背景:在急性肺栓塞(PE)患者中,标准且有效的抗凝治疗3或6个月后,慢性血栓栓塞性疾病(CTED)的发生并不少见。迄今为止,尚没有预测CTED发生的评分模型.
方法:在建立队列(n=1,124)中建立了CTED(PRC)的预测规则,然后在验证队列(n=211)中进行验证。PRC分数的原始和简化版本均通过使用不同的评分和截止值提供。
结果:PRC评分包括10个项目:活动性癌症(3.641;2.338-4.944;p<0.001),自身免疫性疾病(2.218;1.545-2.891;p=0.001),体重指数>30kg/m2(2.186;1.573-2.799;p=0.001),慢性不动(2.135;1.741-2.529;p=0.001),D-二聚体>2,000ng/mL(1.618;1.274-1.962;p=0.005),PE与深静脉血栓形成(3.199;2.356-4.042;p<0.001),既往静脉血栓栓塞(VTE)病史(5.268;3.472-7.064;p<0.001),除VTE外的血栓栓塞(4.954;3.150-6.758;p<0.001),血栓形成(3.438;2.573-4.303;p<0.001),和无缘无故的静脉血栓栓塞(2.227;1.471-2.983;p=0.001)。在建立队列中,灵敏度,特异性,尤登指数(YI),C指数为85.5%,79.7%,0.652和0.821(0.732-0.909)使用原始PRC评分时,而他们是87.9%,74.6%,0.625,和0.807(0.718-0.897)使用简化的,(Kappa系数0.819,McNemar检验的p值0.786)。在验证队列中,灵敏度,特异性,YI,C指数为86.3%,76.3%,0.626和0.815(0.707-0.923)使用原始PRC评分时,而他们是85.0%,78.6%,0.636和0.818(0.725-0.911)当使用简化的,分别(McNemar检验的Kappa系数0.912,p值0.937);两者均优于DASH评分(72.5%,69.5%,0.420和0.621[0.532-0.710])。
结论:CTED发生的预测评分,称为PRC,预测诊断为急性PE的住院患者接受标准抗凝治疗3或6个月后发生CTED的可能性.
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.