Zöller Bengt, Connors Jean M
Center for Primary Health Care Research, Lund University/Region Skåne, Malmö.
Hematology Division, Brigham and Women's Hospital, Boston, MA.
Haematologica. 2024 Dec 1;109(12):3852-3859. doi: 10.3324/haematol.2023.284579.
Multimorbidity, i.e., the presence of two or more long-term health conditions, is challenging for healthcare systems worldwide. A related term is comorbidity. This denotes any condition that has existed or may occur during the clinical course of a patient who has the index disease under study. Moreover, frailty is also inter-related with multimorbidity but represents a distinct clinical concept. Few studies have explored how multimorbidity and frailty are related to venous thromboembolism (VTE), though many studies have looked at how different comorbidities, especially cancer, affect the outcome of VTE. Recently, a graded association between multimorbidity and VTE has been described. Several multimorbidity disease clusters, such as cardiometabolic and psychiatric disorders, have been associated with VTE. The comorbidity burden, i.e., Charlson Comorbidity Index (CCI), has also been related to short-term mortality after VTE. VTE patients without comorbidities, i.e., CCI = 0, have less than 1% three months mortality. Frailty and CCI have been associated with postoperative risk of VTE. In this review, drivers of multimorbidity and VTE risk, disease networks, and disease trajectories will also be discussed. Further studies including multimorbidity and frailty as predictors for VTE in situations of risk could be of clinical importance. Moreover, it will also be important to determine which diseases should be included in a multimorbidity risk score for VTE.
多重疾病，即存在两种或更多种长期健康状况，对全球医疗系统构成挑战。一个相关术语是共病。这指的是在患有正在研究的索引疾病的患者临床过程中已经存在或可能出现的任何状况。此外，虚弱也与多重疾病相互关联，但代表一个独特的临床概念。尽管许多研究关注不同的共病，尤其是癌症，如何影响静脉血栓栓塞（VTE）的结果，但很少有研究探讨多重疾病和虚弱与VTE之间的关系。最近，已经描述了多重疾病与VTE之间的分级关联。几个多重疾病疾病集群，如心脏代谢和精神疾病，已与VTE相关联。共病负担，即查尔森共病指数（CCI），也与VTE后的短期死亡率相关。无共病的VTE患者，即CCI = 0，三个月死亡率低于1%。虚弱和CCI与VTE的术后风险相关。在本综述中，还将讨论多重疾病和VTE风险的驱动因素、疾病网络和疾病轨迹。进一步的研究将多重疾病和虚弱作为风险情况下VTE的预测因素可能具有临床重要性。此外，确定哪些疾病应纳入VTE多重疾病风险评分也很重要。
