Li Yunsong, Cao Pengkai, Zhu Tianyi, Wang Yaqi, Wang Fengkai, Li Liang, Liu Xiangdong, Zhang Yanrong
Department of Vascular Surgery, the Third Hospital of Hebei Medical University, Shijiazhuang, 050051, Hebei, P.R. China.
Department of Clinical Laboratory, the Third Hospital of Hebei Medical University, Shijiazhuang, 050051, Hebei, P.R. China.
BMC Surg. 2024 Dec 31;24(1):426. doi: 10.1186/s12893-024-02724-5.
This retrospective cohort study aimed to identify factors associated with preoperative deep venous thrombosis (DVT) in elderly patients with femoral neck fractures, and to investigate whether combining these factors could improve the ability to predict DVT.
Medical records and laboratory test results were reviewed patients presenting with a femoral neck fracture and receiving routine chemoprophylaxis for DVT between January 2020 and December 2023 in a tertiary referral, university-affiliated hospital. Preoperative DVT was confirmed by Doppler ultrasound or CT venography. Demographic, injury, comorbidity, and laboratory variables were analyzed using univariate and multivariate approaches. The performance of combined predictive factors was evaluated using receiver operating characteristic (ROC) curve analysis.
Among the 499 patients included, 47 (9.4%) were diagnosed with a preoperative DVT. In the univariate analysis, five variables were found to be statistically significant, including alcohol consumption (P = 0.017), history of renal disease (P < 0.001), elevated D-dimer level (both traditional and age-adjusted cut-off used) (P = 0.007 or < 0.003), increased platelet distribution width (PDW) (P < 0.001) and reduced albumin in continuous or categorical variable (P = 0.027, P = 0.002). Multivariate analysis confirmed all except alcohol consumption as independent predictors (all P < 0.05). ROC curve analysis showed that combining these four significant variables with age improved the ability to predict preoperative DVT, with an area under the curve of 0.749 (95% CI: 0.676-0.822, P < 0.001), sensitivity of 0.617, and specificity of 0.757.
This study identified several factors associated with preoperative DVT, and combining them demonstrated improved performance in predicting DVT, which can facilitate risk assessment, stratification and improved management in clinical practice.
这项回顾性队列研究旨在确定老年股骨颈骨折患者术前深静脉血栓形成（DVT）的相关因素，并探讨合并这些因素是否能提高预测DVT的能力。
回顾了2020年1月至2023年12月在一家三级转诊的大学附属医院就诊并接受DVT常规化学预防的股骨颈骨折患者的病历和实验室检查结果。术前DVT通过多普勒超声或CT静脉造影确诊。使用单变量和多变量方法分析人口统计学、损伤、合并症和实验室变量。使用受试者操作特征（ROC）曲线分析评估联合预测因素的性能。
在纳入的499例患者中，47例（9.4%）被诊断为术前DVT。单变量分析发现五个变量具有统计学意义，包括饮酒（P = 0.017）、肾脏疾病史（P < 0.001）、D - 二聚体水平升高（使用传统和年龄调整临界值）（P = 0.007或< 0.003）、血小板分布宽度（PDW）增加（P < 0.001）以及连续或分类变量中白蛋白降低（P = 0.027，P = 0.002）。多变量分析确认除饮酒外所有因素均为独立预测因素（所有P < 0.05）。ROC曲线分析表明，将这四个显著变量与年龄相结合可提高预测术前DVT的能力，曲线下面积为0.749（95% CI：0.676 - 0.822，P < 0.001），敏感性为0.617，特异性为0.757。
本研究确定了几个与术前DVT相关的因素，将它们结合起来在预测DVT方面表现出更好的性能，这有助于临床实践中的风险评估、分层和改善管理。
