Caprini风险评估模型对住院脑卒中患者静脉血栓栓塞症的预测价值

Value of the Caprini risk assessment model in predicting venous thromboembolism in hospitalized stroke patients

摘要:

目的 探讨Caprini风险评估模型对住院脑卒中患者静脉血栓栓塞症(VTE)的预测价值。方法 采用回顾性病例对照研究设计，选取2018年1月1日至2020年6月30日在该院神经内科住院的脑卒中患者中确诊为VTE的患者（75例）为VTE组；依据患者的ID号，采用机械抽样法随机抽取同期在该院神经内科住院的非VTE脑卒中患者（75例）为对照组。采用Caprini风险评估模型对两组患者进行风险评分，比较两组患者Caprini风险评分及危险度分级的差异；分析脑卒中患者并发VTE的危险因素；评价 Caprini评估模型对脑卒中并发VTE的预测价值。结果 VTE组与对照组患者风险评分及危险度分级构成无差异(P>0.05)。Caprini风险评估模型中危险因素的多因素前进法Logistic回归分析显示，年龄、肺炎、有无瘫痪是脑卒中并发VTE的危险因素。Caprini风险评估模型的曲线下面积为(0.768±0.039)，灵敏度为81.3%、特异度为61.3%。以9分为极高危危险度分级界值对住院脑卒中患者并发VTE风险的预测价值最优。结论 Caprini风险评估模型对住院脑卒中患者VTE风险评估特异度低，临床使用建议以9分作为脑卒中极高危患者风险分级界值。

Abstract:

Objective To investigate the value of the Caprini risk assessment model in predicting venous thromboembolism （VTE） in hospitalized stroke patients.Methods A retrospective case-control study was performed. A total of 75 stroke patients who were hospitalized and diagnosed with VTE in Department of Neurology， Xiangya Hospital of Central South University， from January 1， 2018 to June 30， 2020 were enrolled as VTE group， and according to the patient ID number， the mechanical sampling method was used to randomly select 75 stroke patients without VTE who were hospitalized in Department of Neurology， Xiangya Hospital of Central South University， during the same period of time （control group）. The Caprini risk assessment model was used to determine the risk score for both groups， and the two groups were compared in terms of Caprini risk score and risk grade. The risk factors for VTE in stroke patients were analyzed， and the value of the Caprini assessment model in predicting stroke with VTE was assessed.Results There were no significant differences in risk score and the composition of risk grade between the VTE group and the control group （P>0.05）. The multivariate forward logistic regression analysis of the risk factors in the Caprini risk assessment model showed that age， pneumonia， and the presence or absence of paralysis were the risk factors for stroke with VTE. The Caprini risk assessment model had an area under the ROC curve of 0.768±0.039， a sensitivity of 81.3%， and a specificity of 61.3%. The threshold of 9 points for risk stratification showed the best predictive value for the risk of VTE in hospitalized stroke patients.Conclusions The Caprini risk assessment model has low specificity for VTE risk assessment in hospitalized stroke patients in clinical. It is recommended that the score of 9 points be used as the threshold for extremely high risk classification in high-risk stroke patients.