Study on the relativity between the Caprini risk model and 9 thrombosis risk markers in diagnosis with venous thromboembolism

doi:10.3877/cma.j.issn.2095-5820.2014.01.009

Abstract

Abstract:

Objective

To study on the relativity between the Caprini thrombosis risk score and nine plasma thrombosis markers in hospitalized patients and to estimate the value of these methods in the risk assessment of venous thromboembolism (VTE).

Methods

One thousand and sixty-six hospitalized patients were selected from the Tianjin Medical University General Hospital from the 2009 to 2012 for retrospective cohort study, including 685 males and 381 females whose, age were 19-81 years. The level of von Willebrand factor antigen (vWF:Ag), factor Ⅶ activity (FⅦ:A), factor Ⅷ activity (FⅧ:A), antithrombin activity (AT:A), protein C activity (PC:A), free protein S antigen (FPS:Ag), plasminogen activator inhibitor activity (PAI:A), tissue plasminogen activator activity (t-PA:A) and D-dimer (D-D) were determined with IL ACL TOP 700 coagulation analyzer, Sysmex CA7000 coagulation analyzer and the Biomerieux Vidas fluor-euzymelinked immunoassay analyzer assay. The receiver operating characteristic curve (ROC) to analyze the diagnosis performance of the biomarkers were calulated. The correlation between the level of markers and the Caprini score in patients was assessed using Spearman correlation analysis. Kaplan-Meier curve analysis was peformed to determine the survival aralysis.

Results

There was significant difference with level of thrombosis markers among all Caprini risk stratification groups H value of (D-D, t-PA:A and PAI:A was 7.530, 3.221, 4.974, respectively; F value of vWF:Ag, FⅦ:A, FⅧ:A, PC:A, FPS:A, AT:A was 6.395, 3.887, 4.062, 2.905, 3.218, 5.469, respectively, P＜0.01).There was positive correlation between the plasma thrombosis markers and Caprini score (r value was D-D 0.805,vWF:Ag 0.781, FⅦ:A 0.433, FⅧ:A 0.509, FPS:Ag -0.244, AT:A -0.496, t-PA:A -0.263, PAI:A 0.692,respectively,P＜0.01 or 0.05). The ROC analysis indicated the diagnostic efficiency of D-D and vWF:Ag was better than the other markers in extreme high risk and VTE risk (the sensitivity and specificity of D-D was 82.1% and 53.9%,94.7% and 51.7%, respectively; vWF:Ag was 71.4% and 60.9%, 81.3% and 61.0%, respectively). There was higher cumulative risk of VTE within 30 d for patients with extreme high risk group and D-D level exceeded the cut-off(1024 μg/L) group (Log-rank χ² was 65.092 and 20.785 respectively, P=0.000).

Conclusions

There is a strong relationship between the 9 thrombosis markers and the caprini risk stratification. The diagnostic efficiency of D-D is superior to other 8 markers in VTE risk and Caprini extreme high risk. Plasma thrombsis markers could reflect the insidious coagulation disorder, the plasma markers and Caprini model can further increase the diagnostic value in clinical application.

Key words: Caprini risk model, Venous thromboembolism, Thrombosis marker

Jianlong Men, Jing Ren, Lixia Dong, Zhuhua Yao, Wen Zhao, Bo Hou. Study on the relativity between the Caprini risk model and 9 thrombosis risk markers in diagnosis with venous thromboembolism[J]. Chinese Journal of Clinical Laboratory Management(Electronic Edition), 2014, 02(01): 45-50.

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Figures/Tables 6

References 10

1	Suega K, Bakta IM. Correlation between clinical stage of solid tumor and D dimer as a marker of coagulation activation[J]. Acta Med Indones, 2011, 43(3): 162-167.
2	Gould MK, Garcia DA, Wren SM, et al. Prevention of VTE in nonorthopedic surgicalpatients: Antithrombotic Therapy and Prevention of Thrombosis, 9th ed:American College of Chest Physicians Evidence-Based Clinical Practice Guidelines[J].Chest,2012, 141Suppl 2: e227S- 277S.
3	Caprini JA. Risk assessment as a guide for the prevention of the many faces of venous thromboembolism[J]. Amer J Surg, 2010,199 Suppl 1: S3-S10.
4	Bahl V, Hu HM, Henke PK, et al. A validation study of a retrospective venousthromboembolism risk scoring method[J]. Ann Surg, 2010,251(12): 344-350.
5	Angchaisuksiri P. Venous thromboembolism in Asia-an unrecognised and under-treated problem[J]? Thromb Haemost, 2011, 106(4): 585-590.
6	Spyropoulos AC. Risk assessment of venous thromboembolism in hospitalizedmedical patients[J]. Curr Opin Pulm Med, 2010, 16(5)419-425.
7	Spyropoulos AC, Anderson FAJr, Fitzgerald G, et al. Predictive and associative models to identify hospitalized medical patients at risk for VTE[J]. Chest, 2011, 140(3): 706-714.
8	Mandala M, Barni S, Floriani I, et al. Incidence and clinical implications of venousthromboembolism in advanced colorectal cancer patients: the 'GISCAD- alternatingschedule' study findings[J].Eur J Cancer, 2009, 45(1): 65-73.
9	Spyropoulos AC, McGinn T, Khorana AA. The use of weighted and scored risk assessment models for venous thromboembolism[J].Thromb Haemost, 2012, 108(6): 1072-1076.
10	Spyropoulos AC. Upper vs. lower extremity deep vein thrombosis:outcome definitionsof venous thromboembolism for clinical predictor rules or risk factor analysesin hospitalized patients[J]. J Thromb Haemost, 2009, 7(6): 1041-1042.

