshan People's Hospital, Shenzhen, Guangdong Province, 518052, China.

出版信息

BMC Cardiovasc Disord. 2024 Oct 24;24(1):586. doi: 10.1186/s12872-024-04270-7.

Abstract

BACKGROUND

We evaluated the diagnostic value of homocysteine (Hcy) levels combined with the Wells score and established a prediction model for venous thromboembolism (VTE) occurrence in patients with acute exacerbations of chronic obstructive pulmonary disease (AECOPD) based on the Hcy level and the Wells score.

PATIENTS AND METHODS

Clinical information from 914 patients with AECOPD was retrospectively collected in our hospital from June 2020 to October 2023. Receiver operating characteristic curves were plotted to evaluate the diagnostic ability of Hcy concentrations combined with Wells scores and the prediction ability of the model. Univariate and multivariate logistic regressions were used to explore the effects of Hcy levels and the Wells score on VTE occurrence. A nomogram was established for individual risk evaluation.

RESULTS

Hcy levels and Wells scores were significantly greater in the VTE group than in the non-VTE group (P < 0.001). The diagnostic ability of Hcy levels combined with the Wells score was greater than that Hcy levels or the Wells score alone. The AUC of the combined parameters was 0.935, with a sensitivity of 0.864 and a specificity of 0.855. Multivariate logistic regression indicated that elevated Hcy levels (OR:5.17, 95%CI: 3.76-7.09, P < 0.001) and Wells score (OR: 5.26, 95%CI: 3.22-8.59, P < 0.001) were independently associated with the risk of developing VTE in AECOPD patients. Decision curve analysis indicated that the net benefit of the nonadherence prediction nomogram was greater than that of the models adjusted for no or all variables, with a threshold of approximately 0.1-1.0.

CONCLUSIONS

The established prediction model can be used to evaluate an individual's risk of developing VTE on the basis of the Hcy level, Wells score, and clinical parameters. AECOPD patients may benefit from the early intervention based on estimated risk probability.

摘要

背景

我们评估了同型半胱氨酸(Hcy)水平与 Wells 评分联合对慢性阻塞性肺疾病急性加重(AECOPD)患者静脉血栓栓塞(VTE)发生的诊断价值,并基于 Hcy 水平和 Wells 评分建立了预测模型。

患者与方法

回顾性收集我院 2020 年 6 月至 2023 年 10 月收治的 914 例 AECOPD 患者的临床资料。绘制受试者工作特征曲线评估 Hcy 浓度联合 Wells 评分的诊断效能和模型的预测效能。采用单因素和多因素 logistic 回归分析 Hcy 水平和 Wells 评分对 VTE 发生的影响。建立列线图进行个体风险评估。

结果

VTE 组患者的 Hcy 水平和 Wells 评分均显著高于非 VTE 组(P<0.001)。Hcy 水平联合 Wells 评分的诊断效能大于 Hcy 水平或 Wells 评分单独的诊断效能。联合参数的 AUC 为 0.935,灵敏度为 0.864,特异度为 0.855。多因素 logistic 回归分析表明,Hcy 水平升高(OR:5.17,95%CI:3.767.09,P<0.001)和 Wells 评分升高(OR:5.26,95%CI:3.228.59,P<0.001)与 AECOPD 患者发生 VTE 的风险独立相关。决策曲线分析表明,不调整或全部调整变量的预测模型的净获益均大于不纳入该预测模型的情况,阈值约为 0.1~1.0。

结论

基于 Hcy 水平、Wells 评分和临床参数建立的预测模型可用于评估个体发生 VTE 的风险。AECOPD 患者可能受益于基于估计风险概率的早期干预。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/3316/11515543/89184345e348/12872_2024_4270_Fig1_HTML.jpg

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