Research On VTE Risk Early Warning System For Patients With Advanced Lung Cancer Based On CDSS

BackgroundLung cancer is the world’s leading killer with an incidence of 11.4%and a mortality rate of up to 18%.^[1]Venous thromboembolism（VTE）is one of the common complications of lung cancer,with an incidence of about 2%.The complicated VTE of lung cancer can not only increase the hospital stay of advanced lung cancer patients,but also improve the mortality of lung cancer patients.Currently,the commonly used clinical methods to predict the concurrent VTE risk of lung cancer include Caprini risk assessment scale,Rogers assessment scale,Kucher risk electronic assessment scale and Padua prediction score scale.^[2]With the continuous development of medical informatization means and technology,individualized VTE risk prediction and evaluation based on clinical real data is increasingly favored.Clinical Decision Support System（CDSS）is an intelligent application system that uses the systematic clinical knowledge and patient medical records to further improve the medical related action decision-making ability,so as to improve the medical quality and medical service level.^[3]CDSS system has long been introduced at home and abroad for intelligent information assistance management in many industries,but there are few studies to predict concurrent VTE in patients with advanced lung cancer based on CDSS.Through the real-world clinical data analysis of Changhai Hospital,this study aims to build an intelligent risk warning system for VTE based on CDSS,and make full use of the advantages of CDSS system to realize the early detection,early diagnosis and early treatment of VTE in advanced lung cancer.ObjectiveFrom the perspective of VTE prevention in patients with advanced lung cancer,this study established the best clinical practice database of VTE in advanced lung cancer through literature analysis and real clinical data collection and analysis,combined with CDSS system,and the VTE risk warning system for advanced lung cancer patients based on CDSS was constructed and put into clinical use.Methods1.Construction method of concurrent VTE risk early warning system for advanced lung cancer based on CDSSSearch domestic and foreign databases,get the preliminary high-risk factors of lung cancer complicated with VTE,invite two senior experts in respiratory department to discuss and analyze,and summarize the high-risk factor indicators of advanced lung cancer patients complicated with VTE and the diagnosis and treatment measures of VTE.Collect real-world clinical data in strict accordance with the nanodischarge standard,and build a knowledge base of high-risk factors of advanced lung cancer complicated with VTE based on evidence-based medicine,including the influencing factors module of population baseline characteristics,the high-risk factors module of advanced lung cancer complicated with VTE,and the diagnosis and treatment module of VTE.The clinical data were cleaned,quality controlled and analyzed by CDSS to build a real-world best practice database of advanced lung cancer complicated with VTE;Through logistic regression analysis,the prediction risk coefficient equation of advanced lung cancer complicated with VTE is constructed.Finally,the best practice library and the prediction risk coefficient equation are combined with the CDSS system,the VTE risk early warning system for patients with advanced lung cancer based on CDSS is created.2.Statistical treatment methodsBinary Logistic regression analyzed the data using R statistical software,test level=0.05,and P<0.05.The risk prediction model of concurrent VTE in advanced lung cancer was established according to the gradual regression method and AIC screening influencing factors.For the comparison between the two prediction models,the area under the ROC curve（AUC）was calculated by the Z test,and the best cut-off value was determined by the Yoden index.Result1.High-risk factor for concurrent VTE in lung cancerThrough domestic and foreign literature databases,a total of 90785 documents related to"lung cancer"and 25744 related to"venous thrombosis"were searched,and individual cases,books,conference reports and guide interpretation were excluded,and a total of189 documents related to"lung cancer with VTE"were selected.After reading the full text of the literature,the risk factors and measures of VTE were summarized.Finally,45risk factors were included for analysis.2.Three basic factor modules for concurrent risk factors of VTE in advanced lung cancerA total of 12,222 patients with lung cancer first admitted to the respiratory department of Changhai Hospital from 2010 to 2020 were collected through the electronic medical record system of our hospital,and the data of multiple admissions and incomplete information were removed according to the exclusion criteria,and 3,320 cases were actually included.Theoretically,the specific contents of the three basic factor modules include the general situation of patients,clinical characteristics of patients with VTE,tumor related conditions,laboratory test data and imaging examination.Clean and quality control the clinical real data through CDSS,and form a clinical best practice database of high-risk factors of advanced lung cancer complicated with VTE according to the types of influencing factors,including three basic factor modules in the real world:the influencing factor module of population baseline characteristics,the high-risk factor module of advanced lung cancer complicated with VTE,and the diagnosis and treatment module of VTE.The three basic factor modules of each real world include influencing factor indicators and real clinical data.3.Analysis of univariate risk factors for concurrent VTE in advanced lung cancerThe 3320 patients were divided into 67 cases with VTE and 3253 patients without VTE,and the risk factors of VTE included alanine aminotransferase,D-dimer,prothrombin time,glycemic antigen-199,Cytokeratin 19 fragment,fibrin degradation products,SCC-related antigen,albumin and targeted therapy for lung cancer（P<0.05）.4.Analysis of multiple risk factors and VTE prediction with VTEMultivariate analysis by Logistic regression showed that targeted therapy for lung cancer,lower limb varices,fibrin degradation products,and alanine aminotransferase were independent risk factors for concurrent VTE in advanced lung cancer.According to the stepwise regression method and AIC,then the factors associated with VTE in clinic were included,the prediction risk factor of VTE with independent risk factors and factors significantly associated with VTE of lung cancer:In（P/1-P）=-4.911+2.779*lower limb varicoseveins+0.686*lungcancertargetedtherapy+0.109*D-dimer+0.385*CA-199+1.175*fibrin degradation product.5.Construction of risk warning system for VTE in advanced lung cancer based on CDSSCombined with the three basic factor modules of VTE with advanced lung cancer,the prediction risk coefficient equation of VTE with advanced lung cancer and CDSS system,the risk warning system of VTE with advanced lung cancer based on CDSS was initially established.6.Comparative analysis of the risk warning system and Caprini risk assessment scale of advanced lung cancer and VTE based on CDSSThe AUC of the externally verified（validation set）is 0.756（95%CI:0.726-0.785）,sensitivity 0.688,specificity 0.693,positive predictive value 0.042 and negative predictive value 0.991.The test results of the Caprini risk score scale for the same validation set showed an AUC of 0.654（95%CI:0.638-0.670）,sensitivity of 0.672,specificity of 0.637,positive predictive value of 0.036 and negative predictive value of0.990.The results suggest that the early warning efficacy of the CDSS-based system and VTE in advanced lung cancer is not worse than the Caprini risk assessment scale.Conclusion1.Through a large number of domestic and foreign literature search and analysis, cleaning and quality control of real clinical data by CDSS,three basic factors modules for VTE risk prediction of advanced lung cancer were formed,including population baseline influencing factor module,risk factor module for VTE in advanced lung cancer and VTE diagnosis and treatment module.2.Through univariate and multivariate regression analysis,the predicted risk coefficient equation for VTE in advanced lung cancer wasIn（P/1-P）=-4.911+2.779*varicose veins+0.686*targeted therapy for lung cancer+0.109*D-dimer+0.385*CA-199+1.175*fibrin degradation product.3.Combined with the three basic factor modules of VTE with advanced lung cancer,the prediction risk factor equation of VTE with advanced lung cancer and CDSS system,the risk warning system of VTE based on CDSS was initially established.Compared with the Caprini risk assessment scale,the results show that the system has advantages in the risk prediction performance of advanced lung cancer complicated with VTE.