权重分值	风险因素
1分	年龄41～60岁、腿部肿胀和静脉曲张、肥胖（BMI＞25）、小型外科手术、脓毒症（＜1个月）、严重的肺部疾病（＜1个月）、口服避孕药或激素替代治疗、妊娠期或产后、急性心肌梗死、慢性心力衰竭（＜1个月）、卧床内科患者、炎性肠病史、大型外科手术史（＜1个月）、慢性梗阻性肺病、不明原因的流产、反复妊娠丢失和胎儿生长受限
2分	年龄61～74岁、关节腔镜、恶性肿瘤（现病史或既往病史）、腹腔镜检查（＞45 min）、制动（＞72 h）、石膏固定（＜1个月）、中心静脉置管和大型外科手术（＞45 min）
3分	年龄＞75岁、DVT/PE病史、凝血因子Ⅴ Leiden、血栓性疾病家族史、凝血酶原G20210A、狼疮抗凝物阳性、高同型半胱氨酸血症、肝素诱导血小板减少症、抗心磷脂抗体阳性和其他类型的遗传性或获得性易栓症
5分	卒中（＜1个月）、择期下肢关节整形术、髋关节、骨盆或下肢骨折（＜1个月）、急性脊髓损伤（瘫痪＜1个月）和多发性创伤（＜1个月）

权重分值	风险因素
1分	年龄41～60岁、腿部肿胀和静脉曲张、肥胖（BMI＞25）、小型外科手术、脓毒症（＜1个月）、严重的肺部疾病（＜1个月）、口服避孕药或激素替代治疗、妊娠期或产后、急性心肌梗死、慢性心力衰竭（＜1个月）、卧床内科患者、炎性肠病史、大型外科手术史（＜1个月）、慢性梗阻性肺病、不明原因的流产、反复妊娠丢失和胎儿生长受限
2分	年龄61～74岁、关节腔镜、恶性肿瘤（现病史或既往病史）、腹腔镜检查（＞45 min）、制动（＞72 h）、石膏固定（＜1个月）、中心静脉置管和大型外科手术（＞45 min）
3分	年龄＞75岁、DVT/PE病史、凝血因子Ⅴ Leiden、血栓性疾病家族史、凝血酶原G20210A、狼疮抗凝物阳性、高同型半胱氨酸血症、肝素诱导血小板减少症、抗心磷脂抗体阳性和其他类型的遗传性或获得性易栓症
5分	卒中（＜1个月）、择期下肢关节整形术、髋关节、骨盆或下肢骨折（＜1个月）、急性脊髓损伤（瘫痪＜1个月）和多发性创伤（＜1个月）

组别	例数	D-D（μg/L）	vWF:Ag（%）	F Ⅶ:A（%）	F Ⅷ:A（%）	PC:A（%）	FPS:Ag（%）	AT:A（%）	t-PA:A（kU/L）	PAI:A（kAU/L）
健康对照组	100	298（123～495）	116±33	98±16	101±20	105±23	112±26	106±24	0.48（0.23～0.75）	0.58（0.11～0.88）
低危组	109	483（158～720）	145±40	97±14	103±19	105±20	110±24	105±19	0.45（0.24～0.77）	0.79（0.26～1.04）
中危组	105	636（95～1362）	149±37	99±19	102±17	101±21	106±27	94±26	0.47（0.21～0.74）	1.89（0.65～2.90）
高危组	262	1566（143～4595）	188±32	114±33	105±19	94±26	102±30	95±30	0.47（0.14～0.70）	2.65（0.62～4.21）
极高危1组	297	5901（460～12 500）	236±48	133±46	116±20	92±30	97±31	80±24	0.34（0.15～0.72）	3.37（0.74～6.08）
极高危2组	293	6742（1301～15 782）	250±75	140±51	129±27	87±24	91±20	66±32	0.29（0.12～0.60）	3.86（1.25～7.57）

组别	例数	D-D（μg/L）	vWF:Ag（%）	F Ⅶ:A（%）	F Ⅷ:A（%）	PC:A（%）	FPS:Ag（%）	AT:A（%）	t-PA:A（kU/L）	PAI:A（kAU/L）
健康对照组	100	298（123～495）	116±33	98±16	101±20	105±23	112±26	106±24	0.48（0.23～0.75）	0.58（0.11～0.88）
低危组	109	483（158～720）	145±40	97±14	103±19	105±20	110±24	105±19	0.45（0.24～0.77）	0.79（0.26～1.04）
中危组	105	636（95～1362）	149±37	99±19	102±17	101±21	106±27	94±26	0.47（0.21～0.74）	1.89（0.65～2.90）
高危组	262	1566（143～4595）	188±32	114±33	105±19	94±26	102±30	95±30	0.47（0.14～0.70）	2.65（0.62～4.21）
极高危1组	297	5901（460～12 500）	236±48	133±46	116±20	92±30	97±31	80±24	0.34（0.15～0.72）	3.37（0.74～6.08）
极高危2组	293	6742（1301～15 782）	250±75	140±51	129±27	87±24	91±20	66±32	0.29（0.12～0.60）	3.86（1.25～7.57）

组别	例数	VTE患者^a
组别	例数	例数	发生率（%）
低危组	109	2	1.8
中危组	105	2	1.9
高危组	262	5	1.9
极高危1组	297	22	7.4
极高危2组	293	29	9.9

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