Zanetto Alberto, Vitale Alessandro, Pelizzaro Filippo, Simeon Vittorio, Campello Elena, Turco Laura, Balcar Lorenz, Russo Francesco Paolo, Burra Patrizia, Simioni Paolo, Senzolo Marco
Department of Surgery, Oncology and Gastroenterology, University of Padova, Padova, Italy.
Gastroenterology and Multivisceral Transplant Unit, Padova University Hospital, Padova, Italy.
United European Gastroenterol J. 2025 Jun;13(5):728-737. doi: 10.1002/ueg2.12758. Epub 2025 Jan 23.
BACKGROUND & AIMS: Venous thromboembolism (VTE) is a recognized complication of acutely ill patients, but its incidence and risk factors in those with cirrhosis are uncertain.
We retrospectively studied a consecutive cohort of cirrhosis patients non-electively admitted to our medical unit to determine the rates of symptomatic VTE during hospitalization. Firstly, we explored associations with baseline, clinical and laboratory characteristics using logistic regression. Secondly, we developed a clinical prediction model that could predict the risk of in-hospital VTE.
We included 687 patients (median age 61 years old; 68% male; Child-Pugh A/B/C, 13%/40%/47%). During hospitalization, 34 patients (4.9%) experienced VTE. Multivariate analysis showed that male sex (OR: 2.56, p = 0.05), AKI (OR: 3.1, p = 0.001), bacterial infections (OR: 2.6, p = 0.008), Pugh score (OR: 1.6. p < 0.001), family history of thrombosis (OR: 3.1, p = 0.04), reduced mobility (OR: 4.6, p < 0.001), and C-reactive protein (OR: 1.1, p = 0.005) were independent predictors of VTE. We combined these variables in a prediction model (CirrhosisThrombosisModel) that accurately discriminated between high- and low-risk patients. The AUROC of CiThroModel was significantly higher than that of Padua prediction score (0.882 vs. 0.742). After validating the CiThroModel using bootstrapping, the adjusted model maintained optimal discrimination ability (0.862) and calibration. The adjusted formula to calculate the in-hospital risk of VTE was -9.00 + 0.82 [Male sex] + 1.14 [AKI] + 0.98 [Infection] + 0.48 * Child Pugh score + 1.14 [VTE family history] + 1.54 [Reduced mobility] + 0.15 * PCR/10.
The CiThroModel seems a valuable tool for identifying hospitalized patients with cirrhosis at risk of VTE (https://majinzin.shinyapps.io/vterisk/).
静脉血栓栓塞症（VTE）是急性病患者公认的并发症，但其在肝硬化患者中的发病率及危险因素尚不确定。
我们对非选择性入住我院内科的肝硬化患者连续队列进行了回顾性研究，以确定住院期间有症状VTE的发生率。首先，我们使用逻辑回归分析了与基线、临床和实验室特征的相关性。其次，我们开发了一个可预测住院期间VTE风险的临床预测模型。
我们纳入了687例患者（中位年龄61岁；68%为男性；Child-Pugh A/B/C分级，分别为13%/40%/47%）。住院期间，34例患者（4.9%）发生VTE。多因素分析显示，男性（OR：2.56，p = 0.05）、急性肾损伤（AKI，OR：3.1，p = 0.001）、细菌感染（OR：2.6，p = 0.008）、Pugh评分（OR：1.6，p < 0.001）、血栓家族史（OR：3.1，p = 0.04）、活动能力下降（OR：4.6，p < 0.001）和C反应蛋白（OR：1.1，p = 0.005）是VTE的独立预测因素。我们将这些变量整合到一个预测模型（CirrhosisThrombosisModel）中，该模型能够准确区分高风险和低风险患者。CiThroModel的受试者工作特征曲线下面积（AUROC）显著高于帕多瓦预测评分（0.882对0.742）。使用自助法验证CiThroModel后，调整后的模型保持了最佳的区分能力（0.862）和校准度。计算住院期间VTE风险的调整公式为：-9.00 + 0.82[男性] + 1.14[AKI] + 0.98[感染] + 0.48×Child-Pugh评分 + 1.14[VTE家族史] + 1.54[活动能力下降] + 0.15×PCR/10。
CiThroModel似乎是识别有VTE风险的肝硬化住院患者的一个有价值的工具（https://majinzin.shinyapps.io/vterisk/）。
