Correlation Analysis Of Risk Factors For VTE In Hospitalized Patients

Objectives To investigate the risk factors of venous thromboembolism(VTE) through analyze risk factors for patients with VTE during hospitalization. To explore the international commonly used two kind of risk assessment model(caprini model and Padua model), in assessing the effectiveness of VTE risk in hospitalized patients. To explore the relationship between Caprini model and risk of VTE recurrent, in order to establish the VTE risk assessment model for inpatients in China.Methods This research obtained the approval of Coal General Hospital and Chaoyang Hospital Institutional Review Board, studied the patients who diagnosed with VTE during hospitalization. These patients came from Coal General Hospital and Chaoyang Hospital during January 1, 2012 to December 31, 2012. Inclusion criteria: patients diagnosed with VTE, age of more than 18 years, hospitalization time more than 2 days. Exclusion criteria: patients hospitalized for VTE purposes. Diagnosis method: Deep Vein Thrombosis(DVT) was confirmed by venous color ultrasound and intravenous contrast. Pulmonary thromboembolism(PTE) was confirmed by spiral CT angiography(CTA), pulmonary artery angiography, radionuclide pulmonary ventilation or perfusion scan. At first, 387 patients were diagnosed as VTE and 100 patients were excluded because of the condition: to achieve the treatment of VTE for 65 patients, the duration of hospitalization was less than 2 days of 32 patients, aged less than 18 years of 3 patients. Eventually, 287 patients were enrolled in the study for patients who occurred VTE during hospitalization.1. Collected the patients’ clinical data of like name, sex, age, height, weight, admission departments, admission time, hospitalization process, risk factor for VTE, laboratory examination and image learn examination results.2.Analyzed the relationship between VTE and risk factors.3. Used the Caprini risk assessment model and Padua risk assessment model to evaluate the patients’ risk of VTE. Follow up study: the study subjects or their legal guardians signed the informed consent, by outpatient and inpatient follow-up, the mean follow-up time were 30 + 9(24-36) months, all patients were followed up until December 31, 2014. Follow up content: VTE review of patients after discharge(imaging results: venous ultrasound, venography and spiral CT angiography(CTA), pulmonary artery angiography, radionuclide pulmonary ventilation and perfusion scans). Whether the patient continues to take the anticoagulant and the time course of medicine. The prognosis of the patients(recovery or recurrence).Whether the patient died or not and the cause of death. Of the 287 patients with VTE, 11 patients died from non VTE and 16 patients lost the follow-up. 260 patients were followed up successfully. The starting point of observation was defined as occurrence time of VTE during hospitalization. The terminal event was defined as the recurrence of VTE. Survival time was the time length between starting point and terminal event. Statistics analysis: Described the normal distribution measurement data with mean ± standard deviation. Described the skewness distribution measurement data with median of four quantile distance. Described the count data with frequency and percentage. Described the relationship between VTE and risk factors by frequency and percentage. Compared the differences between two models in evaluate the risk of VTE among hospitalized patients by chi square test. Compare the differences between two models in evaluate the risk of VTE among medicine and surgery patients by rank sum test and independent sample T test. Estimate VTE recurrence time in 36 months by Kaplan- Meier method among the four groups from the Caprini model. Compare the four groups by log rank test evaluation. The difference of bilateral P<0.05 was statistically significant.Results Of the 287 patients, 92(32.1%) patients with DVT, 93(32.4%) patients with PTE, 102(35.5%) patients with DVT and PTE. 2. Of the 287 patients, 155 were medicine patients, and 132 were surgical patients.3.The youngest patient was 20 years old, the maximum was 99 years, and the median age was 66 years. 4.146 female patients(51%), 141 male patients(49%), male: female = 1:1.04.5.The minimum BMI was 16kg/m2, the maximum was 40kg/m2, and the median BMI was 25kg/m2.6. The risk factors of VTE were in the top five: BMI>25 kg/m2 in120 patients(63.2%), Protein C or protein S was deficient in 32 patients(52.4%), serum homocysteine was elevated in 9 patients(50%), Long-term bed in 136 patients(47.4%), Severe lung disease in 132 patients(46%).7. Compared with the Padua Prediction Score, the Caprini model was more effective in evaluate the risk of VTE among hospitalized patients and the differences were statistically significant(P<0.0001).8. Padua model was more effective in evaluate the risk of VTE among medicine patients than surgery patients but the differences were not statistically significant(average risk score, 4.43±2.65 vs 4.42±2.83, P=0.962).9. Caprini model was more effective in evaluate the risk of VTE among surgery patients than medicine patients and the differences were statistically significant(average risk score, 7.84±3.45 vs 6.68±3.27, P=0.004).10. Of the 260 cases patients, 15 cases of patients with a primary diagnosis of VTE without taking any anticoagulant drugs, 48 cases of patients with a diagnosis of recurrent VTE, the recurrence rate was 18.5%. The very high-risk patients’ recurrence rate was the highest(29.0%), secondly to high-risk patients(6.5%) and low risk patients had no VTE recurrence. Of the 48 cases patients, 45 patients with recurrent VTE occurred after the cessation of anticoagulation therapy, 3 cases in patients with newly diagnosed VTE without taking any anticoagulant drugs. Estimate VTE recurrence time in 36 months by Kaplan- Meier method among the four groups from the Caprini model. As can be seen in the survival curves, compared with the other three groups, patients at high risk of recurrent VTE is the highest, and the difference is statistically significant(P = 0.021).Conclusions 1.The risk factors for VTE were: BMI>25 kg/m2, Protein C or protein S was deficient, serum homocysteine was elevated,Long-term bed, Severe lung disease.2. In assess the risk of VTE in hospitalized patients, the Caprini model was better than the Padua model.3. Caprini model was more effective in evaluate the risk of VTE among surgery patients than medicine patients.4. In our country, some risk factor for VTE occurrence rate is far lower than in western countries like prothrombin 20210 A positive and factor V Leiden mutation positive,so some points of the Caprini model need to be adjusted according to the characteristics of our ethnic.5. In predicting the risk of VTE recurrence, the Caprini risk assessment model may also be useful.