Analysis Of Risk Factors Of Hospital Acquired Venous Thromboembolism

Objective:To determine the clinical characteristics and related risk factors of hospital-acquired venous thromboembolism.Methods:A retrospective search of the electronic medical record system was conducted to screen the medical records of 2177 patients with venous thromboembolism(VTE)admitted to all departments of Shengjing Hospital,China Medical University from January2011 to November 2019.Finally,274 patients with nosocomial acquired VTE were included as the case group(VTE group),and the same departments were selected over the same period(±30 days)A total of 399 non-VTE patients were used as control group(non-VTE group).The differences between the two groups in general conditions,co-existing diseases,treatment methods and laboratory indicators were compared.The independent risk factors for HA-VTE were determined by multi-factor Logistic regression model,and a simple scoring scale for HA-VTE was developed.The predictive efficiency of the simple rating scale was verified by receiver operating characteristic curve(ROC curve).Subgroup analysis was conducted on the patients undergoing surgery to further clarify the effects of operation method,duration,location,level and anesthesia method on VTE.Results:1)The results of univariate analysis of risk factors:There were significant differences in bedridden(x~2=14.281,P<0.05),transferred to ICU(x~2=22.196,P<0.05),length of hospital stay(t=6.752,P<0.05),major surgery(x~2=22.173,P<0.05),fracture(x~2=6.648,P=0.010),hypertension(x~2=14.586,P<0.05),anemia hypoalbuminemia(x~2=105.010,P<0.05),intestinal obstruction(x~2=8.248,P=0.004)and gallstones(x~2=6.323,P=0.012).The levels of WBC,D-Dimer,ALP,GGT,TC,TG,LDL,CRP,BNP,c Tn I,ASO and TSH in the case group were higher than those in the control group.The levels of BNP,c Tn I,ASO and TSH in the case group were higher than those in the control group.The levels of Hb,PTA,APTT,TP,ALB,BA,FT3,TGAb,TPOAb,ESR,Pa CO2,PO2,AB,BE,Sa O2 and Hb A1c decreased.2)Multivariate analysis:major surgery(O R=3.1 1 6,9 5%C I 1.5 7 7-6.1 5 8),a n e m i a(O R=2.8 5 9,9 5%C I 1.3 3 1-6.1 3 8),hypoproteinemia(OR=2.991,95%CI 1.294-6.915-0.010),hospital stay(OR=1.011,95%CI1.003-1.020),antistreptococcal hemolysin O(OR=1.062,95%CI 1.026-1.099),total cholesterol(OR=4.594,95%CI 2.159-9.774).The increase of OR=1.850,95%CI 1.235 to2.771 was the independent risk factor of hospital acquired venous thromboembolism.3)The results of subgroup analysis showed that the operation time in VTE group was longer than that in non-VTE group.Different surgical methods,sites,grades and anesthetic methods had different effects on VTE.Open surgery(OR=2.848,95%CI 1.921 to 4.224,O R=4.2 8 0,9 5%C I 2.3 9 1 t o 7.6 6 0,a n d i n t r a o p e r a t i v e g e n e r a l a n e s t h e s i a(OR=3.889,95%CI 2.599 to 5.817,P<0.05)had the highest risk of VTE.Intestinal surgery and uterine adnexal surgery increased the risk of VTE by 7.314 times(95%CI1.536 to 34.822,respectively.0.012)and 3.021 times(95%CI 1.744 5.234).4)A simple scoring model was established for independent risk factors according to the results of multivariate Logistic regression analysis,and the predictive efficiency of the model was evaluated by receiver operating characteristic curve.The results showed that the area under the curve was 0.866(95%CI 0.837～0.894,P<0.05).Conclusion:This study confirmed that major surgery,anemia,hypoalbuminemia,elevated ASO,TC,TSH and prolonged hospitalization were independent risk factors for venous thromboembolism in inpatients.Prolonged operation,high grade of operation,open surgery and application of general anesthesia affect the occurrence of venous thromboembolism.It is suggested that in the process of diagnosis and treatment,medical staff should timely and fully assess the risk of thrombosis and take individual preventive measures to reduce the incidence of nosocomial acquired venous thromboembolism.