急性肺栓塞后发生慢性血栓栓塞性疾病的预测规则

IF 2.2 4区医学 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS

Heart, Lung and Circulation Pub Date : 2024-11-01 DOI:10.1016/j.hlc.2024.03.011

Wei Xiong MD, PhD , He Du MD , Yong Luo MD , Yi Cheng MD, PhD , Mei Xu MD , Xuejun Guo MD, PhD , Yunfeng Zhao MD, PhD

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引用次数: 0

摘要

背景：急性肺栓塞（PE）患者在接受标准有效的抗凝治疗 3 或 6 个月后发生慢性血栓栓塞性疾病（CTED）的情况并不少见。迄今为止，还没有预测 CTED 发生的评分模型：在建立队列（n=1124）中建立了 CTED 预测规则（PRC），然后在验证队列（n=211）中进行了验证。通过使用不同的评分和截断值，提供了原始和简化版本的 PRC 评分：PRC评分包括10个项目：活动性癌症（3.641；2.338-4.944；P30 kg/m2（2.186；1.573-2.799；P=0.001）；慢性不运动（2.135；1.741-2.529；p=0.001）、D-二聚体>2 000 ng/mL（1.618；1.274-1.962；p=0.005）、PE伴深静脉血栓形成（3.199；2.356-4.042；p结论：CTED发生率预测评分（PRC）可预测诊断为急性PE的住院患者在标准抗凝治疗3个月或6个月后发生CTED的可能性。

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A Prediction Rule for Occurrence of Chronic Thromboembolic Disease After Acute Pulmonary Embolism

Background

Occurrence of chronic thromboembolic disease (CTED) after 3 or 6 months of standard and effective anticoagulation is not uncommon in patients with acute pulmonary embolism (PE). To date, there has been no scoring model for the prediction of CTED occurrence.

Methods

A Prediction Rule for CTED (PRC) was established in the establishment cohort (n=1,124) and then validated in the validation cohort (n=211). Both original and simplified versions of the PRC score were provided by using different scoring and cut-offs.

Results

The PRC score included 10 items: active cancer (3.641; 2.338–4.944; p<0.001), autoimmune diseases (2.218; 1.545–2.891; p=0.001), body mass index >30 kg/m² (2.186; 1.573–2.799; p=0.001), chronic immobility (2.135; 1.741–2.529; p=0.001), D-dimer >2,000 ng/mL (1.618; 1.274–1.962; p=0.005), PE with deep vein thrombosis (3.199; 2.356–4.042; p<0.001), previous venous thromboembolism (VTE) history (5.268; 3.472–7.064; p<0.001), thromboembolism besides VTE (4.954; 3.150–6.758; p<0.001), thrombophilia (3.438; 2.573–4.303; p<0.001), and unprovoked VTE (2.227; 1.471–2.983; p=0.001). In the establishment cohort, the sensitivity, specificity, Youden index (YI), and C-index were 85.5%, 79.7%, 0.652, and 0.821 (0.732–0.909) when using the original PRC score, whereas they were 87.9%, 74.6%, 0.625, and 0.807 (0.718–0.897) when using the simplified one, respectively (Kappa coefficient 0.819, p-value of McNemar’s test 0.786). In the validation cohort, the sensitivity, specificity, YI, and C-index were 86.3%, 76.3%, 0.626, and 0.815 (0.707–0.923) when using the original PRC score, whereas they were 85.0%, 78.6%, 0.636, and 0.818 (0.725–0.911) when using the simplified one, respectively (Kappa coefficient 0.912, p-value of McNemar’s test 0.937); both were better than that of the DASH score (72.5%, 69.5%, 0.420, and 0.621 [0.532–0.710]).

Conclusions

A prediction score for CTED occurrence, termed PRC, predicted the likelihood of CTED occurrence after 3 or 6 months of standard anticoagulation in hospitalised patients with a diagnosis of acute PE.

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来源期刊

Heart, Lung and Circulation CARDIAC & CARDIOVASCULAR SYSTEMS-

CiteScore

4.50

自引率

3.80%

发文量

912

审稿时长

11.9 weeks

期刊介绍： Heart, Lung and Circulation publishes articles integrating clinical and research activities in the fields of basic cardiovascular science, clinical cardiology and cardiac surgery, with a focus on emerging issues in cardiovascular disease. The journal promotes multidisciplinary dialogue between cardiologists, cardiothoracic surgeons, cardio-pulmonary physicians and cardiovascular scientists.