To Compare The Predictive Value Of Different Vte Risk Score Models For Vte In Diabetic Patients

Objective:(1)To evaluate the predictive value of Pauda score,revised Geneva score,Caprini score and Wells PE score for pulmonary embolism in hospitalized patients with type 2 diabetes mellitus.(2)To evaluate the predictive value of Pauda score,revised Geneva score,Caprini score and Wells DVT score for deep vein thrombosis in hospitalized patients with type 2 diabetes mellitus.Method:(1)Retrospective analysis method was used to collect the 474 th Hospital of PLA from January 2013 to April 2016 by CT pulmonary angiography(computed tomographic pulmonary angiography,CTPA)the clinical data of patients with type 2 diabetes hospitalized medical patients suspected of pulmonary thromboembolism.In patients with type 2 diabetes medicine eventually collected 167 cases of suspected PTE.Patients were scored using Padua score,revised Geneva score,Caprini score,Wells PE scoring method.The scores of four scoring systems were used as the outcome variables.The CTPA findings of pulmonary embolism were the state variables,and the ROC curve was drawn.The higher the area under the ROC curve and the greater the index,the higher the predictive value.(2)Retrospective analysis method was used to collect the 474 th Hospital of PLA from January 2013 to June 2016 with suspected DVT patients with type 2 diabetes medicine,all the patients are limbs and abdominal vascular ultrasound.In patients with type 2 diabetes medicine eventually collected 378 cases of suspected DVT.The patients were scored by Padua score,revised Geneva score,Caprini score and Wells DVT score.The scores of the 4 scores were used as the result variables,and the DVT curve was confirmed as the state variable,and the ROC curve was drawn.The higher the area under the ROC curve and the greater the index,the higher the predictive value.Results:(1)Of the 167 patients with type 2 diabetes hospitalized medical patients and suspected of pulmonary thromboembolism,77 male pations,97 female pations,the average age was(69.2±9.3)years.The final diagnosis of pulmonary thromboembolism was 83 cases,the diagnosis rate was 49.7%(83/167).Comparison of pulmonary thromboembolism and non pulmonary thromboembolism,age,heart rate,tumor,bed,previous history of VTE,heart failure,respiratory failure,unilateral lower extremity deep venous tenderness with lower extremity edema,acute myocardial infarction,are receiving hormone therapy,acute infection had statistically significant difference(P<0.05).The area under curve(AUC)of the ROC curve of the Padua score,revised Geneva score,Caprini score and WellsPE score for diagnosing PTE in medical patients with type 2 diabetic were 0.797±0.034,0.651±0.042,0.724±0.039 and 0.726±0.039,and the sensitivity were 56.63%,89.16%,49.4%,78.31%,the specificity were 94.05%,36.9%,88.1% and 63.1%,the Youden index were 0.51,0.26,0.37,0.41,and the best cutoff values were 4 points,3 points,6 points,1 points.Comparison of the area under the four scoring curves:the difference between Padua score and revised Geneva score was statistically significant(P<0.0083),there was no significant difference between Padua score and Caprini score and Wells PE score(P>0.0083),there was no significant difference between the revised Geneva score and Caprini score and Wells PE score(P>0.0083),There was no significant difference between Padua score and Wells PE score(P>0.0083)(2)Of the 378 patients with type 2 diabetes hospitalized medical patients and suspected of DVT,199 male pations,179 female pations,the average age was(65.9±12)years.The final diagnosis of DVT was 95 cases,the diagnosis rate was 25.1%(95/378).Of the 95 patients with DVT,93 cases were older than 40 years old(97.7%),D-dimer was positive in 90 cases(94.7%),heart rate greater than or equal to 75 beats / min in 81 cases(85.3%),unilateral lower limb pain in 80 cases(84.2%),unilateral lower limb deep vein tenderness with edema in 78 cases(82.1%),acute infection was 74 cases(77.9%),body mass index greater than 25kg/m2 in 48 cases(50.5%).The area under curve(AUC)of the ROC curve of the Padua score,revised Geneva score,Caprini score and Wells DVT score for diagnosing DVT in medical patients with type 2 diabetic were 0.795±0.022、0.884±0.0237、0.623±0.0303、0.854±0.022,and the sensitivity were 85.26%,80.00%,72.63% and 82.11%,the specificity were 70.67%,90.11,49.47% and 81.63%,the Youden index were 0.56,0.70,0.22 and 0.64,and the best cutoff values were 2 points,7 points,3 points,1 points.Comparison of the area under the four scoring curves: there were no significant difference between the Padua score and Wells DVT score(P>0.0083),there were significant difference between Padua score and Caprini score and revised Geneva score(P<0.0083),there were significant difference between Caprini score and revised Geneva score and Wells DVT score(P<0.0083),there were no significant difference between the revised Geneva score and Wells DVT score(P>0.0083).Conclusions:(1)The Padua score,revised Geneva score,Caprini score and Wells PE score could predict the risk of PTE in medical inpatients with type 2 diabetes in some extent.Padua score had the highest predictive value,revised Geneva score had the lowest predictive value,WellsPE score and Caprini score were slightly lower than Padua score,but the predictive value of the four kinds of scores were limited,not up to excellent.(2)The Padua score,revised Geneva score,Caprini score and Wells DVT score could predict the risk of DVT in medical inpatients with type 2 diabetes in some extent.The four kinds of scores prediction value from large to small were revised Geneva score,Wells DVT score,Padua score,Caprini score,the revised Geneva score was the highest predictive value and the best.The Wells DVT score was slightly higher than the Padua score,but the difference was not statistically significant,the predictive value of the same,can reach more than moderate,Caprini score predictive value was poor.